Neuromodulación del núcleo talámico anterior como opción terapéutica para epilepsia de difícil control / Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy

La estimulación cerebral profunda (ECP) consiste en la estimulación eléctrica de las estructuras subcorticales mediante el implante de electrodos conectados a un generador de impulsos. El tálamo, al ser una estructura que posee múltiples conexiones con diversas partes del sistema nervioso central, es un target adecuado para la ECP. El núcleo talámico anterior (NA) sirve como un sitio de relevo importante para el sistema límbico al recibir aferencias desde el hipocampo y los cuerpos mamilares y enviar eferencias hacia el giro del cíngulo, formando así el circuito de Papez. Debido a estas conexiones, el NA constituye una vía idónea para la propagación de la actividad epileptogénica. La ECP-NA tiene excelentes resultados en el control de las crisis parciales complejas. La gran mayoría de pacientes con ECP-NA han demostrado una reducción significativa en la frecuencia de sus crisis de más del 50% (AU)

Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50% (AU)

Intradiploic epidermoid cyst with intracranial hypertension syndrome: Report of two cases and literature review.

INTRODUCTION: Intradiploic epidermoid intracranial cysts (IEIC) derive from ectodermal cells and are covered with stratified squamous epithelium. They are extremely rare, and most common locations are in the occipital, frontal and parietal bones. They have a very slow growth and can be asymptomatic until becoming evident by the deformation produced. The treatment is based on the removal of the lesion, and subsequent histopathological confirmation. PRESENTATION OF CASE: Two cases are reported, with intracranial hypertension syndrome, which is very uncommon because of the slow growth of this type of pathology; however, decompensations occurring in the space-occupying lesions at intracranial level explain this type of clinical presentation. DISCUSSION: The most common presentation of intracranial intradiploic epidermoid cysts (IEIC) is asymptomatically, which is made evident by the prominence at the level of the soft tissues and then presenting less frequently local pain and cephalea; rarely the size of the lesion can cause focal neurological signs. CONCLUSION: These benign lesions, although they are of low incidence, are seen very rarely in intradiploic locations and above all, of significant size, may produce significant mass effect in patients, which was initially tolerated because of its slow growth, however, they may become decompensate and cause intracranial hypertension syndrome.