[A retrospective study about 11 cases of Esthesioneuroblastomas treated in Hospital Santa Creu i Sant Pau between 2000 and 2008 and literature review]. / Estudio retrospectivo de 11 casos de estesioneuroblastomas tratados en el Hospital Santa Creu i Sant Pau entre los años 2000 y 2008 más revisión de la literatura.

INTRODUCTION. Esthesioneuroblastoma (ENB) is a very uncommon malignant tumor with a neuroectodermal origin that usually involves the anterior cranial fossa and nasal cavity. OBJECTIVES. To review our experience in the management of ENB and assess the validity of the histopathological diagnosis, modality of treatment and prognostic factors of the disease comparing our findings with the literature. METHODS. A retrospective study of 11 cases with the diagnosis of esthesioneuroblastoma treated in our hospital between 2000 and 2008. Statistical analysis was performed in search for prognostic factors. The bibliography about ENB published between 1990 and 2009 was reviewed RESULTS. There were 3 women and 8 men, with a mean age of 42 years old (range 20-71y). Their symptoms upon admission were nasal obstruction (81%), epistaxis (27%), visual loss (18%), headache and others. According to the Kadish Stage, 2 were stage B and 9 were stage C. Dulguerov and Calcaterra Classification was also used: 2 were T2, 3 were T3 and 6 were T4. The hystopathological result according to the Hyams classification was: 2 cases in stage I, 4 in stage II, 3 in stage III and 2 in stage IV. The two cases classified in stage IV changed the diagnosis to undifferenciate tumor in the second biopsy. A subcranial approach was performed in 8 cases combined with endonasal endoscopy to confirm the total removal, followed by radiotherapy in all and chemotherapy in one case, resulting on 62% (5 patients) being alive without disease, 12,5% (1 p) alive with disease, and 25% (2 p) dead of disease. Another patient was operated by a single endonasal endoscopic approach and a subtotal removal was achieved. This patient is alive without disease. The other 2 patients were treated by biopsy plus radiotherapy and chemotherapy, because they were considered unresectable, and one of them is alive with disease and the other one is dead of disease. Radiotherapy was performed in all cases and chemotherapy in 5 cases. The hystopathological grading system of Hyams was considered statistically significant as a prognostic factor of disease-free survival. CONCLUSIONS. When the hystopathological diagnosis of ENB is considered, the Hyams classification can be valid considering grade IV as an advanced stage that is sometimes difficult to differentiate from other undiferentiated tumors. The subcranial approach or craneofacial resection in advanced stages (Kadish C and some B) should be considered as the first treatment of choice. Radiotherapy is indicated in all cases and chemotherapy in selected cases. Hyams' classification was the only staging system that proved useful as a prognostic factor in our series.

Estudio retrospectivo de 11 casos de estesioneuroblastomas tratados en el Hospital Santa Creu i Sant Pau entre los años 2000 y 2008 más revisión de la literatura / A retrospective study about 11 cases of Esthesioneuroblastomas treated in Hospital Santa Creu i Sant Pau between 2000 and 2008 and literature review

Introducción. El estesioneuroblastoma (ENB) es un tumor maligno de origen neuroectodérmico poco habitual que afecta principalmente a la fosa craneal anterior y cavidad nasal. Objetivos. Revisar nuestra experiencia en el manejo de los ENB, evaluar la validez del diagnóstico anatomopatológico, el tipo de tratamiento y factores pronósticos de la enfermedad comparando nuestros hallazgos con los descritos en la literatura. Material y métodos. Estudio retrospectivo de 11 casos de ENB tratados en nuestro hospital en el periodo comprendido entre 2000 y 2008. Se realiza análisis estadístico sobre la existencia de factores pronósticos. Se revisa la bibliografía publicada sobre el ENB entre 1990 y 2009.Resultados. Se trataron 3 mujeres y 8 hombres, cuya edad media fue 42 años (rango 20-71 años). El síntoma inicial fue la obstrucción nasal (81%), epistaxis (27%), disminución de agudeza visual (18%), cefalea y otros. Según la clasificación de Kadish, 2 son estadío B y 9 estadío C; según la clasificación de Dulguerov, 2 son T2, 3 son T3 y 6 son T4. El resultado histológico según la clasificación de Hyams fue de 2 casos en grado I, 4 en grado II, 3 en grado III y 2 en grado IV. Dos de los casos inicialmente catalogados en grado IV cambiaron de diagnóstico en la segunda (..) (AU)

Introduction. Esthesioneuroblastoma (ENB) is a very uncommon malignant tumor with a neuroectodermal origin that usually involves the anterior cranial fossa and nasal cavity. Objectives. To review our experience in the management of ENB and assess the validity of the histopathological diagnosis, modality of treatment and prognostic factors of the disease comparing our findings with the literature. Methods. A retrospective study of 11 cases with the diagnosis of esthesioneuroblastoma treated in our hospital between 2000 and 2008. Statistical analysis was performed in search for prognostic factors. The bibliography about ENB published between 1990 and 2009 (..) (AU)

[Current management of arteriovenous malformations. Retrospective study of 31 cases and literature review]. / Manejo actual de las malformaciones arteriovenosas. Estudio retrospectivo de 31 casos y revisión de la literatura.

OBJECTIVE: To establish some therapeutic criteria about the treatment of AVMs of III, IV and V grade of Spetzler and Martin and to analyse the results in the subgroup of preoperative embolization plus surgery. METHODS: We perform a retrospective analysis of a group of 31 patients with arteriovenous malformations (AVMs) treated in our center between 1999 and 2004. There were 19 women and 12 men, with a mean age of 31.6 years old (range, 1-62a). Their symptoms upon admission were intracranial hemorrhage in 77.4%, seizures in 12.9%, headache, ischemic event and incidental finding in 3.2% each group. Diagnostic angiography was performed in 29 cases and anatomopathologic diagnostic in 2 cases. The malformations were classified with Spetzler and Martin Grading Scale, in 10.3% grade I, 24.1% grade II, 37.9% grade III, 24.1% grade IV and 3.4% grade V. Patients were classified in 6 subgroups of treatment (surgery, embolization, radiosurgery, embolization plus surgery, embolization plus radiosurgery and conservative treatment). RESULTS: AVMs grade III, IV and V (19 patients) were treated with surgery (6 cases), embolization plus surgery (5 cases), but also other kind of treatments (embolization alone, radiosurgery and conservative) were used. Functional results in these groups of patients were 36.8% (7 cases) with no symptoms or slights symptoms (modified Rankin 0-1), 52.6% (10 cases) minor disability (mRankin 2), 5.3% (1 case) moderate disability and 5.3% (1 case) mortality. We observe a high rate of postembolization hemorrhage in the group of patients in which the combination of preoperative embolization plus surgery was used. In these cases, early surgery was performed with a good functional recovery. There was one case of postoperative mortality. CONCLUSION: We should consider some factors like the natural history, clinical presentation (hemorrhage), angiographic features (deep arterial supply, aneurisms), Spetzler and Martin Grading and the clinical condition of the patient before treating a cerebral AVM. In the subgroup of treatment with embolization plus surgery, we recommend to achieve a subtotal preoperative embolization > 50%, not to obliterate more than 50% in one session, to perform staged embolization waiting from 4 to 6 weeks between procedures, and from 1 to 3 weeks between the last embolization and surgery.

Manejo actual de las malformaciones arteriovenosas. Estudio retrospectivo de 31 casos y revisión de la literatura / Actual Management of arteriovenous malformations. Retrospective study of 31 cases and literature review

Objetivos. Establecer unos criterios terapéuticos en las malformaciones arterio venosas (MAVs) grados III,IV y V de Spetzler y Martin y análisis de resultados en el subgrupo de tratamiento con embolización más cirugía. Material y métodos. Estudio retrospectivo de 31pacientes con MAVs cerebrales tratados en nuestro servicio entre 1999 y 2004. Se trata de 19 mujeres y 12 hombres, con una edad media de 31,6 años (rango de 1 a 62a).La forma de presentación fue en un 77,4% hemorragiaintracraneal, en un 12,9% crisis comicial y en un 3,2%cefalea, infarto isquémico y hallazgo casual en cada uno de ellos. En 29 casos se realizó arteriografía diagnóstica y en 2 casos el diagnóstico fue anatomo-patológico. Según la clasificación de Spetzler y Martin, 10,3%fueron de Grado I, 24,1% de Grado II, 37,9% de GradoIll, 24,1% de Grado IV y 3,4% de Grado V. Se clasificaron en 6 grupos según el tratamiento realizado (cirugía, embolización, radiocirugía, embolización más cirugía, embolización más radiocirugía y tratamiento conservador).Resultados. Las MAVs grado III, IV y V (19 pacientes)fueron tratadas en su mayoría por cirugía (6 casos) y embolización más cirugía (5 casos) pero también se utilizaron otras modalidades de tratamiento (embolización, radiocirugía y conservador). Los resultados funcionales de estos 3 subgrupos muestra un 36,8% (7 casos) de asintomáticos o con mínimos síntomas (Rankin m 0-1),un 52,6% (10 casos) de discapacidad leve pero independientes(Rankin m=2), un 5,3% (1 caso) de moderada discapacidad (Rankin m=3), y un 5,3% (1 caso)de mortalidad. En el manejo combinado embolización más cirugía de malformaciones complejas, se observa un alto porcentaje de sangrado postembolización que motivó cirugía precoz con buen resultado funcional. Hubo un caso de mortalidad postquirúrgica. Conclusiones. En el tratamiento de las MAVs cerebralesse debe tener en cuenta factores como la historia natural, la forma de presentación (hemorragia), las características angioestructurales (presencia de aporte arterial profundo, aneurismas), la escala de Spetzler y Martin y el estado clínico del paciente. En el tratamiento con embolización más cirugía es recomendable obtener una embolización prequirúrgica subtotal > 50%, no ocluir más del 50% por sesión, mantener un intervalo entre sesiones de embolización entre4 y 6 semanas y un intervalo entre última embolización y cirugía entre 1 y 3 semanas

Objective. To stablish some therapeutic criteria about the treatment of AVMs of III, IV and V grade of Spetzler and Martin and to analyse the results in the subgroup of preoperative embolization plus surgery. Methods. We perform a retrospective analysis of a group of 31 patients with arteriovenous malformations(AVMs) treated in our center between 1999 and 2004.There were 19 women and 12 men, with a mean age of 31,6 years old (range, 1-62a). Their symptoms upon admission were intracranial hemorrhage in 77,4%, seizures in 12,9%, headache, ischemic event and incidental finding in 3,2% each group. Diagnostic angiography was performed in 29 cases and anatomopathologic diagnosticin 2 cases. The malformations were classified with Spetzler and Martin Grading Scale, in 10,3% grade I,24,1% grade II, 37,9% grade III, 24,1% grade IV and3,4% grade V. Patients were classified in 6 subgroups of treatment (surgery, embolization, radiosurgery, embolizationplus surgery, embolization plus radiosurgery and conservative treatment).Results. AVMs grade III, IV and V (19 patients) were treated with surgery (6 cases), embolization plus surgery(5 cases), but also other kind of treatments (embolization alone, radiosurgery and conservative) were used. Functional results in these groups of patients were36,8% (7 cases) with no symptoms or slights symptoms(modified Rankin 0-1), 52,6% (10 cases) minor disability(mRankin 2), 5,3% (1 case) moderate disability and 5,3% (1 case) mortality. We observe a high rate of postembolization hemorrhage in the group of patients in which the combination of preoperative embolization plus surgery was used. In these cases, early surgery was performed with a good functional recovery. There was one case of postoperative mortality. Conclusion. We should considerer some factors likethe natural history, clinical presentation (hemorrhage),angiographic features (deep arterial supply, aneurisms), Spetzler and Martin Grading and the clinical condition of the patient before treating a cerebral AVM. In the subgroup of treatment with embolization plus surgery, we recommend to achieve a subtotal preoperative embolization > 50%, not to obliterate more than50% in one session, to perform staged embolization waiting from 4 to 6 weeks between procedures, and from 1 to 3 weeks between the last embolization and surgery

Age effects on long-term neuropsychological outcome in paediatric traumatic brain injury.

In order to investigate the relationship between age at injury and long-term neuropsychological impairment, 29 children and adolescents who sustained traumatic brain injury (TBI) were studied at least 6 years post-trauma. Tests of intellectual, memory, visuospatial and frontal lobe functions were administered to patients and 29 normal matched control subjects. Correlations between performance on neuropsychological tests and age showed the following direction: the younger the child when TBI was sustained, the worse the cognitive outcome. After controlling for injury severity, visuospatial functions remained related to age. Patients' performance differed significantly from that of controls in half of the neuropsychological variables analysed. To further investigate the effects of age at injury, the sample was divided in two groups (TBI before and after age of 8) and then compared with their respective controls. Patients damaged earlier presented impaired intellectual and visuospatial functions. The results suggest that neuropsychological sequelae remain after at least 6 years of evolution, and that there is an age at injury effect.

Estimulación de cordones posteriores como tratamiento del dolor crónico / Stimulation of posterior spiral cords as treatment of chronic pain

La neuroestimulación comenzó su desarrollo moderno con la publicación de Melzack y Wal, de su teoría sobre la puerta entrada en el control del dolor (1,2). en 1965 Sweet y Wepsic implantaron los primeros electrodos en los nervios periféricos como tratamiento del dolor

New retractor for a surgical approach to the spine: technical note.

This technical note presents a retractor based on interchangeable blades--a totally different concept in retractors. With this retractor, there is less traction on the structures, more stability, and excellent visibility of the surgical field because only a minimal incision is needed.

[The tethered cord syndrome : a review of causes]. / El síndrome de médula anclada: revisión casuística.

We present eighteen cases with Tethered cord syndrome (TCS). They were eleven adults and eight children. There were eight cases with surgical interventions performed in other centers during the newborn period for different types of spinal disraphisms. Clinical onset was insidious in 88% of the cases, and in 12% of the cases was acute, due to a precipitating factor. The main clinical findings were neurological skeletal , urological and cutaneous alterations in variable frequencies. Magnetic resonance imaging (MRI) was the best diagnostic test. Urodynamic studies in patients with urological alterations were abnormal and they helped to establish additional pharmacological treatment. After surgery 88% of the patients had an improvement or an arrest in the progression of the symptoms. Patients with shorter duration of the symptoms (less than 2 years) had a better prognosis.

[Treatment of acromegaly. Results in 56 patients]. / Tratamiento de la acromegalia. Resultados en 56 pacientes.

The results of the treatment of acromegaly in 56 patients have been reviewed. Transsphenoidal pituitary adenomectomy (TPA) represented the most effective therapy, as it resulted in a cure rate of 64.7%, with 8.8% of complications and 14.7% of endocrine insufficiencies secondary to surgery. When radiotherapy was administered after surgery (when the latter had not been curative), the overall rate of cure increased to 73.5%. By contrast, the patients treated only with radiotherapy had a markedly lower cure rate (44.4%), with a higher rate of endocrine insufficiency (55%). The occurrence of extrasellar extension shown in preoperative pituitary computed tomography did not correlate with a worse postoperative cure rate; by contrast, the invasive character of the adenoma represented a reduction in the postoperative cure rate. It was concluded that TPA is the treatment of choice in acromegaly, independently of the tumor size.