Presurgical evaluation of temporal lobe epilepsy: Is an outpatient prolonged ambulatory EEG study sufficient to recommend a surgical resection?

PURPOSE: Inpatient Video EEG Monitoring (VEM) is the typical study performed in presurgical evaluations. It is expensive and not widely available in developing countries. Recent studies suggested that in selected patients with mesial temporal lobe epilepsy secondary to unilateral mesial temporal sclerosis (MTS), the recording of unilateral interictal epileptiform activity ipsilateral to the MTS may yield sufficient presurgical EEG data. Outpatient prolonged ambulatory EEG (AEEG) could be an alternative in these cases. The purpose of this study was to compare the post-surgical seizure outcome and costs between patients evaluated with AEEG versus VEM. METHODS: Thirty patients with TLE were included: 21 evaluated with VEM and 9 with AmbEEG and underwent surgery between 2011 and 2017. The minimum, post-surgical follow-up period was 1 year. RESULTS: Seven of nine patients who underwent AEEG had seizures ipsilateral to MTS. In two patients only unilateral interictal activity ipsilateral to the lesion was recorded. All patients were free of disabling seizures (Engel Class I) at last follow-up. The mean cost per patient of AEEG was $980 and was $4680 for VEM. CONCLUSION: AEEG may be used to identify candidates for temporal lobectomy in selected patients with unilateral lesional mesial TLE. This approach to EEG monitoring could make epilpesy surgery more affordable to some patients in developing countries.

Long-chain omega-3 fatty acids in aneurysmal subarachnoid hemorrhage: A randomized pilot trial of pharmaconutrition.

BACKGROUND: Functional recovery after aneurysmal subarachnoid hemorrhage (SAH) remains a significant problem. We tested a novel therapeutic approach with long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs) to assess the safety and feasibility of an effectiveness trial. METHODS: We conducted a multicentre, parallel, randomized, open-label pilot trial. Patients admitted within 72 hours after SAH with modified Fisher scale scores of 3 or 4 who were selected for scheduled aneurysm clipping were allocated to receive either n-3 PUFA treatment (parenteral perioperative: 5 days; oral: 8 weeks) plus usual care or usual care alone. Exploratory outcome measures included major postoperative intracranial bleeding complications (PIBCs), cerebral infarction caused by delayed cerebral ischemia, shunt-dependent hydrocephalus, and consent rate. The computed tomography evaluator was blinded to the group assignment. RESULTS: Forty-one patients were randomized, but one patient had to be excluded after allocation. Twenty patients remained for intention to treat analysis in each trial arm. No PIBs (95% confidence interval [CI]: 0.00 to 0.16) or other unexpected harm were observed in the intervention group (IG). No patient suspended the intervention due to side effects. There was a trend towards improvements in all benefit-related outcomes in the IG. The overall consent rate was 0.91 (95% CI: 0.78 to 0.96), and there was no consent withdrawal. CONCLUSIONS: Although the balance between the benefit and harm of the intervention appears highly favourable, further testing on SAH patients is required. We recommend proceeding with amendments in a dose-finding trial to determine the optimal duration of parenteral treatment.

Tratamiento quirúrgico de aneurisma de la arteria espinal posterior roto: reporte de un caso y revisión de la literatura / Surgical treatment of ruptured posterior spinal arteryaneurysm. case report and literature review

Los aneurismas de la arteria espinal posterior (AEP) se presentan en su gran mayoría asociados a patologías que generan aumento del flujo arterial como malformaciones o fístula arteriovenosas y también asociadas a enfermedades del colágeno. Su presentación aislada es rara, con 11 casos publicados en la literatura a nuestro conocimiento. Presentamos una paciente de 56 años de edad, usuaria de anticoagulantes orales por accidente cerebro vascular antiguo no secuelado secundario a fibrilación auricular, que se presenta con dolor lumbar súbito no irradiado, al que luego se agrega paraplejia fláccida. En resonancia nuclear magnética se observa hemorragia subaracnoidea espinal con importante compresión medular secundaria. Estudio con angiografía demostró aneursima de aspecto disecante en arteria espinal posterior. Debido a pequeño calibre de arteria nutricia se optó por tratamiento quirúrgico. Angiografia de control mostró exclusión completa de aneurisma. En los controles posteriores la paciente ha mostrado recuperación progresiva del déficit neurológico. Tanto el tratamiento endovascular como el quirúrgico se han reportado para la exclusión de aneurismas de la AEP. El presente caso muestra que el tratamiento quirúrgico precoz es una alternativa sobre todo si además se requiere realizar descompresión medular.

Aneurysms of the Posterior spinal artery (PSA) usually present secondary to high-flow pathologies such as arteriovenous malformations or dural arteriovenous fistulas, also can be associated whit collagen diseases. Isolate PSA aneurysms are rare, whit 11 cases reported, to our knowledge. We present a 56 years old patient, user of oral anticoagulant for an old isquemic stroke, secondary to atrial fibrillation, who presented whit subit lumbar pain and flaccid paraplejia. The magnetic resonance image shows an extensive spinal subarachnoid hemorrhage and secondary medular compression. Spinal angiography study demonstrated a dissecting aneurysm of PSA. Due to the small size of the artery, on which the aneurysm was located, surgical treatment was performed. Follow up angiography shows complete exclusion of the lesion. The patient has had a progressive recovery on her deficit. Both surgical and endovascular treatment have been reported. The present case shows that early surgical treatment is an option, especially if medular decompression is needed.

Quistes radiculares o de Tarlov: casos clínicos y revisión de la literatura / Radicular cysts or Tarlov cysts: clinical cases and review

Los quistes radiculares o de Tarlov constituyen lesiones a nivel de canal medular, sobre todo sacral, que se diferencia fundamentalmente por la presencia de raíces nerviosas en su pared. Clínicamente destaca su efecto compresivo sobre la medula lo que repercutirá sobre los distintos síntomas y signos en nuestros pacientes. La indicación quirúrgica es actualmente la opción más adecuada para los pacientes sintomáticos. Se pretende realizar una revisión del tema y ejemplificar a través de casos clínicos la experiencia en un hospital clínico de nuestro sistema de salud.

Angiolipoma espinal extradural. Reporte de un caso clínico de presentación en el embarazo / Extradural spinal angiolypoma. Report of a clinical case in pregnancy

Spinal Extradural Angiolipomas (SEA) are benign and rare tumors that may clinically presents as subacute spinal cord compression syndrome. The diagnosis may be suspected by spinal MRI, where fat suppression techniques are important to. Usually ,the lesion is amenable to total surgical excision and the functional prognosis is good. Histopathologically consist in a adipose cell matrix intermixed with vascular endothelial channels. We present a case of an thoracic SEA, whose was clinically evident during pregnancy. A literature review is made and the relationships between SEA and pregnancy are discussed as well as the main diagnostic and therapeutic approaches of this lesion.

Conversión en colecistectomía laparoscópica. Experiencia hospital San Martín de Quillota, 8 años después / Conversion in laparascopic cholecystectomy. Experience of hospital San Martín de Quillota, 8 years later

La colecistectomía laparoscópica se realiza en nuestro país 1990 y en el Hospital San Martín de Quillota desde 1992. Se realizó un estudio sobre las causas de conversión de colecistectomía laparoscópica a colecistectomía clásica, transcurrido un tiempo de aprendizaje por el staff de cirujanos, comparando las causas de conversión con un estudio previo realizado en el Hospital San Martín de Quillota entre 1992-1995. Se evaluaron las cirugías efectuadas entre julio del 2000 hasta marzo 2002, sumando 799 casos, de los cuales 45 debieron ser convertidos. Se evaluaron las variables edad, sexo, antecedentes mórbidos, clínica, ecografía, diagnóstico pre y post operatorio, tiempo operatorio, anatomía patológica, complicaciones posteriores y las causas de la conversión. En nuestro estudio del total de cirugías, un 5,6 por ciento de los casos debieron ser convertidos, en comparación con el índice de conversión de un 7,8 por ciento obtenido en el mismo centro hace 8 años. De las cuasas de conversión se observó una variación con respecto al estudio preliminar. En este último, la principal causa de conversión fue la dificultad técnica (29,2 por ciento), en cambio en el estudio actual fue el plastrón vesicular (37 por ciento de los casos). Nuestros resultados, al igual como los de otros autores, reflejan la transición entre la dificultad técnica y el hallazgo de plastrón como la primera causa de conversión, una vez transcurrido la curva de aprendizaje de esta técnica.