[The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy]. / Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras.

INTRODUCTION: Surgery for resection of supratentorial lesions near the motor areas and/or internal capsule carries an associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at once. Thus, a small movement may be missed while attention is focused on another site. AIM: To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. PATIENTS AND METHODS: We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. RESULTS: No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. CONCLUSIONS: Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery.

Utilidad de la monitorización electromiográfica durante la estimulación eléctrica cortical intraoperatoria en áreas motoras / The usefulness of electromyographical monitoring with intraoperative brain mapping during motor lesionectomy

Introducción. La resección de lesiones adyacentes a áreas sensitivomotoras conlleva el riesgo de lesionar las vías motoras corticosubcorticales. La realización de un mapa funcional de la corteza expuesta en la craneotomía mediante estimulación eléctrica cortical mejora notablemente los índices de resecabilidad lesional y reduce los riesgos de morbimortalidad. La valoración de la respuesta tras el estímulo consiste en detectar un movimiento o una contracción muscular en el paciente. En algunas ocasiones, debido a la posición del paciente, la iluminación o por tratarse de una contracción mínima, esta respuesta puede pasar desapercibida. Objetivo. Determinar la utilidad de la monitorización electromiográfica simultánea a la estimulación eléctrica corticosubcortical como ayuda a la localización de áreas motoras. Pacientes y métodos. Se registra la actividad electromiográfica simultánea en múltiples grupos musculares durante la estimulación eléctrica cortical y subcortical con electrodos de superficie en una serie consecutiva de 40 pacientes sometidos a craneotomías para resección de lesiones cercanas a áreas funcionales motoras. Al pretender monitorizar el mayor número posible de músculos, cada electrodo (activo e indiferente) se coloca en dos músculos adyacentes en la misma región del cuerpo por cada amplificador. Resultados. No se objetivaron respuestas motoras clínicas ni electromiográficas en el 20% de los pacientes. Se detectó sólo respuesta electromiográfica en el 17% de los pacientes. La respuesta motora clínica y electromiográfica fue simultánea en el 76% de los pacientes. Conclusiones. La utilización de monitorización electromiográfica durante el mapeo cortical con estimulación eléctrica facilita la localización de la corteza motora primaria y las vías motoras subcorticales (AU)

Associated risk of damage to cortical or subcortical motor pathways. Intraoperative brain mapping, using direct cortical electric stimulation, is a surgical adjunct used during lesionectomy in functional cortex. The technique of observing movements elicited by electrical stimulation has proved useful for intraoperative localization of motor pathways but it is difficult observe the entire body at onces. Thus, a small movement may be missed while attention is focused on another site. Aim. To determinate the usefulness of electromyographical monitoring in locating motor pathways during neurosurgery in functional cortex. Patients and methods. We recorded multichannel electromyography activity during cortical and subcortical electric stimulation in a consecutive series of 40 patients undergoing craniotomies for lesionectomy near motor cortex or subcortical motor tracts. Because the aim of the electromyography recordings was to sample as many muscles as possible, the two electrodes connected to each different amplifier input were placed in different muscles in the same region of the body. Results. No motor responses were detected by either electromyographical monitoring or visual inspection in 20% patients. Electromyographical activity was the only indication of motor response in 17%. Motor responses were detected simultaneously by either electromyographical monitoring and visual inspection in 76%. Conclusions. Electromyography monitoring enhances the ability to detect the location of primary motor cortex and subcortical pathways with electrical stimulation during neurosurgery (AU)

Absceso cerebral asociado a la enfermedad de Rendu-Osler-Weber / Cerebral abscess associated to Rendu-Osler-Weber

No disponible

No disponible

[Percutaneous thermocoagulation of sensory lumbar nerve roots in the treatment of pain]. / Die perkutane Thermokoagulation der sensiblen lumbalen Wurzeln zur Behandlung von Schmerzen.

The study was carried out on the experiences with 20 patients with low back pain. They were treated by thermoelectrocoagulation of the posterior lumbar roots. 60% optimal and 10% good results without permanent complications.