Continuous Subcutaneous Apomorphine Infusion before Subthalamic Deep Brain Stimulation: A Prospective, Comparative Study in 20 Patients.

BACKGROUND: Studies comparing the clinical efficacy of apomorphine infusion (APO) with subsequent subthalamic deep brain stimulation (STN-DBS) in advanced Parkinson's disease (aPD) are currently lacking. Retrospective data have shown that patients treated with APO are usually older, have a more prolonged disease, and a more severe phenotype. OBJECTIVE: To compare the benefit of APO with that of STN-DBS on motor, non-motor, cognitive, and quality of life in the same patient when given sequentially. METHODS: We prospectively analyzed 20 aPD patients over 3 different treatment phases: baseline (optimized medical treatment), during APO treatment, and during subsequent STN-DBS treatment. The APO and STN-DBS phases were stable for 6 months, and evaluation of the different treatments was separated by 6 months. RESULTS: Compared to baseline, APO, and STN-DBS reduced mean daily off time by 70.5% and 89.3% (P = 0.012), respectively, and scores for Unified Parkinson's Disease Rating Scale (UPDRS) IV by 27.5% and 80.5% (P ≤ 0.001), Non-motor symptoms scale (NMSS) by 24.6% and 49.3% (P ≤ 0.001), Montgomery Asberg depression scale (MADRS) by 7.4% and 39.0% (P = 0.27), Starkstein apathy scale (SAS) by 51.1% and 39.9% (P = 0.734), Parkinson's disease sleep scale 2 (PDSS-2) by 25.7% and 56.7% (P ≤ 0.001), and Parkinson's disease questionnaire 39 item (PDQ-39) by 39.6% and 64.9% (P ≤ 0.001). Global cognition did not change with either therapy, but phonetic fluency worsened after STN-DBS compared to APO (P = 0.022). CONCLUSIONS: Both APO and STN-DBS improved motor and non-motor symptoms and quality of life compared to optimized medical treatment in aPD. Overall, STN-DBS was the most effective treatment, but APO showed a pronounced benefit on motor symptoms. Effective treatment for aPD should not be delayed, even when waiting for surgery.

Factores pronósticos en gliomas de alto grado / Prognostic factors in high grade gliomas

No disponible

Quistes aracnoideos e higroma subdural / Arachnoid cysts and subdural hygroma

No disponible

Parálisis nuclear del III par craneal en el contexto de un traumatismo craneoencefálico / Nuclear paralysis of the oculomotor nerve within the context of traumatic brain injury

No disponible

Experiencia en el manejo de metástasis cerebrales tratadas con radiocirugía estereotáctica / Experience with the radiosurgical treatment of brain metastases

Objetivos: Analizar la supervivencia de una cohorte de pacientes con metástasis cerebrales tratados con radiocirugía y determinar qué factores pueden influir en los resultados. Pacientes y método: Estudio retrospectivo descriptivo sobre una cohorte de 126 pacientes diagnosticados de metástasis intracraneal tratados con radiocirugía. Se excluyeron aquellos casos en los que se realizó cirugía (antes o después de la radiocirugía). Se analizó la supervivencia en función de factores clínicos (edad, sexo, tumor primario), radiológicos (número, localización y volumen de las lesiones) y de radioterapia (dosis de tratamiento, radioterapia holocraneal). Se realizó análisis univariante y multivariante de regresión de Cox. Resultados: Entre febrero de 2008 y abril de 2015 se trataron 225 metástasis cerebrales en 126 pacientes con edad media de 59,8 ± 11,6 años. La mediana de supervivencia fue de 8,2 meses. La supervivencia global a los 6, 12 y 24 meses fue del 60,3, del 31,5 y del 12,8%, respectivamente. Los orígenes más frecuentes fueron pulmonar (59,5%) y mama (14,3%), y la localización principal, los hemisferios cerebrales (77%). El volumen medio fue de 10,35cc (0,2-43,5). Se encontraron como factores significativos de supervivencia, entre otros: edad menor de 60años (p = 0,046), sexo femenino (p < 0,001), cáncer de mama (p < 0,001); KPS > 80 (p = 0,001), puntuación en la escala SIR > 6,5 (p = 0,031), escala GPA ≥ 2,5 (p = 0,003). Conclusiones: La radiocirugía es una técnica adecuada para el tratamiento de las metástasis cerebrales, y entre los factores pronósticos encontrados destacan la edad menor de 60 años, el sexo femenino y las mejores puntuaciones en las escalas de Karfnosky, SIR y GPA

Objective: To analyse the survival rate of a cohort of patients with intracranial metastases treated with radiosurgery, and to determine the factors that influence the results. Patients and method: Retrospective analysis performed on a cohort of 126 patients undergoing radiosurgery for brain metastases. Patients treated with surgery before or after radiosurgery were excluded. Survival is analysed based on clinical (age, sex, primary tumour), radiological (number, location and volume of lesions), and radiotherapy factors (treatment dose, holocraneal radiation). Univariate and multivariate analyses were performed to determine significant prognostic factors. Results: A total of 225 brain metastases in 126 patients, with a mean age of 59.8 ± 11.6 years, were treated between February 2008 and April 2015. The mean survival was 8.2 months. The overall survival rates at 6 months, 1 year, and 2 years were 60.3%, 31.5%, and 12.8%, respectively. Lung (59.5%) and breast (14.3) were the most common primary tumours, and the most common site for metastases was the cerebral hemisphere (77%) and the average volume was 10.35 cc (0.2-43.5). Significant survival factors were: age under 60 (P = .046), female (P < .001), breast cancer (P < .001), KPS > 80 (P = .001), SIR6 > 5 (P = .031), and GPA ≥ 2.5 (P = .003). Conclusions: Radiosurgery is an appropriate technique for the treatment of brain metastases, and the main prognostic factors include being age under 65, female, breast cancer, and good scores on Karnofsky, SIR, and GPA scales

Mutismo cerebeloso / Cerebellar mutism

No disponible

Síndrome del uno y medio de origen traumático / One-and- a-half syndrome after head trauma

No disponible

Siringomielias en pediatría / Syringomyelias in paediatrics

No disponible

[Experience with the radiosurgical treatment of brain metastases]. / Experiencia en el manejo de metástasis cerebrales tratadas con radiocirugía estereotáctica.

OBJECTIVE: To analyse the survival rate of a cohort of patients with intracranial metastases treated with radiosurgery, and to determine the factors that influence the results. PATIENTS AND METHOD: Retrospective analysis performed on a cohort of 126 patients undergoing radiosurgery for brain metastases. Patients treated with surgery before or after radiosurgery were excluded. Survival is analysed based on clinical (age, sex, primary tumour), radiological (number, location and volume of lesions), and radiotherapy factors (treatment dose, holocraneal radiation). Univariate and multivariate analyses were performed to determine significant prognostic factors. RESULTS: A total of 225 brain metastases in 126 patients, with a mean age of 59.8±11.6years, were treated between February 2008 and April 2015. The mean survival was 8.2 months. The overall survival rates at 6months, 1year, and 2years were 60.3%, 31.5%, and 12.8%, respectively. Lung (59.5%) and breast (14.3) were the most common primary tumours, and the most common site for metastases was the cerebral hemisphere (77%) and the average volume was 10.35 cc (0.2-43.5). Significant survival factors were: age under 60 (P=.046), female (P<.001), breast cancer (P<.001), KPS >80 (P=.001), SIR6 >5 (P=.031), and GPA ≥2.5 (P=.003). CONCLUSIONS: Radiosurgery is an appropriate technique for the treatment of brain metastases, and the main prognostic factors include being age under 65, female, breast cancer, and good scores on Karnofsky, SIR, and GPA scales.

Hematoma subdural crónico en pacientes muy ancianos / Chronic subdural haematomas in very elderly patients

Introducción. El hematoma subdural crónico (HSC) es una patología frecuente en los servicios de neurocirugía, y especialmente prevalente entre los pacientes de edad avanzada. El objetivo de este estudio es analizar las características demográficas, clínicas y radiológicas en una serie de pacientes mayores de 85 años afectados de un HSC. Pacientes y métodos. Realizamos un estudio retrospectivo sobre una serie de pacientes mayores de 85 años entre abril de 1986 y noviembre de 2015. Se recogieron las características clínicas (edad, sexo, comorbilidades, factores de riesgo, características radiológicas) y los resultados quirúrgicos (complicaciones fundamentalmente centradas en las recidivas y mortalidad). Analizamos las particularidades de este grupo de edad y su relación entre edad, sexo, grado clínico, tratamiento antiagregante o anticoagulante, arquitectura del hematoma, desplazamiento de la línea media y número de trépanos realizados con la mortalidad y recidiva del hematoma. Resultados. Analizamos 200 pacientes con una edad media de 88,5 años (rango 85-104), con una relación varón:mujer de 1:1,1. Se recogió antecedente traumático en 114 casos (57%) y estaban sometidos a terapia anticoagulante o antiagregante 71 pacientes (35,5%). Al ingreso, 114 pacientes (57%) tenían un buen estado clínico (grado 0-2 de Markwalder). El principal síntoma fue el deterioro cognitivo en 82 casos (41%). El HSC estaba localizado en el hemisferio izquierdo en 89 (44,5%), derecho en 78 casos (39%) y bilateral en los restantes 33 (16,5%). Se presentaron 59 complicaciones en 59 casos (29 recidivas) y el grado clínico de Markwalder se relacionó con unos mayores índices de complicaciones y mortalidad (p<0,0001). Conclusiones. El HSC es una patología frecuente en los pacientes muy ancianos. Clínicamente se manifiesta con deterioro cognitivo y déficit neurológico. La situación clínica al ingreso representó en nuestra serie un importante factor predictivo tanto de complicaciones como de mortalidad (AU)

Introduction. Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. Patients and methods. A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. Results. A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). Conclusions. CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality (AU)

Meningiomas en el anciano / Meningiomas in the elderly

No disponible

Neuromonitorización en el traumatismo craneoencefálico grave pediátrico / Neuromonitoring in severe paediatric head injury

No disponible

[Chronic subdural haematomas in very elderly patients]. / Hematoma subdural crónico en pacientes muy ancianos.

INTRODUCTION: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. PATIENTS AND METHODS: A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. RESULTS: A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CONCLUSIONS: CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.

Quiste aracnoideo bilateral del ángulo pontocerebeloso / Bilateral cerebellopontine arachnoid cyst

Introducción. Los quistes aracnoideos bilaterales del ángulo pontocerebeloso son excepcionales, y únicamente existen tres casos publicados en la bibliografía. Caso clínico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolución. La exploración clínica era normal y la resonancia magnética craneal mostraba dos lesiones extraaxiales localizadas en ambos ángulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogéneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existía restricción en las secuencias de difusión. No se indicó tratamiento quirúrgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el ángulo pontocerebeloso son excepcionales. La principal indicación para el tratamiento quirúrgico es la presencia de síntomas o signos neurológicos coincidentes con la localización de los quistes (AU)

Introduction. Bilateral cerebellopontine arachnoid cysts are very rare, and only three cases have been previously reported. Case report. A 14-year-old previously healthy girl presented to our outpatient clinic with a 6-weeks history of frontal headache. They typically would start in the occipital region and then radiate bifrontally. The neurological examination was unremarkable. Magnetic resonance imaging revealed an extra-axial bilateral lesion in bilateral cerebellopontine angle, larger on left side. The lesions were homogeneously hypointenese on T1 -weighted imaging and hyperintense on T2- weighted imaging without evidence of contrast enhancement and without evidence of restriction on diffusion-weighted imaging. No surgical treatment was indicated. Conclusions. Bilateral arachnoid cysts of the cerebellopontine angle are very infrequent and the main indication for surgery is the existence of clinical symptoms or neurological deficit coincident with the locations of the cysts (AU)