Gamma Knife radiosurgery for the management of glomus jugulare tumors: A systematic review and report of the experience of a radioneurosurgery unit in Latin America.

Background: Glomus jugulare tumors (GJTs) are rare and mainly affect women between the 5th and 6th decades of life. Its localization and anatomic relationships make conventional surgical treatment difficult and with a considerable risk of complications. This manuscript aims to describe the results of Gamma Knife radiosurgery (GKR) in patients with GJT treated in a single center in Latin America, as well as to systematically review the literature to determine the clinical and radiological effectiveness of this technique. Methods: A search of information from January 1995 to June 2023 was performed. Twenty-two articles reporting 721 GJT patients treated with GKR were included in the study. Variables such as symptomatic control, control of tumor size, and complications were evaluated. These variables were described using measures of central tendency and proportions. For the institutional experience, 77 patients with GJT tumors were included in the study. Pre-treatment clinical variables and follow-up data were collected from medical charts and phone interviews. The Short Form-36 scale was applied to assess the quality of life. The data were analyzed using the statistical program STATA17.0. Results: A total of 721 patients were considered. The median of patients included in these studies was 18.5. The mean age was 58.4 years. The median of symptom control was 89%, and the median of imaging control was 95.7%. In our institution, 77 patients were included in the study. The mean age was 53.2 years. The median hospital stay was 4.92 hours. For the clinical follow-up, information on 47 patients was obtained. An improvement in pre-treatment symptoms was described in 58%, with general symptomatic control of 97%. The tumor-control rate was 95%, and there were statistically significant differences in six of the nine Short Form-36 scale domains. Conclusion: GKR is an effective, safe, and cost-effective technique that offers a high degree of symptomatic and tumor size control in patients with GJT.

Gamma Knife radiosurgery - 12 years of experience in a high-complexity center of a middle-income country.

Background: Gamma Knife radiosurgery (GKR) is a technique that consists of the release of a high dose of ionizing radiation onto a therapeutic target, which has been previously delimited. This technique was described by Lars Leksell and Borje Larsson in 1951. In Colombia, there is only one GKR unit functioning machine nowadays. The objective of this study is to describe the institutional experience of a single institution with Gamma Knife Perfexion over 12 years. Methods: We conducted a retrospective observational study. A total of 1906 medical records, taken from the period between May 4, 2010, and May 4, 2022, were included in the study. Descriptive analysis was performed through STATA 17 as statistic tool. Measures of central tendency were calculated depending on the distribution of the continuous data and proportions were taken into account in the case of qualitative variables. Results: A total of 1906 procedures were performed. Patients from 1 year to 99 years old were treated, with a median age of 51 years. The most frequent diagnoses were meningioma (20.8%), arteriovenous malformation (AVM) (17%), vestibular schwannoma (15.6%), metastases (9.81%), and trigeminal neuralgia (9.12%). At 3-year posttreatment, in meningiomas, tumor size stability was observed in 57.3%, size decrease in 36%, and disappearance in 1.3%. In AVM, complete obliteration of the lesion was described in 36.8% and a decrease in size in 52.6%. Intracranial hemorrhage occurred in 5.2% during the follow-up period and 3.5% of all treated patients required a new procedure due to residual malformation. In vestibular schwannomas, tumor size remained stable in 62.2% and decreased in 28.8%. No new cases of facial paralysis after the procedure were described. At 1-year posttreatment, in metastasis, the size of the lesions remained stable in 40% of the patients, decreased in 47.5%, and disappeared in 2.5%. In trigeminal neuralgia, 88.4% of patients had pain relief and recurrences occurred in 16.6%. Acute complications were generally uncommon, the main ones being headache, pain at frame fixation points, and nausea. Conclusion: Our experience suggests that GKR is a noninvasive procedure with a broad spectrum of clinical applications, low frequency of complications, feasible, with good enough control size of tumor and vascular lesions in images, and good clinical results in the medium and long term.

Ataque cerebrovascular recurrente secundario a síndrome del opérculo torácico arterial causado por sinostosis de la primera y la segunda costillas torácicas: reporte de caso / Recurrent Stroke Secondary to Arterial Thoracic Outlet Syndrome Caused by First and Second Ribs Synostosis: Case Report

El ataque cerebrovascular recurrente (ACV) es una complicación rara del síndrome del opérculo torácico arterial. Presentamos un paciente de 24 años con isquemia del miembro superior derecho y ACV recurrente en territorio vertebro basilar secundario a estenosis y aneurisma de la arteria subclavia, causado por sinostosis de la primera y segunda costillas torácicas. El paciente fue tratado quirúrgicamente con costocondrectomía y escalenectomía bilateral, resección de aneurisma de la arteria subclavia derecha y anastomosis primaria. Se analizó el caso y se revisó la literatura pertinente sobre ACV y síndrome de opérculo torácico arterial.

Stroke is a rare complication of arterial thoracic outlet syndrome. We present a 24-year old man with right arm ischemia and recurrent vertebrobasilar stroke caused by synostosis of the first and second thoracic ribs. The patien was treated with supraclavicular resection of both first ribs and bilateral scalenectomy, aneurysmal resection and primary anastomosis of the right subclavian artery. We analize this case and review the pertinent literature on stroke and arterial thoracic outlet syndrome.

Derivación lumboperitoneal como tratamiento de quistes de Tarlov sintomáticos / Lumboperitoneal shunt for treatment of symptomatic lumbar Tarlov cysts

La Lumbalgia es una causa frecuente de discapacidad y de limitación funcional en nuestra sociedad, con un costo financiero, social y laboral muy alto. Es un problema común que afecta a ambos sexos y la mayoría de las edades, para las que aproximadamente uno de cada cuatro adultos busca atención al cabo de seis meses. En los EE.UU., para las personas de 45 años o menos, el dolor lumbar es la causa más frecuente de limitación de actividad. Hay diferentes causas de lumbalgia siendo la enfermedad degenerativa lumbar la causa más común. Dentro de la causas menos frecuente de lumbalgia, se encuentra las asociadas quistes perineurales, llamados también quistes de Tarlov. La gran mayoría de los quistes de Tarlov son asintomáticos, su ubicación más frecuente es la región sacra. Algunos de ellos se tornan sintomáticos y requieren tratamiento. Se han descrito varias formas de manejo entre las cuales se encuentra la resección quirúrgica, la punción percutánea del quiste y las derivaciones quiste peritoneal o Lumboperitoneal. Hasta el momento, no hay consenso sobre cuál es la mejor forma de tratar éstas lesiones. En este artículo pretendemos mostrar una serie de 3 casos donde los pacientes fueron tratados con derivación lumboperitoneal con mejoría clínica completa. Se ha realizado una revisión de la literatura acerca del tratamiento de esta patología que es poco frecuente.

Lumbar pain is one of the causes of incapacity and limitation in our society. There are different causes of lumbar pain, having the degenerative cause being the most frequently found. Perineural cysts are a rare cause of incapacitating lumbar pain and the majority of these cysts are asymptomatic. There is a little information about the treatment of symptomatic perineural cysts. There has been described different treatment options which varies from surgical excision, cyst drainage and lumbar o cyst shunt to the peritoneal cavity. Till this moment there is no consensus on the optimal treatment of these lesions. In this article we want to show a small case series of 3 cases where these patients were treated with lumbo-peritoneal Shunt. This entire patient showed clinical improvement after the treatment. We will also review the literature regarding these rare lesions.

Trombosis severa de senos venosos cerebrales / Severe cerebral venous sinus thrombosis

La trombosis de senos venosos cerebrales (TSVC) es una patología poco común del sistema nervioso central, con una mortalidad cercana al 9%. El manejo de esta enfermedad es usualmente médico. Algunos eventos de TSVC pueden tomar un curso maligno en los casos donde la presión intracraneana aumenta excesivamente. Este aumento de la pre¬sión intracraneana puede deberse a edema del tejido cerebral por el impedimento del retorno venoso y en ocasiones se asocia a hemorragia intracerebral. Se ha visto una evolución favorable cuando se realizan diagnóstico y tratamiento tempranos. Se han descrito varias técnicas de manejo endovascular que han ayudado a mejorar el flujo venoso en esta patología; sin embargo, hasta el momento sólo son pequeñas series de casos, sin evidencia suficiente para recomendarla de rutina. La mayoría de los médicos no tienen muy claro el papel con el cual interviene el neurocirujano en el manejo de la TSVC. Hay diferentes procedimientos quirúrgicos que se deben tener en cuenta, entre los cuales se encuentra la craniectomía descompresiva, cuando existe hipertensión endocraneana severa o maligna, siendo ésta la única opción terapéutica para reducir la morbimortalidad.