[Syncytial intramedullary meningioma associated with cervical syringomyelia]. / Meningioma sincitial intramedular asociado a siringomielia cervical.

TITLE: Meningioma sincitial intramedular asociado a siringomielia cervical.

Hidrocefalia crónica del adulto idiopática / Idiopathic chronic hydrocephalus in adults

No disponible

[Nuclear paralysis of the oculomotor nerve within the context of traumatic brain injury]. / Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

TITLE: Paralisis nuclear del III par craneal en el contexto de un traumatismo craneoencefalico.

Delayed complications of deep brain stimulation: 16-year experience in 249 patients.

BACKGROUND: Over the years, most of the deep brain stimulation (DBS) complications described have been mainly related to the surgery itself or the stimulation. Only a few authors have dealt with chronic complications or complications due to implanted material. METHODS: We retrospectively analyzed complications beyond the 1st month after surgery in 249 patients undergoing DBS at our site for 16 years, with 321 interventions overall. RESULTS: Our results show that infection is the most frequent delayed complication (12.5%), the pulse generator being the most common location. Lead breaks (9.3%) are the second most frequent complication. Symptomatic peri-lead edema and cyst formation were exceptional. CONCLUSIONS: The best knowledge about DBS complications allows for better solutions. In case of infection, conservative treatment or partial removal of the DBS system appears to be safe and reasonable. Intracranial complications related to DBS material such as peri-lead edema and cyst formation have a good prognosis. They may appear long after DBS implantation.

[Cerebellar mutism]. / Mutismo cerebeloso.

Mutismo cerebeloso.

Bilateral pallidal deep brain stimulation in myoclonus-dystonia: our experience in three cases and their follow-up.

BACKGROUND: Myoclonus-dystonia syndrome (MDS) is an autosomal dominant movement disorder caused by mutations in the SGCE gene. MDS is characterized by mild dystonia and myoclonic jerks, and a constellation of psychiatric manifestations. Deep brain stimulation (DBS) of bilateral internal globus pallidus (GPi) has recently been introduced as a new and beneficial technique to improve motor symptoms in MDS. METHODS: We report three proven genetically MDS cases with successful response to DBS, and their clinical evolution over years. RESULTS: DBS improves significantly the Unified Myoclonus Rating Scale and Burke-Fahn-Marsden Dystonia Rating Scale in all three patients. This improvement is sustained over the years and no major adverse events were recorded. DBS stimulation parameters employed are justified and compared with cases reported throughout the literature. DISCUSSION: DBS of bilateral GPi is an effective and safe therapy to be considered in MDS refractory cases. Careful neuropsychological evaluation is essential inside the presurgery planning. Correct location of the DBS electrodes and individualized selection of stimulation parameters in each case are the main determinants of the best clinical response.

[Bilateral cerebellopontine arachnoid cyst]. / Quiste aracnoideo bilateral del angulo pontocerebeloso.

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.

TITLE: Quiste aracnoideo bilateral del angulo pontocerebeloso.Introduccion. Los quistes aracnoideos bilaterales del angulo pontocerebeloso son excepcionales, y unicamente existen tres casos publicados en la bibliografia. Caso clinico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolucion. La exploracion clinica era normal y la resonancia magnetica craneal mostraba dos lesiones extraaxiales localizadas en ambos angulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogeneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existia restriccion en las secuencias de difusion. No se indico tratamiento quirurgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el angulo pontocerebeloso son excepcionales. La principal indicacion para el tratamiento quirurgico es la presencia de sintomas o signos neurologicos coincidentes con la localizacion de los quistes.

Paraganglioma de cauda equina / Paraganglioma of the cauda equina

No disponible

Linfomas primarios del sistema nervioso central / Primary central nervous system lymphoma

Introducción: Los linfomas primarios del sistema nervioso central son una variedad poco frecuente de linfomas no hodgkinianos que constituyen alrededor del 4%de los tumores del sistema nervioso central. Pacientes y métodos: realizamos una revisión retrospectiva de 24 pacientes diagnosticados de linfoma primario del sistema nervioso central entre enero de 1990 y diciembre de 2010. Todos los pacientes fueron diagnosticados con resonancia magnética y confirmados quirúrgicamente. Resultados: De los 24 pacientes analizados, 4 presentaban inmunodeficiencia. La media de edad era de 59,3 anos (intervalo 13-79) y la relación entre varones y mujeres de 1 a 1,1. El deterioro cognitivo (33,4% de los pacientes) y la cefalea (22,5%) fueron los signos de presentación más frecuentes. El diagnóstico se realizó en 13 casos (54%) tras llevar a cabo una craneotomía y en los otros 11 (46%) mediante biopsia estereotáctica. La distribución histoló- gica mostró que 22 casos (91,6%) eran linfomas tipo B, un caso un linfoma anaplásico de células gigantes y el otro correspondió a un linfoma de células T. La supervivencia media fue de 12,8 meses y a un ano˜ del 37,5%. Conclusiones: Los linfomas cerebrales primarios se presentan alrededor de la sexta década dela vida y clínicamente se manifiestan con deterioro cognitivo, cefalea y déficits neurológicos focales. El 75% de los pacientes (18 casos) presentaban únicamente una lesión intracraneal y elrestante 25% (6 pacientes) entre 2 y 4 lesiones. El estado clínico preoperatorio constituye el factor pronóstico más importante (AU)

Introduction: Primary central nervous system lymphoma is a rare subtype of extranodal nonHodgkin lymphoma that accounts for 4% of central nervous system tumours Patients and methods: Retrospective review of 24 patients diagnosed with primary central nervous system lymphoma between 1990 and 2010. All patients were diagnosed using magnetic resonance imaging and the diagnosis was confirmed surgically. Results: Ofthe 24 patients analysed, all except 4 were immunocompetent. Median age at diagnosis was 59.3 years (range 13-79) and the sex ratio (male to female) was 1:1.1. Cognitive decline (in 33.4%) and headache (in 25%) were the most common complaints. Diagnosis was performed In 13 cases (54%) following craniotomy and in the other 11 cases (46%) after stereotactic biopsy. Breakdown by pathology was as follows: 22 cases of B-cell lymphoma (91.6%), 1 case of anaplastic large-cell lymphoma, and 1 case of T-cell lymphoma. Mean survivaltime was 12.8 months with an overall 1-year survival rate of 37.5%. Conclusions: Primary central nervous system lymphoma often presents in the sixth decadewith cognitive decline, headache, and focal neurological deficits. A single intracranial lesión was present in 75% of the patients (18 cases), and the remaining 25% (6 cases) had between 2 and 4 lesions. Preoperative clinical status was the mostimportantfactor determining prognosis (AU)

Primary central nervous system lymphoma.

INTRODUCTION: Primary central nervous system lymphoma is a rare subtype of extranodal non-Hodgkin lymphoma that accounts for 4% of central nervous system tumours. PATIENTS AND METHODS: Retrospective review of 24 patients diagnosed with primary central nervous system lymphoma between 1990 and 2010. All patients were diagnosed using magnetic resonance imaging and the diagnosis was confirmed surgically. RESULTS: Of the 24 patients analysed, all except 4 were immunocompetent. Median age at diagnosis was 59.3 years (range 13-79) and the sex ratio (male to female) was 1:1.1. Cognitive decline (in 33.4%) and headache (in 25%) were the most common complaints. Diagnosis was performed In 13 cases (54%) following craniotomy and in the other 11 cases (46%) after stereotactic biopsy. Breakdown by pathology was as follows: 22 cases of B-cell lymphoma (91.6%), 1 case of anaplastic large-cell lymphoma, and 1 case of T-cell lymphoma. Mean survival time was 12.8 months with an overall 1-year survival rate of 37.5%. CONCLUSIONS: Primary central nervous system lymphoma often presents in the sixth decade with cognitive decline, headache, and focal neurological deficits. A single intracranial lesion was present in 75% of the patients (18 cases), and the remaining 25% (6 cases) had between 2 and 4 lesions. Preoperative clinical status was the most important factor determining prognosis.

Estimulación cerebral profunda. Una alternativa a la cirugía bariátrica / Deep brain stimulation. An alternative to bariatric surgery

La obesidad, constituye actualmente un problema sanitario de primera magnitud en el mundo occidental. La mayoría de las técnicas de cirugía bariátrica se basan en modificar el tracto digestivo (bypass gástrico, la banda gástrica o el balón intragástrico). A pesar de haberse reducido los índices de mortalidad, la ganancia de peso se produce en numerosas ocasiones después de la cirugía debido al mal control de la dieta. La estimulación cerebral profunda es una técnica quirúrgica de elección en un grupo de pacientes seleccionados con diferentes trastornos del movimiento y dado su buen resultado en estas patologías se han extendido sus aplicaciones a ciertas alteraciones del comportamiento (depresión y trastorno obsesivo compulsivo). Realizamos una revisión de la literatura sobre las diferentes regiones anatómicas del cerebro involucradas con la obesidad y las evidencias de trabajos experimentales que apoyan estas regiones como posibles dianas para estimulación cerebral profunda en pacientes con obesidad (AU)

Obesity has become one of the greatest threats to global public health in the new millennium. Most surgical interventions for obesity have focused on modifying the anatomy of the alimentary tract and include gastric bypass, gastric banding and intragastric balloon placement. Despite reductions in mortality rates, weight gain may occur following bariatric surgery due to dietary relapse. High-frequency deep brain stimulation is the treatment of Choice for well selected patients with medically refractory movement disorders. The success of deep brain stimulation in relieving parkinsonism has led to its application in multiple neurological diseases and more recently to treatment psychiatric condition (depression and obsessive compulsive disorders). We revised the literature implicating various neural regions in the pathophysiology of obesity, as well as the evidence supporting these regions as targets for deep brain stimulations, in order to explore the therapeutic promise of brain stimulation in obesity (AU)