Respiratory physiotherapy as a tool to allow and optimize lung donation.

Lung donation is complex and sometimes the secretion retention makes it impossible. We report a case of a patient that was screened as potential lung donor with PaO2/FiO2 ratio below range. As in viable patients, the respiratory physiotherapist applied a ventilator-based group of techniques with removal of huge amount of secretions and consequent increase in the PaO2/FiO2 ratio that allowed the inclusion of the patient as potentially lung donor. The protocol was applied until the extraction day, with successful extraction and transplantation. We believe that respiratory physiotherapy could have a potential role in increasing lung viability.

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

OBJECTIVES: The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN: This was an observational retrospective study. SETTINGS: A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS: A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS: More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS: Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

Rapid chest compression effects on intracranial pressure in patients with acute cerebral injury.

BACKGROUND: Patients with acute brain injury often require invasive mechanical ventilation, increasing the risk of developing complications such as respiratory secretions retention. Rapid chest compression is a manual chest physiotherapy technique that aims to improve clearance of secretions in these patients. However, the rapid chest compression technique has been suggested to be associated with increased intracranial pressure in patients with acute brain injury. The aim of this work is to elucidate the effects of the technique on intracranial pressure in mechanically ventilated patients with acute brain injury. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied. METHODS: Randomized clinical trial, double-blinded. Patients with acute brain injury on invasive mechanical ventilation > 48 h will be included and randomized in two groups. In the control group, a technique of passive hallux mobilization will be applied, and in the intervention group, it will be performed using the rapid chest compression technique. Intracranial pressure (main variable) will be collected with an intracranial pressure monitoring system placed at the lateral ventricles (Integra Camino). DISCUSSION: The safety of chest physiotherapy techniques in patients at risk of intracranial hyperpressure is still uncertain. The aim of this study is to identify if the rapid manual chest compression technique is safe in ventilated patients with acute brain injury. TRIAL REGISTRATION: NCT03609866 . Registered on 08/01/2018.

Parkinson's Disease Symptoms Associated with Developing On-State Axial Symptoms Early after Subthalamic Deep Brain Stimulation.

Background: The relationship between axial symptoms in Parkinson's disease (PD) and subthalamic deep brain stimulation (STN-DBS) is still unclear. Purpose: We searched for particular clinical characteristics before STN-DBS linked to on-state axial problems after surgery. Methods: We retrospectively analyzed baseline motor, emotional and cognitive features from PD patients with early axial symptoms (within 4 years after STN-DBS) and late axial symptoms (after 4 years). We also considered a group of PD patients without axial symptoms for at least 4 years after surgery. Results: At baseline, early-axial PD patients (n = 28) had a higher on-state Unified Parkinson's Disease Rating Scale III (15.0 ± 5.6 to 11.6 ± 6.2, p = 0.020), higher axial score (2.4 ± 1.8 to 0.7 ± 1.0, p < 0.001) and worse dopaminergic response (0.62 ± 0.12 to 0.70 ± 0.11, p = 0.005), than non-axial PD patients (n = 51). Early-axial PD patients had short-term recall impairment, not seen in non-axial PD (36.3 ± 7.6 to 40.3 ± 9.3, p = 0.041). These variables were similar between late-axial PD (n = 18) and non-axial PD, but late-axial PD showed worse frontal dysfunction. Conclusions: PD patients with early axial symptoms after DBS may have a significantly worse presurgical motor phenotype, poorer dopaminergic response and memory impairment. This may correspond to a more severe form of PD.

Cystic paraganglioma of the filum terminale / Paraganglioma quístico del filum terminal

Spinal Paragangliomas are rare tumors, most frequently involving the cauda equina and the filum terminale. We report the case of a 62-year old woman presenting with a one month's lower back pain, left sciatica and leg weakness. Spinal magnetic resonance imaging showed a extramedullary lesion at L3-L4 level, measuring 37 x 52 x 21 mm with contrast enhancement. It presented an unenhancing intradural cystic lesion in the upper pole. The patient underwent lumbar laminectomy, and with neurofisiologic monitorization the tumor was completely resected. Microscopic examination of the tumor revealed a paraganglioma. In a review of the literature, we found only five previous reported cases in which the tumor is accompanied by a cyst.

Los paragangliomas son tumores poco frecuentes que se localizan en la región de la cauda equina y filum terminal. Presentamos el caso de una mujer de 62 años con una historia de 1 mes de evolución de lumbalgia, ciática y debilidad en el miembro inferior izquierdo. Una resonancia magnética lumbar mostró una tumoración extramedular en el nivel L3-L4 que medía 37 x 52 x 21 mm que se realzaba con contraste. Presentaba así mismo una lesión quística en el polo superior del tumor. Se realizó una laminectomía lumbar y bajo control neurofisiológico se realizó una extirpación completa el tumor. El estudio microscópico revelo que se trataba de un paraganglioma. Realizamos una revisión de la literatura encontrando únicamente otros cinco casos de paraganglioma espinal con lesión quística acompañante

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain.

OBJECTIVE: To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. SETTINGS: The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. PARTICIPANTS: This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. INTERVENTIONS: An exploratory factorial analysis was performed to select the most relevant variables of the sample. PRIMARY AND SECONDARY OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. RESULTS: Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. CONCLUSIONS: Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality. TRIAL REGISTRATION NUMBER: CEIM 20/217.

Regresión espontánea de quiste coloide de tercer ventrículo en paciente pediátrica / Spontaneous resolution of colloid cyst of the third ventricle in a pediatric patient

Los quistes coloides son lesiones intracraneales benignas localizadas mayoritariamente en el III ventrículo en la región de los agujeros de Monro. La mayoría se presentan entre la tercera y cuartas décadas de la vida, y son poco frecuentes por debajo de los 10 años. Presentamos el caso de una niña de 2,5 años que presentaba un quiste coloide incidental que fue seguido de manera conservadora, observándose en los estudios de resonancia magnética una progresiva regresión en su tamaño. Realizamos una revisión de los 4 casos similares publicados con anterioridad (AU)

Colloid cyst are benign intracranial lesions located in the III ventricle in the region of the foramen of Monro. The majority present in the third and fourth decades of life and are rare under the age of ten. We report a case of an incidentally colloid cyst presented in a 2.5 -years-old girl who was managed conservatively; follow-up with MRI showed a progressive reduction in size. We review the four similar case previously reported (AU)

Neumoencéfalo a tensión, una extraña complicación del uso de oxígeno en neonatos. Descripción de un caso y revisión de la literatura / Tension pneumocephalus, an uncommon complication of oxygen therapy in preterm newborns. Presentation of a case and literature review

El neumoencéfalo a tensión es una complicación extremadamente rara en el uso de la ventilación a presión positiva en el neonato, cuyo diagnóstico requiere un alto grado de sospecha clínica. Presentamos el caso de un recién nacido prematuro, que recibió oxígeno a través de cánulas nasales de alto flujo debido a enfermedad de membrana hialina, propia de su prematuridad, y que desarrolló signos clínicos de hipertensión intracraneal. La ecografía transfontanelar y la TAC craneal pusieron de manifiesto un importante neumoencéfalo a tensión que fue evacuado a través de punción directa a través de la fontanela anterior (AU)

Tension pneumocephalus is an extremely rare complication of positive-pressure ventilation in neonates, the diagnosis of which requires a high degree of clinical suspicion. We present the case of a preterm newborn, who received high-flow nasal cannula oxygen therapy because of hyaline membrane disease, due to his prematurity, and developed clinical signs of intracranial hypertension. Transfontanellar ultrasound and cranial CT scan revealed significant tension pneumocephalus, which was evacuated with direct needle puncture through the anterior fontanelle (AU)

Tension pneumocephalus, an uncommon complication of oxygen therapy in preterm newborns. Presentation of a case and literature review. / Neumoencéfalo a tensión, una extraña complicación del uso de oxígeno en neonatos. Descripción de un caso y revisión de la literatura.

Tension pneumocephalus is an extremely rare complication of positive-pressure ventilation in neonates, the diagnosis of which requires a high degree of clinical suspicion. We present the case of a preterm newborn, who received high-flow nasal cannula oxygen therapy because of hyaline membrane disease, due to his prematurity, and developed clinical signs of intracranial hypertension. Transfontanellar ultrasound and cranial CT scan revealed significant tension pneumocephalus, which was evacuated with direct needle puncture through the anterior fontanelle.

Spontaneous resolution of colloid cyst of the third ventricle in a pediatric patient. / Regresión espontánea de quiste coloide de tercer ventrículo en paciente pediátrica.

Colloid cyst are benign intracranial lesions located in the III ventricle in the region of the foramen of Monro. The majority present in the third and fourth decades of life and are rare under the age of ten. We report a case of an incidentally colloid cyst presented in a 2.5 -years-old girl who was managed conservatively; follow-up with MRI showed a progressive reduction in size. We review the four similar case previously reported.

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

No disponible

Quistes aracnoideos espinales y neurocirugía / Spinal arachnoid cyst and neurosurgery

No disponible

Baclofeno intratecal para el tratamiento de la espasticidad: revisión de los casos presentes tratados en nuestro servicio / Intrathecal baclofen as a treatment for spasticity: Review of the cases treated in our hospital

Introducción: La espasticidad representa un problema médico cuya incidencia está aumentando debido a enfermedades como parálisis cerebral, ictus, esclerosis múltiple, traumatismos o encefalopatías, afectando tanto a adultos como a niños. Los tratamientos incluyen rehabilitación, farmacoterapia y cirugía, entre las cuales destacamos las bombas de baclofeno intratecal. Material y métodos: Seleccionamos a los pacientes portadores de bomba de baclofeno intratecal implantada en el Hospital Clínico de Santiago de Compostela entre 2005-2018 y analizamos retrospectivamente los resultados mediante escalas de valoración de espasticidad, como la de Ashworth, así como las complicaciones observadas. Resultados: Se implantaron bombas de baclofeno a 17 pacientes, obteniendo una mejoría de 2 puntos en la escala de Ashworth en el 88,2% y de 1 punto en la escala de Penn en el 94%. Se observaron complicaciones en 3 pacientes. Conclusiones: El tratamiento con baclofeno intratecal es una técnica sencilla con resultados muy positivos para mejorar la calidad de vida de pacientes con espasticidad

Introduction: Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy, stroke, multiple sclerosis, trauma or encephalopathy, affecting both adults and children. The treatments include rehabilitation, pharmacotherapy and surgery, among which we highlight intrathecal baclofen infusion devices. Material and methods: Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales, such as Ashworth scale. Complications are described. Results: Surgery was performed in 17 patients for baclofen pump implant, achieving an improvement of 2 points on the Ashworth Scale in 88,2% of the patients and of 1 point on the Penn Scale in 94%. Complications were seen in 3 patients. Conclusions: Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity

A1 asynchrony, a potential risk factor for the rupture of anterior communicating artery aneurysms: A computational fluid dynamics study / Asincronía de A1, un factor de riesgo potencial para la rotura de aneurismas de la arteria comunicante anterior: un estudio de dinámica de fluidos computacional

Introduction and objectives: The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms. Materials and methods: From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured. Results: The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA. Conclusions: In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location

Introducción y objetivos: El complejo comunicante anterior es una de las localizaciones más frecuentes para el desarrollo de aneurismas; recibe sangre de ambas circulaciones carotídeas y el efecto de la sincronía en la llegada de sangre no ha sido estudiado previamente. El objetivo de este estudio es comparar las condiciones de asincronía del pulso de A1 y sus efectos en las condiciones hemodinámicas de los aneurismas de la arteria comunicante anterior (ACoA). Materiales y métodos: Desde 2008 hasta 2017, 54 aneurismas de la ACoA tratados en nuestro centro se incluyeron en el estudio. Se emplearon técnicas de dinámica de fluidos computacional y las simulaciones consistieron en condiciones de completa sincronía y en la introducción de un retraso de 0,2s en la arteria A1 no dominante. Se realizaron mediciones del TAWSS, área de bajo cizallamiento (LSA), diámetros de A1 y ángulos de la AcoA. Resultados: La diferencia producida en el LSA en condiciones de sincronía y asincronía resultó en un amplio rango de valores positivos y negativos. El índice de simetría (p=0,04) y el ángulo A1/A2 en la arteria dominante (p=0,04) se relacionan con los cambios en el LSA. Conclusiones: En asincronía, el LSA se incrementó en ausencia de asimetría A1 y ángulos A1/A2 menores, incrementando potencialmente el riesgo de rotura de aneurismas en esta localización

A1 asynchrony, a potential risk factor for the rupture of anterior communicating artery aneurysms: A computational fluid dynamics study.

INTRODUCTION AND OBJECTIVES: The anterior communicating complex is one the most common locations for aneurysm development. It receives blood from both carotid circulations and the effect of synchrony on the arrival of blood flow has not been previously studied. The objective of this study was to compare the asynchrony conditions of the A1 pulse and its effects on the haemodynamic conditions of anterior communicating artery (ACoA) aneurysms. MATERIALS AND METHODS: From 2008 to 2017, 54 anterior communicating artery aneurysms treated at our centre were included in the study. Computational fluid dynamics (CFD) techniques were employed and simulations consisted of complete conditions of synchrony and introducing a delay of 0.2s in the non-dominant A1 artery. Time-averaged wall shear stress (TAWSS), low shear area (LSA), A1 diameter and ACoA angles were measured. RESULTS: The difference in the LSA in conditions of synchrony and asynchrony resulted in a broad range of positive and negative values. The symmetry index (p=0.04) and A1/A2 angle on the dominant artery (p=0.04) were associated with changes in LSA. CONCLUSIONS: In asynchrony, LSA increased in the absence of A1 asymmetry and low A1/A2 angles, potentially increasing the risk of aneurysm rupture in this location.

Intrathecal baclofen as a treatment for spasticity: Review of the cases treated in our hospital. / Baclofeno intratecal para el tratamiento de la espasticidad: revisión de los casos presentes tratados en nuestro servicio.

INTRODUCTION: Spasticity represents a medical problem whose incidence is increasing during the last years due to pathologies such as cerebral palsy, stroke, multiple sclerosis, trauma or encephalopathy, affecting both adults and children. The treatments include rehabilitation, pharmacotherapy and surgery, among which we highlight intrathecal baclofen infusion devices. MATERIAL AND METHODS: Intrathecal baclofen devices implanted patients in Clinical Hospital of Santiago de Compostela from 2005 to 2018 were selected for retrospective analysis using assessment of spasticity scales, such as Ashworth scale. Complications are described. RESULTS: Surgery was performed in 17 patients for baclofen pump implant, achieving an improvement of 2 points on the Ashworth Scale in 88,2% of the patients and of 1 point on the Penn Scale in 94%. Complications were seen in 3 patients. CONCLUSIONS: Intrathecal baclofen is a simple technique with good results for improving the quality of life of patients with spasticity.

Continuous subcutaneous apomorphine in advanced Parkinson's disease patients treated with deep brain stimulation.

INTRODUCTION: Deep brain stimulation (DBS) is an effective therapy for patients with advanced Parkinson's disease (PD). However, sometimes, it is not sufficient to adequately control motor symptoms. We describe our experience with continuous subcutaneous apomorphine infusion (APO) in patients with DBS. METHODS: We undertook a retrospective analysis of all patients treated with DBS and APO at our centre over 12 years. Subjects were allocated to four groups: (1) APO temporarily before DBS, (2) APO after DBS complications before a new DBS, (3) APO after definitive DBS removal, and (4) APO in patients with DBS and declining response. Motor state and other parameters were analysed and compared for the different treatments. RESULTS: Data for 71 patients were evaluated. Group 1: (n = 18) patients improved their motor function significantly with both APO and DBS (off-hours before APO 5.4 ± 1.4; after APO 1.4 ± 1.2, p > 0.001; after DBS 0.7 ± 0.8, p < 0.001). Group 2: (n = 11) patients were found to have mild but significant worsening of motor state between the first DBS treatment (off-hours 0.7 ± 1.0) and APO (2.2 ± 1.5, p = 0.02), and improvement between APO and the second DBS treatment (off-hours 0.6 ± 0.8, p = 0.03). Group 3: (n = 12) patients had mild but significant worsening of motor function between DBS (off-hours 1.1 ± 1.0) and APO (2.0 ± 0.9, p = 0.03). Group 4: (n = 13) significant improvement in motor function was observed between DBS alone (off-hours 3.9 ± 2.6) and DBS combined with APO (2.2 ± 1.3, p = 0.03). CONCLUSION: In advanced PD, DBS may be not sufficient or may fail to control motor symptoms adequately. In these cases, APO, whether alone or in combination with DBS, is a good choice to improve the disease control.