Nuevo nomenclátor estandarizado de Neurocirugía: criterios e indicadores cuantitativos y cualitativos de baremación de actos médicos / A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures

Objetivos: Actualizar el nomenclátor de actos médicos de la especialidad de Neurocirugía, eliminando actos en desuso y añadiendo las nuevas técnicas quirúrgicas desarrolladas en los últimos años, para que se adapte fielmente a la práctica médica habitual de nuestra especialidad, así como establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración. Material y método: La elaboración del nuevo nomenclátor se dividió en 3 fases: 1) identificación y selección de los actos médicos, 2) establecimiento del grado de dificultad de cada uno de ellos basado en la experiencia y el tiempo necesarios para su realización, así como el porcentaje y gravedad de las posibles complicaciones y 3) consenso con los miembros de la SENEC mediante su envío individualizado, realizando los retoques necesarios y posterior aprobación en asamblea de la especialidad. Resultados: El nuevo nomenclátor cuenta con 255 actos médicos agrupados en 4 grupos: consultas y visitas, actos terapéuticos, procedimientos diagnósticos e intervenciones quirúrgicas. Se han eliminado 42 procedimientos recogidos en el nomenclátor de la OMC por obsoletos, no ser propios de la especialidad o resultar demasiado vagos. Se han introducido nuevas técnicas y se han definido de forma más precisa los actos médicos. Conclusiones: Este nomenclátor proporciona una terminología actualizada y servirá para ofertar la cartera de servicios, medir y conocer el valor relativo de nuestra actividad y de los costes aproximados de los procedimientos, y adicionalmente, para realizar estudios comparativos longitudinales. Debe constituir una herramienta para mejorar la atención de los pacientes y minimizar la variabilidad geográfica en todos los ámbitos asistenciales.(AU)

Purpose: Update the list of medical acts in the specialty of neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. Material and method: The elaboration of the new nomenclator was divided into three phases: (1) identification and selection of medical acts, (2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and (3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. Results: The new nomenclator has 255 medical acts grouped into four groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. Forty-two procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. Conclusions: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimize geographic variability in all healthcare settings.(AU)

A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures.

PURPOSE: Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. METHODS: The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. RESULTS: The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. CONCLUSIONS: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.

Extradural minipterional approach: Evolving indications of the minipterional craniotomy.

BACKGROUND: In this paper, we report a clinical series of skull base lesions operated on trough the MiniPT, extending its application to skull base lesions, either using the classical minipterional or a variant, we call extradural minipterional approach (MiniPTEx). METHODS: We describe our surgical technique of operating on complex skull base lesions using a minipterional extradural approach. Anterior clinoidectomy, middle fossa peeling, transcavernous, and Kawase approaches were performed as needed. In total, we carried out 24 surgeries: three skull base tumors, 1 Moyamoya case, and 20 giant/complex intracranial aneurysms. All the patients present good neurological result (mRs < 3). Only two patients had paralysis of any cranial nerve and only one patient had a mild hemiparesis. RESULTS: This surgery series there are 24 cases, 10 patients were treated with exclusive MiniPT. MiniPT extradural approach was made in 14 patients. Twelve were treated using pure MiniPTEx approach, 1 patient using transcavernous approach, and in 1 patient, the anterior clinoid was resected with the combination of a MiniPT, a medium fossa peeling, and the Kawase anterior petrosectomy for skull base surgery. CONCLUSION: We further advance the indications of the MiniPT by extending it to operate on the cranial base tumors or complex vascular lesions without additional morbidity. MiniPT approach may be safely associated with skull base techniques, including anterior and posterior clinoidectomies, peeling of the middle fossa, transcavernous approach, and anterior petrosectomy. The versatility of the MiniPT craniotomy and the feasibility of performing skull base surgery through the MiniPT technique have been demonstrated in this paper.

Low-grade malignant triton tumor in the lumbar spine: a rare variant of malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation.

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon type of sarcoma that arises from peripheral nerve sheaths and rarely involves the spinal roots. The origin of this tumor is thought to be Schwann cells or pluripotent cells of the neural crest. The subgroup of tumors in which malignant Schwann cells coexist with malignant rhabdomyoblasts is termed malignant triton tumor (MTT). MPNSTs can show different degrees of malignancy, but overall spinal MTTs are high-grade lesions. We report the exceptional instance of a spinal low-grade MTT in a 39-year-old man treated with total surgical removal followed by local radiation therapy. Histological low grade was based on the lack of necrosis, a low grade of atypia, a low mitotic rate and a Ki-67 labelling index <25%. After 18 months of follow-up the patient is alive with no evidence of disease. A thorough review of the literature yielded 57 well-documented spinal MPNSTs. Ten of them corresponded to MTTs, but none showed low-grade features. An analysis of the clinical, radiological and treatment data was performed to identify factors that might influence the outcome. Overall the 18-month survival rate was 45% but dropped to 0% in the subgroup of spinal MTTs. Besides, a size exceeding 2 cm, extra-spinal extension, association with neurofibromatosis and subtotal removal were all related to a worse outcome. In conclusion, spinal MTTs generally exhibit a more aggressive behavior than conventional MPNSTs. The occurrence of a spinal low-grade MTT with a better prognosis should also be recognized.

Endovascular treatment of a vertebral artery pseudoaneurysm following posterior C1-C2 transarticular screw fixation.

We present a case of vertebral artery pseudoaneurysm after a posterior C1-C2 transarticular screw fixation procedure that was effectively treated with endovascular coil occlusion. Vertebral artery pseudoaneurysm complicating posterior C1-C2 transarticular fixation is extremely rare, with only one previous case having been reported previously. Endovascular occlusion is better achieved in the subacute phase of the pseudoaneurysm, when the wall of the pseudoaneurysm has matured and stabilized. Further follow-up angiographies are mandatory in order to confirm that there is no recurrence of the lesion.