Terson's syndrome after endoscopic removal of a colloid cyst.

An extremely rare complication of endoscopic colloid cyst removal is presented. Terson's syndrome related to endoscopic resection of a colloid cyst has been reported only twice before in the literature and it could be explained by intracranial hypertension related to rinsing during the procedure. The case is described and the complications in the neuroendoscopic removal of colloid cyst are reviewed from the literature.

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.

Symptomatic sacral Tarlov cyst: Case report and review of literature / Quiste de Tarlov sacro sintomatico: presentacion de un caso y revision de la literatura

Tarlov cysts are a common finding in MRI. Most of them are asymptomatic but in some cases can cause pain in urogenital region. Diagnosis and treatment are controversial and most of the symptomatic cases are not well diagnosed and treated because of unawareness of neurosurgeons about them. Treatment of symptomatic TC is effective and good results have been published with percutaneous and surgical techniques. A case of a young woman with a symptomatic sacral cyst treated surgically successfully is presented and literature about it is reviewed (AU)

Los quistes de Talov son un hallazgo frecuente en resonancia magnética. La mayoría de ellos son asintomáticos, pero en algunos casos pueden producir síntomas dolorosos urogenitales. El diagnóstico y el tratamiento de los quistes de Tarlov es controvertido y la mayoría de los casos sintomáticos no son diagnosticados adecuadamente debido a que el neurocirujano no es capaz de identificar el cuadro clínico. El tratamiento de los quistes de Tarlov sintomáticos es efectivo y se han publicado buenos resultados tanto con técnicas percutáneas como quirúrgicas. Se presenta el caso de una mujer joven con quiste de Tarlov sintomático intervenida quirúrgicamente con resolución de la clínica y se revisa la literatura publicada al respecto (AU)

Desarrollo de una solución integrada para pacientes con dolor crónico portadores de neuroestimulador en tiempos del COVID-19: una aplicación para móvil con centro de soporte / Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center

Introducción El dolor crónico es una de las afecciones más prevalentes en el mundo. El tratamiento con neuroestimuladores se realiza en los casos más extremos tras una cuidadosa selección, y demanda una gran inversión de recursos en su seguimiento. En estos momentos de pandemia por la COVID-19, presentamos una solución integrada para el seguimiento de estos de pacientes, que incluye el desarrollo de una aplicación para dispositivos móviles y un centro de soporte para seguimiento remoto (CSSR). Material y metodología El proyecto se ha desarrollado basándose en evidencia científica en las siguientes fases: 1) Aprobación de la idea en sesión clínica multidisciplinar de implantes para dolor crónico, 2) Formación de un grupo de expertos, 3) Adaptación del protocolo para el seguimiento de los pacientes con dolor crónico a las características del entorno de un smartphone, 4) Adaptación de la plataforma tecnológica al protocolo clínico (entorno tecnológico y flujo de trabajo entre el hospital y el CSSR) y 5) Evaluación de la calidad mediante encuesta (cuantitativa y cualitativa) con una pequeña muestra de pacientes. Resultados La aplicación de paciente se evaluó solicitando opiniones de los usuarios sobre el diseño y la utilidad de la misma entre los primeros pacientes implantados que la usaron. Se realizaron algunos ajustes menores en relación con el material para descargar, y sobre el texto y el color de la pantalla. Conclusiones El proceso de creación de una solución integrada debe estar basado en principios científicos y acorde con los protocolos establecidos. Un centro de soporte permite asegurar una mayor adherencia al seguimiento y una mejor atención a los pacientes (AU)

Introduction Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of COVID-19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MMaterial and methodology The project was developed according to the scientific evidence in the following phases: (1) approval in a multidisciplinary clinical committee of implants for chronic pain, (2) setting up a group of experts, (3) protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) quality evaluation by survey (quantitative and qualitative) of a small series of patients. Results The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. Conclusions Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care (AU)

[Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center]. / Desarrollo de una solución integrada para pacientes con dolor crónico portadores de neuroestimulador en tiempos del COVID-19: una aplicación para móvil con centro de soporte.

Introduction: Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of COVID-19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MMaterial and methodology: The project was developed according to the scientific evidence in the following phases: (1) approval in a multidisciplinary clinical committee of implants for chronic pain, (2) setting up a group of experts, (3) protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) quality evaluation by survey (quantitative and qualitative) of a small series of patients. Results: The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. Conclusions: Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care.

Brain lymphoma development related to a long lasting epidermoid cyst.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Development of an integrated solution for patients with neurostimulator for chronic pain in times of COVID-19: A mobile application with a support center.

INTRODUCTION: Chronic pain is one of the most prevalent pathologies in the world. Treatment with neurostimulators is carried out in the most extreme cases and requires a large investment of resources. In these times of the COVID19 pandemic, we present a comprehensive solution for monitoring this kind of patient, this solution includes the development of a mobile application and a support center for remote monitoring (SCRM). MATERIAL AND METHODOLOGY: The project was developed according to the scientific evidence in the following phases: (1) Approval in a multidisciplinary clinical committee of implants for chronic pain, (2) Setting up a group of experts, (3) Protocol adaptation for the follow-up of patients with chronic pain to the Smartphone environment, (4) Technology platform adaptation to the clinical protocol (technological environment and workflow between the hospital and the SCRM), and (5) Quality evaluation by survey (quantitative and qualitative) of a small series of patients. RESULTS: The application was evaluated by asking for user opinions about design and usefulness with the first implanted patients. Some minor adjustments were made concerning downloadable material and screen color and text. CONCLUSIONS: Developing a comprehensive solution should be based on scientific principles and in accordance with established protocols. A support center ensures greater adherence for follow-up and better patient care.

Brain lymphoma development related to a long lasting epidermoid cyst. / Desarrollo de un linfoma cerebral con relación a un quiste epidermoide de larga evolución.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal / Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring

Las fístulas espontáneas de líquido cefalorraquídeo (LCR) constituyen una entidad clínica relativamente frecuente en la práctica neuroquirúrgica. El tratamiento quirúrgico va encaminado al cierre del defecto y el porcentaje de recurrencias no es bajo. La asociación de fístula espontánea de LCR e hipertensión intracraneal idiopática (HII) es frecuente y posiblemente sea la causa de esta baja tasa de éxito. La semiología clínica de la HII asociada a la fístula espontánea de LCR no es típica, lo que hace que su diagnóstico pase a menudo desapercibido. La monitorización continua de la presión intracraneal permite diagnosticar situaciones de hipertensión intracraneal crónica en estos pacientes, por lo que su utilización es de extraordinaria utilidad a la hora de plantear alternativas terapéuticas

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients

[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring]. / Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal.

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients.

Estudio retrospectivo para evaluar la eficacia y la seguridad de la radiocirugía en enfermedad de Cushing: 24 casos y revisión / Retrospective analysis to evaluate efficacy and safety of stereotactic radiosurgery in Cushing's disease: 24 cases and a review

Introducción: En los últimos años la radiocirugía (RC) se ha postulado como una buena alternativa terapéutica, por lo general de segunda línea, en el manejo de los adenomas hipofisarios productores de ACTH. Se realiza un estudio retrospectivo para evaluar la eficacia y la seguridad de dicho tratamiento en estos pacientes. Material y métodos: Se recogieron datos de los pacientes tratados mediante RC por adenoma hipofisario productor de ACTH entre 1996 y 2008, con al menos un año de seguimiento, analizando la tasa de normalización hormonal y mejoría clínica (estigmas del síndrome de Cushing, hipertensión arterial), así como la aparición de efectos adversos y de recidiva. Se consideró normalización hormonal -y por tanto curación- como una tasa normal de cortisol libre urinario (CLU) en 24 h (< 100 μg/día). Resultados: Treinta pacientes fueron tratados, de los que 24 entraron en el estudio. Todos ellos tenían cifras elevadas de CLU previamente al tratamiento con RC. La curación se consiguió en 12 (50%), en un promedio de 28meses, y en otros 3 pacientes se normalizaron las cifras de CLU con tratamiento con ketoconazol posterior. En todos mejoraron los estigmas de Cushing, y en 13 (de 14) mejoró la HTA. No se evidenció ningún caso de recidiva una vez instaurada la curación. Entre las complicaciones destacan 9 déficits hormonales nuevos (siendo el más frecuente el hipotiroidismo), una radionecrosis y un empeoramiento de la campimetría previa. No se encontró ningún caso de tumor radioinducido. Conclusiones: La RC es un tratamiento efectivo para aquellos pacientes con adenoma productor de ACTH en que la cirugía ha fallado o que no son candidatos a la misma, consiguiéndose buenas tasas de normalización hormonal y de control clínico de la enfermedad, con un bajo porcentaje de efectos adversos

Background: In the past few years, stereotactic radiosurgery (SRS) has been suggested as a good alternative, second line therapy for the management of patients with ACTH-secreting pituitary adenomas. A retrospective study has been conducted in order to evaluate the efficacy and safety of this treatment in these patients. Material and methods: Data were collected on all patients treated with SRS for an ACTH-secreting pituitary adenoma between 1996 and 2008, and with at least one year of follow-up. An analysis was carried out by analysing the return to normal of the hormone levels and clinical improvement rates (including Cushing signs, arterial hypertension), as well as adverse effects, and disease relapse. A return to normal of the 24hour urinary free cortisol (24-UFC) levels (<100μg/day) without any ACTH-secretion suppressor drug treatment, was considered as cure or improvement. Results: A total of 30 patients were treated with SRS, of which 24 were included in the analysis. They all had high 24-UFC levels before the treatment. Cure was achieved in 12 (50%) in a mean of 28months, and in other 3 patients 24-UFC levels returned to normal with treatment with ketoconazole after the SRS. Cushing signs improved in all cases, as well as arterial hypertension in 13 out of 14 cases. There were relapses after cure consolidation. As far as adverse effects, it should be mentioned that there were 9 cases of new pituitary hormonal dysfunction (the most frequent being hypothyroidism), one radionecrosis, and one case of visual field defect impairment. Radiation-related neoplasm was not detected in any of the cases. Conclusions: SRS is an effective treatment for those patients with ACTH-secreting pituitary adenoma in whom surgery has failed, or in those that are not good candidates for it. It showed good rates of hormone levels returning to normal, as well as clinical disease control and a low level of adverse effects

[Retrospective analysis to evaluate efficacy and safety of stereotactic radiosurgery in Cushing's disease: 24 cases and a review]. / Estudio retrospectivo para evaluar la eficacia y la seguridad de la radiocirugía en enfermedad de Cushing: 24 casos y revisión.

BACKGROUND: In the past few years, stereotactic radiosurgery (SRS) has been suggested as a good alternative, second line therapy for the management of patients with ACTH-secreting pituitary adenomas. A retrospective study has been conducted in order to evaluate the efficacy and safety of this treatment in these patients. MATERIAL AND METHODS: Data were collected on all patients treated with SRS for an ACTH-secreting pituitary adenoma between 1996 and 2008, and with at least one year of follow-up. An analysis was carried out by analysing the return to normal of the hormone levels and clinical improvement rates (including Cushing signs, arterial hypertension), as well as adverse effects, and disease relapse. A return to normal of the 24 hour urinary free cortisol (24-UFC) levels (<100 µg/day) without any ACTH-secretion suppressor drug treatment, was considered as cure or improvement. RESULTS: A total of 30 patients were treated with SRS, of which 24 were included in the analysis. They all had high 24-UFC levels before the treatment. Cure was achieved in 12 (50%) in a mean of 28 months, and in other 3 patients 24-UFC levels returned to normal with treatment with ketoconazole after the SRS. Cushing signs improved in all cases, as well as arterial hypertension in 13 out of 14 cases. There were relapses after cure consolidation. As far as adverse effects, it should be mentioned that there were 9 cases of new pituitary hormonal dysfunction (the most frequent being hypothyroidism), one radionecrosis, and one case of visual field defect impairment. Radiation-related neoplasm was not detected in any of the cases. CONCLUSIONS: SRS is an effective treatment for those patients with ACTH-secreting pituitary adenoma in whom surgery has failed, or in those that are not good candidates for it. It showed good rates of hormone levels returning to normal, as well as clinical disease control and a low level of adverse effects.

Tratamiento microquirúrgico de los quistes aracnoideos intracraneales / Microsurgical treatment of intracraneal arachnoid cysts

Una de las principales opciones de tratamiento en quistes aracnoideos sintomáticos es la craneotomía con fenestración de membranas. Las principales ventajas de la cirugía abierta incluyen la inspección directa del quiste, la toma de muestra para biopsia, la posibilidad de fenestración en quistes multitabicados y, en ciertas localizaciones, la comunicación del quiste con las cisternas de la base. El objetivo de este trabajo es el de repasar las ventajas e inconvenientes de esta modalidad de tratamiento para quistes de diferentes localizaciones anatómicas

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations

[Microsurgical treatment of intracraneal arachnoid cysts]. / Tratamiento microquirúrgico de los quistes aracnoideos intracraneales.

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations.

Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna / Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri

Objetivo: Evaluar la utilidad del análisis del registro de presión intracraneal (PIC) en el diagnóstico de la hipertensión intracraneal benigna (HIB). Material y métodos: Diez pacientes con sospecha clínica de HIB en los que no se cumplen por completo los criterios diagnósticos. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de la PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6meses de la intervención. Resultados: Todos los pacientes fueron mujeres jóvenes. La PIC media no fue superior a los 250 mmH2O en 5 de los 8 pacientes con registros patológicos. El análisis morfológico del trazado evidencia ondas A en un porcentaje elevado de pacientes (62,5%), correlacionándose en general con PIC media más elevada, aunque esta situación no se correspondió de forma sistemática con presencia de papiledema. Las ondas B de alta amplitud estuvieron presentes en todos los registros. La amplitud del registro fue superior a 5mmHg en la mayoría de los casos considerados patológicos. Todos los pacientes tratados conforme a los criterios de monitorización de PIC experimentaron mejoría tras la intervención. No hubo complicaciones relacionadas con el procedimiento de monitorización. Conclusiones: Los datos clínicos y de exploración son en ocasiones insuficientes para establecer el diagnóstico de HIB, especialmente en los casos en que el paciente ha sido tratado médica o quirúrgicamente con anterioridad. La monitorización de la PIC es un método seguro y fiable, útil en el diagnóstico de esta entidad. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta a la derivación. La amplitud del trazado expresa la complianza cerebral y es un dato relacionado también con respuesta a la derivación

Objectives. To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). Material and methods: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6months after surgery. Results: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. Conclusions: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well

Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución / Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults

Objetivo: Evaluar la utilidad del análisis del registro de la presión intracraneal (PIC) en el manejo de pacientes con marcada ventriculomegalia de larga evolución. Material y métodos: Veintidós pacientes con ventriculomegalia radiológica y clínica neurológica. Se recogen los datos demográficos, clínicos y radiológicos, así como los datos de monitorización de PIC y las complicaciones relacionadas con el procedimiento. Se evalúan resultados clínicos a los 6 meses de la intervención. Resultados: Las edades oscilaron entre los 20 y los 70 años, con una media de 44 años. El síntoma de consulta más frecuente fue la cefalea. Los índices de Evans oscilaron entre 0,35 y 0,66, con una media de 0,47. El 55% asociaban estenosis de acueducto de Silvio. La PIC media fue superior a 12 mmHg en solo el 9% de los pacientes, en tanto que el análisis morfológico de los trazados catalogó al 64% de los mismos como patológicos. El análisis morfológico del trazado evidencia ondas A premeseta en 7 pacientes y ondas B en 20 pacientes (14 de ellos con ondas B de alta amplitud). Se consideraron patológicos y por tanto candidatos a cirugía a 14 pacientes, de los que 12 aceptaron la intervención (derivación de líquido cefalorraquídeo o ventriculostomía). El 70% de ellos habían experimentado mejoría a los 6 meses. No hubo complicaciones relacionadas con la monitorización. Conclusiones: La monitorización de la PIC es un método seguro y fiable, útil en el manejo de esta entidad, que permite seleccionar los pacientes candidatos a cirugía. Es imprescindible un análisis morfológico del trazado, ya que la PIC media es un dato de escasa utilidad, en tanto que la presencia de ondas A y B de alta amplitud se relaciona con una buena respuesta al shunt

Objectives: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. Material and methods: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. Results: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. 'Pre-plateau' A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. Conclusions: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response

Costes del tratamiento endovascular frente al quirúrgico en hemorragia subaracnoidea aneurismática / Endovascular versus surgical treatment in subarachnoid haemorrhage: Cost analysis

Objetivo: Evaluar los costes derivados del tratamiento quirúrgico y endovascular de una serie consecutiva de 80 pacientes con hemorragia subaracnoidea aneurismática (HSAa). Material y métodos: Se revisan 80 pacientes ingresados en nuestro centro con HSA aneurismática que recibieron tratamiento endovascular (EV) (n = 57) o quirúrgico (Q) (n = 23) entre enero de 2010 y junio de 2011. Se analizan datos demográficos (edad y sexo), clínicos (Fischer y Hunt-Hess al ingreso) y los resultados (GOS a los 6 meses) de ambas series. Se registra estancia hospitalaria (UCI y planta), coste del tratamiento (número de coils, catéteres, craneotomía…), del seguimiento (arteriografías de control, angio-RMN) y de los retratamientos de cada una de las técnicas. Se calculan los costes según los precios medios estimados de hospitalización, material fungible y procedimientos. Resultados: No hay grandes diferencias entre ambas series en cuanto a características clínicas (edad, Hunt-Hess y Fischer) ni a los resultados a los 6 meses medidos en la escala GOS. Existen diferencias en cuanto al tiempo de hospitalización tanto en UCI (superior en algo más de 1,4 días en el grupo Q) como en planta (1,7 días más). La hospitalización también se relaciona con la edad, la puntuación de Hunt-Hess y la de Fischer. Los gastos derivados de los materiales de embolización, del seguimiento y de los retratamientos (un 12% de la serie EV) hace que el coste global tratamiento endovascular sea un 4,1% más caro que el quirúrgico (35.835 Euros versus 34.404 Euros). El procedimiento endovascular en sí, incluyendo los retratamientos resulta un 110% más caro que el quirúrgico (8.015 Euros versus 3.817 Euros). Conclusiones: Los resultados en cuanto a morbimortalidad obtenidos mediante tratamiento quirúrgico o embolizador no son diferentes. La estabilidad del tratamiento quirúrgico es superior al del endovascular, con mayores tasas de oclusión y menor necesidad de retratamiento. El tratamiento endovascular resulta más caro que el quirúrgico en aneurismas rotos, fundamentalmente debido al precio de los materiales de embolización, a la tasa de retratamientos y al seguimiento que precisan. Estas diferencias podrían ser aún más significativas en el caso de aneurismas no rotos, en los que se presupone un ingreso hospitalario menor, fuente principal del gasto en el tratamiento quirúrgico de esta patología

Objectives: To analyse costs of endovascular versus surgical treatment in 80 patients with aneurysmal subarachnoid haemorrhage (aSAH). Material and methods: We analysed data on 80 consecutive patients with aSAH between January 2010 and June 2011. Endovascular treatment was used in 57 patients and surgical in 23 patients. Demographic (gender and age) and clinical data (Hunt-Hess and Fisher scales), length of stay (ICU and ward) and results at 6 months (Glasgow outcome scale, [GOS]) were collected. Costs including stay, follow-up, complications and retreatments were calculated. Results: Age was higher in the endovascular group (statistically significant). There were no differences between the 2 groups in Hunt-Hess and Fisher scales. Results at 6 months were also similar, although slightly better in the surgical group. Length of stay was longer in surgical patients, both in ICU (mean 1.4 days) and ward (1.7 days). Hospitalisation length was also related to age and Hunt-Hess and Fisher scales. Costs from embolisation devices, follow-up and retreatment (12% in this series) made final endovascular treatment 4.1% more expensive than surgical treatment (Euros 35,835 versus Euros 34,404). Endovascular procedure (including retreatments) was 110% more expensive than surgical treatment (Euros 8,015 versus Euros 3,817). Conclusions: There are no differences between the 2 treatments in terms of morbidity and mortality. Stability of surgical treatment was higher than that of endovascular, with better occlusion and lower retreatment rates. Endovascular treatment is more expensive in ruptured aneurysms, principally due to embolisation device costs, long-term follow-up and retreatments, in retreatments, in spite of shorter hospital stay. In incidental aneurysms, which usually need shorter hospitalisation, differences between the 2 treatments could be even larger

[Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri]. / Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna.

OBJECTIVES: To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). MATERIAL AND METHODS: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6 months after surgery. RESULTS: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. CONCLUSIONS: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well.

[Endovascular versus surgical treatment in subarachnoid haemorrhage: Cost analysis]. / Costes del tratamiento endovascular frente al quirúrgico en hemorragia subaracnoidea aneurismática.

OBJECTIVES: To analyse costs of endovascular versus surgical treatment in 80 patients with aneurysmal subarachnoid haemorrhage (aSAH). MATERIAL AND METHODS: We analysed data on 80 consecutive patients with aSAH between January 2010 and June 2011. Endovascular treatment was used in 57 patients and surgical in 23 patients. Demographic (gender and age) and clinical data (Hunt-Hess and Fisher scales), length of stay (ICU and ward) and results at 6 months (Glasgow outcome scale,[GOS]) were collected. Costs including stay, follow-up, complications and retreatments were calculated. RESULTS: Age was higher in the endovascular group (statistically significant). There were no differences between the 2 groups in Hunt-Hess and Fisher scales. Results at 6 months were also similar, although slightly better in the surgical group. Length of stay was longer in surgical patients, both in ICU (mean 1.4 days) and ward (1.7 days). Hospitalisation length was also related to age and Hunt-Hess and Fisher scales. Costs from embolisation devices, follow-up and retreatment (12% in this series) made final endovascular treatment 4.1% more expensive than surgical treatment (€35,835 versus €34,404). Endovascular procedure (including retreatments) was 110% more expensive than surgical treatment (€8,015 versus €3,817). CONCLUSIONS: There are no differences between the 2 treatments in terms of morbidity and mortality. Stability of surgical treatment was higher than that of endovascular, with better occlusion and lower retreatment rates. Endovascular treatment is more expensive in ruptured aneurysms, principally due to embolisation device costs, long-term follow-up and retreatments, in retreatments, in spite of shorter hospital stay. In incidental aneurysms, which usually need shorter hospitalisation, differences between the 2 treatments could be even larger.