Tic convulsivo doloroso como manifestación de dolicoestasia y aneurisma vertebrobasilar / Painful tic convulsif as manifestation of vertebrobasilar dolichoectasia and aneurysm

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Cirugía reparadora de la parálisis facial mediante colgajo libre microvascularizado de músculo gracilis / Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy

Introducción/objetivos: La transferencia de colgajo libre muscular microneurovascular es actualmente el procedimiento de elección para la parálisis facial de larga evolución. Presentamos una serie de casos de pacientes tratados con colgajo libre de músculo gracilis con inervación motora por el nervio maseterino. Se analiza la técnica quirúrgica y cuantificamos el movimiento otorgado por el músculo, así como la mejoría en la calidad de vida y los resultados estéticos obtenidos. Materiales y métodos: Se analizan 10 pacientes con parálisis facial unilateral, quienes fueron intervenidos con colgajo muscular libre gracilis, durante los años 2010 y 2012 en 2 centros hospitalarios de tercer nivel. Resultados: No encontramos fallo de la microsutura con supervivencia de todos los colgajos realizados. El movimiento muscular se cuantificó mediante vectores en reposo y contracción, con un promedio de 1,7 cm, se inició aproximadamente hacia el cuarto mes después de la intervención. Se demuestra también una mejoría significativa de la simetría en reposo, así como de la competencia oral y ocular. Conclusiones: Como se presenta actualmente en la literatura los colgajos libres microvascularizados son la técnica de elección para la reanimación facial. En nuestra experiencia consideramos que el colgajo con músculo gracilis inervado por el nervio maseterino es una técnica fiable y segura, que ofrece adecuados resultados tanto funcionales como estéticos (AU)

Introduction and objectives: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. Materials and methods: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. Results: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. Conclusion: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results (AU)

Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy.

INTRODUCTION AND OBJECTIVES: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. MATERIALS AND METHODS: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. RESULTS: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. CONCLUSION: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results.

Resultados en el tratamiento quirúrgico de los neurinomas del acústico gigantes / Results in the surgical treatment of giant acoustic neuromas

Introducción y objetivos: Comparar los resultados obtenidos en la resección de 21 schwanomas vestibulares gigantes, mediante vía retrosigmoidea y combinada retrosigmoidea/translaberíntica en cuanto a complicaciones intra y postoperatorias, preservación del nervio facial y secuelas posquirúrgicas. Métodos: Se realiza un estudio retrospectivo de 21 pacientes a los que se practicó resección de neurinoma vestibular gigante según la escala de Tos & Thomsen (igual o mayor a 4cm), en un hospital de tercer nivel en el periodo entre 2000 y 2008. Se presentan las características más significativas de la serie estudiada, y se analizan las ventajas e inconvenientes de los distintos abordajes, comparando los resultados obtenidos. Asimismo, se analizan los resultados en cuanto a la preservación de la función del nervio facial. Resultados: Destaca la ausencia de mortalidad en el grupo de 21 pacientes estudiado. No hubo complicaciones intraoperatorias importantes. Se consiguió la resección total de la lesión en el 87% de los casos, con una preservación anatómica del nervio facial del 73% en el abordaje combinado retrosigmoideo/translaberíntico, respecto a un 40% en el retrosigmoideo. La función del nervio facial a los dos años fue aceptable o buena en un 67% (incluyendo los resultados de las anastomosis heteronerviosas). Se observó un porcentaje global del 14,3% de fístula de líquido cefalorraquídeo y un 9,5% de meningitis. Conclusiones: nuestros resultados demuestran que el abordaje combinado retrosigmoideo translaberíntico para el tratamiento de schwannomas gigantes ofrece mayor preservación del nervio facial y disminución de la morbilidad, siendo una importante opción en el tratamiento de estos tumores, gracias a un enfoque multidisciplinar(AU)

Introduction and objectives: To compare the results obtained in the resection of 21 giant vestibular schwannomas via retrosigmoid (RS) and combined retrosigmoid/translabyrinthine (RS/TL) approaches with respect to intra- and postoperative complications, facial nerve preservation and postsurgical sequelae. Methods: This was a retrospective study of 21 patients who underwent a resection of a giant vestibular neuroma according to the Tos & Thomsen Scale (greater than or equal to 4 centimetres) in a tertiary care centre in the period between 2000 and 2008. We present the most significant characteristics of the series studied and the analysis of the advantages and inconveniences of each approach. We also analyse the results regarding facial nerve function preservation. Results: We highlight the absence of mortality in the 21-patient group. There were no important intraoperative complications. Total resection of the lesion was achieved in the 87% of the cases, with facial nerve preservation of 73% using the combined RS/TL approach, in comparison to 40% using the RS. Facial nerve function after two years was acceptable or good in 67% (including those with heteronerve anastomosis). A global percentage of 14.3% of cerebrospinal liquid fistula was observed, as well as 9.5% of meningitis. Conclusions: The results of the study demonstrate that the combined retrosigmoid translabyrinthine approach for giant schwannoma treatment offers increased facial nerve preservation and lower morbidity, constituting an important option in the treatment of this kind of tumours thanks to a multidisciplinary approach(AU)

[Results in the surgical treatment of giant acoustic neuromas]. / Resultados en el tratamiento quirúrgico de los neurinomas del acústico gigantes.

INTRODUCTION AND OBJECTIVES: To compare the results obtained in the resection of 21 giant vestibular schwannomas via retrosigmoid (RS) and combined retrosigmoid/translabyrinthine (RS/TL) approaches with respect to intra- and postoperative complications, facial nerve preservation and postsurgical sequelae. METHODS: This was a retrospective study of 21 patients who underwent a resection of a giant vestibular neuroma according to the Tos & Thomsen Scale (greater than or equal to 4 centimetres) in a tertiary care centre in the period between 2000 and 2008. We present the most significant characteristics of the series studied and the analysis of the advantages and inconveniences of each approach. We also analyse the results regarding facial nerve function preservation. RESULTS: We highlight the absence of mortality in the 21-patient group. There were no important intraoperative complications. Total resection of the lesion was achieved in the 87% of the cases, with facial nerve preservation of 73% using the combined RS/TL approach, in comparison to 40% using the RS. Facial nerve function after two years was acceptable or good in 67% (including those with heteronerve anastomosis). A global percentage of 14.3% of cerebrospinal liquid fistula was observed, as well as 9.5% of meningitis. CONCLUSIONS: The results of the study demonstrate that the combined retrosigmoid translabyrinthine approach for giant schwannoma treatment offers increased facial nerve preservation and lower morbidity, constituting an important option in the treatment of this kind of tumours thanks to a multidisciplinary approach.

Toxina botulínica y parálisis facial. Nuestra experiencia / Botulinum toxin and facial palsy. Our experience

Introducción y objetivos: La indicación terapéutica de la parálisis facial periférica depende del grado de lesión nerviosa. Una parálisis facial severa (electroneuronografía menor o igual al 10%) evoluciona hacia una curación con secuelas. Las secuelas de una parálisis facial son las contracturas, el espasmo hemifacial y las sincinesias. El propósito de este trabajo es demostrar que este tipo de pacientes puede beneficiarse de un tratamiento rehabilitador. Métodos: Presentamos un estudio con 48 pacientes afectos de parálisis facial periférica severa. Fueron tratados a partir del inicio de la reinervación motora facial mediante ejercicios faciales según la Escuela de Wisconsin y toxina botulínica. Resultados: La eficacia subjetiva de la rehabilitación es alta. Conclusiones: el tratamiento rehabilitador permite informar al paciente sobre sus posibilidades de recuperación, tener un control y calidad de la mímica facial, lograr una mayor simetría facial y con ello dar una mejor funcionalidad y calidad de vida (AU)

Introduction and objectives: Therapeutic indication of peripheral facial paralysis depends on the degree of nerve injury. Severe facial palsy (electroneuronographic study less than or equal to 10%) leads to healing with sequelae. The sequelae of facial paralysis are contractures, hemifacial spasm and synkinesis. Our purpose was to demonstrate that these patients could benefit from rehabilitation treatment. Methods: We present a study of 48 patients with severe peripheral facial paralysis. They were treated from the beginning of reinnervation with botulinum toxin and facial exercises according to the Wisconsin School. Results: The subjective efficacy of rehabilitation is high. Conclusions: Rehabilitation treatment can inform patients about their chances of recovery, give them control over and quality of facial expression and help to achieve greater facial symmetry. These factors provide better functionality and quality of life (AU)

[Botulinum toxin and facial palsy. Our experience]. / Toxina botulínica y parálisis facial. Nuestra experiencia.

INTRODUCTION AND OBJECTIVES: Therapeutic indication of peripheral facial paralysis depends on the degree of nerve injury. Severe facial palsy (electroneuronographic study less than or equal to 10%) leads to healing with sequelae. The sequelae of facial paralysis are contractures, hemifacial spasm and synkinesis.Our purpose was to demonstrate that these patients could benefit from rehabilitation treatment. METHODS: We present a study of 48 patients with severe peripheral facial paralysis. They were treated from the beginning of reinnervation with botulinum toxin and facial exercises according to the Wisconsin School. RESULTS: The subjective efficacy of rehabilitation is high. CONCLUSIONS: Rehabilitation treatment can inform patients about their chances of recovery, give them control over and quality of facial expression and help to achieve greater facial symmetry. These factors provide better functionality and quality of life.