Cross-cultural adaptation and validation of the Spanish version of the Oswestry disability index for Mexican population.

PURPOSE: This study aimed to adapt a Spanish translation of the Oswestry Disability Index (ODI) into a cross-cultural version for the Mexican population. The objectives were to verify the validity and reliability of the adapted ODI and to compare pain perception between patients with and without obesity. MATERIAL AND METHODS: We included 102 patients with low back pain from two neurosurgery departments in Mexico. The ODI questionnaire was translated and culturally adapted. Validity and construct were evaluated using exploratory factor analysis, and the external convergent validity was assessed by correlating ODI scores with pain intensity, age, and obesity. Test-retest reliability was calculated using the intraclass correlation coefficient, and confirmatory analysis was employed to validate the factorial structure. RESULTS: Patients with obesity were older and had higher pain scores than patients without obesity. The exploratory analysis of the ODI in Mexican Spanish showed good reliability (Cronbach's alpha of 0.923) and validity (factorial loading range, 0.681 - 0.818). The confirmatory analysis showed almost null or very low discrepancy between the proposed model and the real data. CONCLUSIONS: A Spanish translation of ODI was cross-culturally adapted for the Mexican population. The Mexican version of the ODI showed good reliability and validity in Mexican culture.

The Oswestry Disability Index (ODI) is a widely used tool to measure physical disability in daily activities due to low back pain.A Spanish-language version has not been culturally adapted and validated for Mexican habits and lifestyle.This study describes the process of the Spanish ODI translation and cultural adaptation, showing it is a reliable and valid tool for assessing disability in patients with low back pain, with a good factorial structure.

Association between the Symptomatic Appearance of Dural Arteriovenous Fistula and Trigeminal Ganglion Radiofrequency Thermocoagulation.

Fluoroscopy-guided radiofrequency thermocoagulation of the trigeminal ganglion is an alternative treatment for symptomatic trigeminal neuralgia. The most common complications of the procedure are circumscribed to sensitivity alterations. We report a case of an 83-year-old female patient with a history of petroclival meningioma resection, radiotherapy at the level of the petrous apex, and radiofrequency thermocoagulation for trigeminal neuralgia who developed a symptomatic dural arteriovenous fistula as an early complication, which required selective embolization. Dural arteriovenous fistula as an immediate complication of percutaneous thermocoagulation of the trigeminal ganglion has not been previously reported.

Prevalence of Incidental Clinoid Segment Saccular Aneurysms.

INTRODUCTION: Clinoid segment aneurysms are cerebral vascular lesions recently described in the neurosurgical literature. They arise from the clinoid segment of the internal carotid artery, which is the segment limited rostrally by the dural carotid ring and caudally, by the carotid-oculomotor membrane. Even although clinoid segment aneurysms represent a common incidental finding in magnetic resonance studies, its prevalence has not been yet reported. OBJECTIVE: To determine the prevalence of incidental clinoid segment saccular aneurysms diagnosed by magnetic resonance imaging as well as their anatomic architecture and their association with smoking, arterial hypertension, age, and sex of patients. METHODS: A total of 500 patients were prospectively studied with magnetic resonance imaging time-of-flight sequence and angioresonance with contrast material, to search for incidental saccular intracranial aneurysms. The site of primary interest was the clinoid segment, but the presence of aneurysms in any other location was determined for comparison. The relation among the presence of clinoid segment aneurysms, demographic factors, and secondary diagnosis of arterial hypertension, smoking, and other vascular/neoplastic cerebral lesions was analyzed. RESULTS: We found a global prevalence of incidental aneurysms of 7% (95% confidence interval, 5-9), with a prevalence of clinoid segment aneurysms of 3% (95% confidence interval, 2-4). Univariate logistic regression analysis showed a statistically significant relationship among incidental aneurysms, systemic arterial hypertension (P = 0.000), and smoking (P = 0.004). CONCLUSIONS: In the studied population, incidental clinoid segment aneurysms constitute the variety with highest prevalence.

Prevalence of Aneurysmal Subarachnoid Hemorrhage Safety Indicators and Their Relation with Health Care Outcomes in a Mexican Population.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (ASAH) is a serious and unstable condition. Patient safety indicators (PSI) are a group of potentially preventable events in patient health care. The aim of this study is to determine the prevalence of 8 relevant PSI in a group of patients with ASAH and their relation with 2 health care outcomes. METHODS: We performed a retrospective review of all patients admitted with ASAH. A total of 35 patients were selected with the following variables: age, sex, Hunt and Hess scale at admission, brain aneurysm treatment, length of hospital stay, and Glasgow Outcome Scale (GOS) score with the presence or absence of all 8 PSI: decubitus ulcer, pneumothorax, bacteremia, perioperative hematoma, postoperative respiratory failure, deep vein thrombosis (DVT), pulmonary thromboembolism, and accidental puncture or laceration. RESULTS: Average age (±standard deviation) was 53 ± 13.9 years, with a female predominance of 63%. The most common PSI was decubitus ulcer followed by central line-related bacteremia. Prolonged hospital stay was increased for inpatients with DVT. Males had a risk effect (odds ratio, 6.25) in relation to the appearance of pulmonary thromboembolism as well as a poor neurologic condition according to the GOS (GOS score <4) related to the appearance of DVT (odds ratio, 8.0). CONCLUSIONS: In our study population, we found 3 PSI related to a poor outcome measured with the GOS or to a longer hospital stay: decubitus ulcer, central line-related bacteremia, and DVT. PSI have been academically considered as useful tools in clinical, epidemiologic, and research outcome scenarios. An adequate prevention protocol for these indicators could produce better outcomes in medical care for patients with ASAH.

[Biomarkers in high-grade gliomas: A systematic review]. / Biomarcadores en gliomas de alto grado: revisión sistemática.

BACKGROUND: Biomarkers are a subcategory of clinical signs that can be measured and reproduced with precision and influence to predict outcome. Tissue, cells, and fluid conform the biological process. Biomarker usefulness is to determine and specify illness predisposition counting with variability and validity. Process systematization can reduce operative costs. To date, four major biomarkers have been described for high-grade gliomas: 1p/19q deletion, O6-methylguanine-DNA methyltransferase (MGMT) promoter mutation, IDH1/IDH2 mutation, and microRNA. In this manuscript we present a systematic review according to the MOOSE protocol to establish the bases to describe the utility of biomarkers in high-grade tumors. MATERIALS AND METHODS: We conducted a systematic review of the literature according to the PRISMA and MOOSE guides of all the published data from January 2004 to November 2014 with the key words: "biological markers" and "glioblastoma" that included OR and 95% CI. One researcher performed data extraction and analysis. RESULTS: A total of 169 articles were found in three major medical search engines: PubMed (42), Embase (30) and Ovid (96). CONCLUSION: Biomarkers are tools designed for early detection of specific illnesses such as high-grade glioma. Lack of methodological standardization slows down the speed of progress.

[Traumatic occipitocervical and atlantoaxial dislocation with clivus fracture in a child. Case report]. / Luxación traumática occipitocervical y atlantoaxial con fractura del clivus en un paciente pediátrico. Reporte de un caso.

BACKGROUND: Cranieovertebral junction lesions in the paediatric population are associated with a low survival rate, which has declined in recent years. Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity. Survival after these kinds of injuries has been more often reported in adults, but are limited in the paediatric population. CLINICAL CASE: A case is reported of an 8-year-old male with occipitocervical and atlantoaxial dislocation associated with clivus fracture, brain oedema, and post-traumatic subarachnoid haemorrhage (SAH). A halo vest system was placed with no traction. One month after the trauma the patient was surgically treated with C1 and C2 trans-articular screws, occipitocervical fixation with plate and screws, and C1- C2 fixation with tricortical bone graft and wires without complication. He has now returned to school and is self-sufficient. CONCLUSIONS: With better pre-hospital medical care and with improved surgical techniques the mortality rate has declined in this kind of lesion.

Endoscopic approach for the treatment of pineal region tumors.

Tumors of the pineal region account for 3 to 8% of the tumors involving the central nervous system. The most common are germ cell tumors (39%). Less common examples include teratomas, primitive neuroectodermic tumors, astrocytomas, and choriocarcinomas. Clinical presentation in pediatric patients is in direct relation to the anatomical structures surrounding the pineal region and to the associated hydrocephalus that is present in almost 90% of cases. The diagnosis of a tumor in the pineal region is based on radiological findings and the presence of tumor markers such as α-fetoprotein and human chorionic gonadotrophic hormone subfraction ß. Neuroendoscopy is considered to be one of the minimally invasive techniques useful for the management of such patients. This minimally invasive approach to pineal region tumors allows the treatment of hydrocephalus in a safe and effective way, avoiding the complications derived from other procedures such as external ventricular drainage or shunt surgery.

Pituitary tumor surgery: review of 3004 cases.

OBJECTIVE: To report the efficacy, safety, and outcomes through time of the biggest series to our knowledge of pituitary surgery using transcranial, transsphenoidal, and endoscopic techniques. METHODS: An observational, retrospective, and descriptive review was performed of 3004 patients surgically treated by the senior author from 1973 to June 2011 in Mexico City. A sublabial approach was used in 3000 patients, and a transnasal approach was used in the remaining 4 patients. Tumors were classified according to size as microadenomas or macroadenomas. RESULTS: During the time period of this study, 3004 patients were surgically treated; there were 510 prolactinomas, 822 growth hormone adenomas, 62 adrenocorticotropic hormone-producing adenomas, 8 tumors that produced Nelson syndrome, and 1562 adenomas that were not biologically active. The cure rate of prolactinoma was 82% for microadenomas and 9% for macroadenomas. Gender distribution showed a male predominance of 57.1%. Cure rate for growth hormone adenomas was 87%. Adrenocorticotropic hormone adenomas showed no cure rate; surgery simply aided pharmacologic control. Global mortality rate was 1.6%. The main complications were cerebrospinal fluid fistula, diabetes insipidus, and meningitis. CONCLUSIONS: The sum of this 38-year experience of managing pituitary pathology and its surgical treatment shows the importance of working together with other specialists such as endocrinologists, ophthalmologists, and radiologists. The correct treatment approach for each case must be individually selected. Transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in all cases except for prolactinomas that respond to pharmacologic therapy (dopamine agonist).

[Acute spontaneous lumbar subdural hematoma associated with subacute cranial subdural hematoma. Case report]. / Hematoma subdural lumbar agudo espontáneo asociado a hematoma subdural subagudo craneal. Reporte de un caso.

BACKGROUND: Acute spontaneous spinal subdural hematoma associated with subacute cranial subdural hematoma is a rare entity. There is no precise age of presentation, and there is a slight female predominance. Origin is primary or secondary to hematologic factors or vascular and iatrogenic procedures. The main symptom is motor deficit in 57% of the cases. Surgical treatment is warranted only with neurological deficits. CLINICAL CASE: We present the case of a 44-year-old male with severe headache and diagnosis of subacute frontoparietotemporal subdural hematoma and signs of lumbar radiculopathy. Prognosis is proportional to the initial neurologic deficit. CONCLUSIONS: Patients with cranial subdural hematoma who develop neurological symptoms in the lower extremities should have magnetic resonance imaging study to rule out spinal subdural hematoma.

Hematoma subdural lumbar agudo espontáneo asociado a hematoma subdural subagudo craneal: reporte de un caso / Acute spontaneous lumbar subdural hematoma associated with subacute cranial subdural hematoma: case report

BACKGROUND: Acute spontaneous spinal subdural hematoma associated with subacute cranial subdural hematoma is a rare entity. There is no precise age of presentation, and there is a slight female predominance. Origin is primary or secondary to hematologic factors or vascular and iatrogenic procedures. The main symptom is motor deficit in 57% of the cases. Surgical treatment is warranted only with neurological deficits. CLINICAL CASE: We present the case of a 44-year-old male with severe headache and diagnosis of subacute frontoparietotemporal subdural hematoma and signs of lumbar radiculopathy. Prognosis is proportional to the initial neurologic deficit. CONCLUSIONS: Patients with cranial subdural hematoma who develop neurological symptoms in the lower extremities should have magnetic resonance imaging study to rule out spinal subdural hematoma.

[Spontaneous regression of aneurysmal bone cyst of the skull. Case report]. / Quiste óseo aneurismático de cráneo con resolución espontánea. Reporte de un caso.

BACKGROUND: Aneurysmal bone cyst (ABC) is a benign expansible cystic lesion most often occuring during the second decade of life. It may occur in any bone in the body. The etiology and pathophysiology remain unclear. Treatment has been intralesional curettage. Spontaneous regression is not common. Other surgical options have been suggested. CLINICAL CASE: We describe the case of an 8-year-old asymptomatic patient with spontaneous regression of a frontal aneurysmal bone cyst in a 4-month period. CONCLUSIONS: In the diagnosed cases of ABC on the skull it is important to establish differential diagnosis with benign and malignant bone tumors like giant cell tumors. In order to obtain precise information on cases with spontaneous regression, serial radiological studies previous to surgery should be performed in asymptomatic patients.