Risk factors for shunt-dependent hydrocephalus after spontaneous subarachnoid hemorrhage.

INTRODUCTION: Subarachnoid haemorrhage (SAH) is one of the most frequent neurosurgical emergencies, most of them due to intracranial aneurysm rupture. Hydrocephalus is a prevalent complication with a high rate of complications. The aims of this study are to identify predictors of shunt-dependent hydrocephalus following aneurysmal SAH and to quantify the complications arising from ventriculoperitoneal shunts. METHODS: This study is about an observational retrospective analytic study of the patients with spontaneous SAH admitted to Miguel Servet Universitary Hospital between 2017 and 2022. Patients' clinical and radiological characteristics, type of treatment, diagnoses and treatment of hydrocephalus, complications of ventriculoperitoneal shunts and mortality are some of the data achieved in this study. A descriptive study of these variables has been done and, subsequently, the most relevant variables have been statistically analysed to identify patients with increasing risk of shunting for hydrocephalus. This study was authorized by the Ethics Committee prior to its elaboration. RESULTS: A total of 359 patients with spontaneous SAH were admitted to Miguel Servet Universitary Hospital between 2017 and 2022, with an intrahospitalary death rate of 25.3%. 66.3% of the total of patients with SAH were due to intracranial aneurysm rupture (n = 238). 45.3% of the patients with aneurysmal SAH required an external ventricular drain (EVD) to treat acute hydrocephalus. 11.7% (n = 28) developed a shunt-dependent hydrocephalus. Statistical significance was found between shunt-dependent hydrocephalus and the following: high score in modified Fisher scale and placement of EVD. The mean interval from EVD to ventriculoperitoneal shunt placement was 26.1 days. The mean rate of reoperation of patients after shunt was 17.7%, mostly due to infection. CONCLUSIONS: The most significant risk factor for shunt-dependent hydrocephalus after aneurysmal SAH was high Fisher grade and previous need of EVD. Shunt infections is the main cause of shunt reoperation. Early shunt placement in selected patients might reduce the rate of infectious complications.

Tailored Design of a Water-Based Nanoreactor Technology for Producing Processable Sub-40 Nm 3D COF Nanoparticles at Atmospheric Conditions.

Covalent organic frameworks (COFs) are crystalline materials with intrinsic porosity that offer a wide range of potential applications spanning diverse fields. Yet, the main goal in the COF research area is to achieve the most stable thermodynamic product while simultaneously targeting the desired size and structure crucial for enabling specific functions. While significant progress is made in the synthesis and processing of 2D COFs, the development of processable 3D COF nanocrystals remains challenging. Here, a water-based nanoreactor technology for producing processable sub-40 nm 3D COF nanoparticles at ambient conditions is presented. Significantly, this technology not only improves the processability of the synthesized 3D COF, but also unveils exciting possibilities for their utilization in previously unexplored domains, such as nano/microrobotics and biomedicine, which are limited by larger crystallites.

A study comparing baseline and best-corrected visual acuity after iodine-125 episcleral brachytherapy in uveal melanoma.

Purpose: The aim of this study was to analyze the course of visual acuity (VA) in visual outcomes of patients treated with iodine-125 (125I) brachytherapy in our center, based on original VA before treatment. Material and methods: Visual acuity was prospectively assessed using a case series of 305 patients treated with 125I between 1996 and 2022. To examine how VA behaves over time, we divided patient sample into 4 groups: (1) Patients with visual acuity of less than V ≤ 0.1 at baseline; (2) Patients with low to moderate VA, ranging 0.1 < V < 0.4; (3) Patients with moderate-high VA, ranging 0.4 < V < 0.8; (4) Patients with very high VA of V > 0.8. Each of the four groups was studied separately over a 60-month period to determine the percentage of patients with VA improvement, worsening, or with the same VA status. Finally, visual outcomes over time were estimated with 95% confidence interval (CI) using Kaplan-Meier analysis, and VA maintenance rates were reported at 1, 3, 5, 10, 15, and 20 years of follow-up. Results: The median follow-up time was 78.2 months (range, 6-254 months). The cumulative probabilities of survival analysis at 1, 3, 5, and 10 years were 16%, 3%, 2%, and none for the first sub-group; 46%, 20%, 17%, and 14% for the second; 65%, 53%, 29%, and 15% for the third; and 86%, 56%, 48%, and 41% for the fourth sub-group. The median survival in years was 0.30, 0.80, 3.10, and 4.40 for each sub-cohort, respectively. Conclusions: The decrease and maintenance of VA depends on the initial VA of patients. Most patients experience a marked worsening of their VA, regardless of their VA status before treatment with episcleral brachytherapy. Patients with a higher baseline VA retain VA best over time.

Scalable Synthesis and Electrocatalytic Performance of Highly Fluorinated Covalent Organic Frameworks for Oxygen Reduction.

In this study, we present a novel approach for the synthesis of covalent organic frameworks (COFs) that overcomes the common limitations of non-scalable solvothermal procedures. Our method allows for the room-temperature and scalable synthesis of a highly fluorinated DFTAPB-TFTA-COF, which exhibits intrinsic hydrophobicity. We used DFT-based calculations to elucidate the role of the fluorine atoms in enhancing the crystallinity of the material through corrugation effects, resulting in maximized interlayer interactions, as disclosed both from PXRD structural resolution and theoretical simulations. We further investigated the electrocatalytic properties of this material towards the oxygen reduction reaction (ORR). Our results show that the fluorinated COF produces hydrogen peroxide selectively with low overpotential (0.062 V) and high turnover frequency (0.0757 s-1 ) without the addition of any conductive additives. These values are among the best reported for non-pyrolyzed and metal-free electrocatalysts. Finally, we employed DFT-based calculations to analyse the reaction mechanism, highlighting the crucial role of the fluorine atom in the active site assembly. Our findings shed light on the potential of fluorinated COFs as promising electrocatalysts for the ORR, as well as their potential applications in other fields.

A new species of Hoya R.Br. (Apocynaceae, Asclepiadoideae) from the Philippines.

Hoyamedusa M.D.De Leon, Cabactulan, Cuerdo & Rodda, sp. nov. (Apocynaceae, Asclepiadoideae) is described from the Philippines. Even though numerous taxa with a shrubby habit from this area are known, it can be immediately separated because of its urceolate corolla and prominent elongated corona lobes. No other species in the genus possesses such a combination of characters.

Plyometric Training's Effects on Young Male Karatekas' Jump, Change of Direction, and Inter-Limb Asymmetry.

This study analysed the effects of performing a plyometric training programme on different types of jumping and specific changes of direction, and their respective asymmetries in karatekas. Twenty male karatekas (age 19 ± 4 years) were distributed in two groups, the control group (CG) and the experimental group (EG). The EG group (n = 10) performed a 6-week intervention of unilateral plyometric training, performing countermovement jumps (CMJ), drop jumps (DJ), and long jumps (SH). The tests performed at the beginning and at the end of the intervention were a unilateral and bilateral countermovement jump test (CMJ), single-leg hop test (SH), single-leg side-hop test (SSH), triple hop test (TH), and change of direction in a karate position test (MKUKS). The EG group obtained improvements in the CMJ with the stronger (p = 0.01; ES = 0.39) and weaker leg (p = 0.01; ES = 0.59), in the SH with the weaker leg (p = 0.01; ES = 0.45), in the SSH with the weaker leg (p = 0.03; ES = 0.33), in the MKUKS (p = 0.00; ES = 0.98), and improved the asymmetries obtained in the TH (p = 0.02; ES = -0.85). The GC group obtained significant differences in the CMJ with the stronger (p = 0.03; ES = 0.46) and weaker leg (p = 0.00; ES = 0.69), in the bilateral CMJ (p = 0.02; ES = 0.24), in the SH with the weaker leg (p = 0.00; ES = 0.34), in the TH with the stronger (p = 0.00; ES = -0.15) and weaker leg (p = 0.01; ES = 0.09), and in the MKUKS test (p = 0.04; ES = -0.94). A between-group analysis showed improvements of the EG over the GC in the TH with the stronger leg (p = 0.02; ES = 1.05). Performing plyometric training provides improvements in jumping, mainly in horizontal jumps, reducing inter-limb asymmetries in repetitive jumps.

Therapist reactions to patient personality: A pilot study of clinicians' emotional and neural responses using three clinical vignettes from in treatment series.

Introduction: Therapists' responses to patients play a crucial role in psychotherapy and are considered a key component of the patient-clinician relationship, which promotes successful treatment outcomes. To date, no empirical research has ever investigated therapist response patterns to patients with different personality disorders from a neuroscience perspective. Methods: In the present study, psychodynamic therapists (N = 14) were asked to complete a battery of instruments (including the Therapist Response Questionnaire) after watching three videos showing clinical interactions between a therapist and three patients with narcissistic, histrionic/borderline, and depressive personality disorders, respectively. Subsequently, participants' high-density electroencephalography (hdEEG) was recorded as they passively viewed pictures of the patients' faces, which were selected from the still images of the previously shown videos. Supervised machine learning (ML) was used to evaluate whether: (1) therapists' responses predicted which patient they observed during the EEG task and whether specific clinician reactions were involved in distinguishing between patients with different personality disorders (using pairwise comparisons); and (2) therapists' event-related potentials (ERPs) predicted which patient they observed during the laboratory experiment and whether distinct ERP components allowed this forecast. Results: The results indicated that therapists showed distinct patterns of criticized/devalued and sexualized reactions to visual depictions of patients with different personality disorders, at statistically systematic and clinically meaningful levels. Moreover, therapists' late positive potentials (LPPs) in the hippocampus were able to determine which patient they observed during the EEG task, with high accuracy. Discussion: These results, albeit preliminary, shed light on the role played by therapists' memory processes in psychotherapy. Clinical and neuroscience implications of the empirical investigation of therapist responses are discussed.

Covalent transfer of chemical gradients onto a graphenic surface with 2D and 3D control.

Control over the functionalization of graphenic materials is key to enable their full application in electronic and optical technologies. Covalent functionalization strategies have been proposed as an approach to tailor the interfaces' structure and properties. However, to date, none of the proposed methods allow for a covalent functionalization with control over the grafting density, layer thickness and/or morphology, which are key aspects for fine-tuning the processability and performance of graphenic materials. Here, we show that the no-slip boundary condition at the walls of a continuous flow microfluidic device offers a way to generate controlled chemical gradients onto a graphenic material with 2D and 3D control, a possibility that will allow the sophisticated functionalization of these technologically-relevant materials.

Iron Oxyhydroxide-Covalent Organic Framework Nanocomposite for Efficient As(III) Removal in Water.

The presence of heavy metal ions in water is an environmental issue derived mainly from industrial and mineral contamination. Metal ions such as Cd(II), Pb(II), Hg(II), or As(III) are a significant health concern worldwide because of their high toxicity, mobility, and persistence. Covalent organic frameworks (COFs) are an emerging class of crystalline organic porous materials that exhibit very interesting properties such as chemical stability, tailored design, and low density. COFs also allow the formation of composites with remarkable features because of the synergistic combination effect of their components. These characteristics make them suitable for various applications, among which water remediation is highly relevant. Herein, we present a novel nanocomposite of iron oxyhydroxide@COF (FeOOH@Tz-COF) in which lepidocrocite (γ-FeOOH) nanorods are embedded in between the COF nanoparticles favoring As(III) remediation in water. The results show a remarkable 98.4% As(III) uptake capacity in a few minutes and impressive removal efficiency in a wide pH range (pH 5-11). The chemical stability of the material in the working pH range and the capability of capturing other toxic heavy metals such as Pb(II) and Hg(II) without interference confirm the potential of FeOOH@Tz-COF as an effective adsorbent for water remediation even under harsh conditions.

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.

Multi-laboratory performance assessment of diffuse optics instruments: the BitMap exercise.

SIGNIFICANCE: Multi-laboratory initiatives are essential in performance assessment and standardization-crucial for bringing biophotonics to mature clinical use-to establish protocols and develop reference tissue phantoms that all will allow universal instrument comparison. AIM: The largest multi-laboratory comparison of performance assessment in near-infrared diffuse optics is presented, involving 28 instruments and 12 institutions on a total of eight experiments based on three consolidated protocols (BIP, MEDPHOT, and NEUROPT) as implemented on three kits of tissue phantoms. A total of 20 synthetic indicators were extracted from the dataset, some of them defined here anew. APPROACH: The exercise stems from the Innovative Training Network BitMap funded by the European Commission and expanded to include other European laboratories. A large variety of diffuse optics instruments were considered, based on different approaches (time domain/frequency domain/continuous wave), at various stages of maturity and designed for different applications (e.g., oximetry, spectroscopy, and imaging). RESULTS: This study highlights a substantial difference in hardware performances (e.g., nine decades in responsivity, four decades in dark count rate, and one decade in temporal resolution). Agreement in the estimates of homogeneous optical properties was within 12% of the median value for half of the systems, with a temporal stability of <5 % over 1 h, and day-to-day reproducibility of <3 % . Other tests encompassed linearity, crosstalk, uncertainty, and detection of optical inhomogeneities. CONCLUSIONS: This extensive multi-laboratory exercise provides a detailed assessment of near-infrared Diffuse optical instruments and can be used for reference grading. The dataset-available soon in an open data repository-can be evaluated in multiple ways, for instance, to compare different analysis tools or study the impact of hardware implementations.

Snf1p/Hxk2p/Mig1p pathway regulates hexose transporters transcript levels, affecting the exponential growth and mitochondrial respiration of Saccharomyces cerevisiae.

The Crabtree effect molecular regulation comprehension could help to improve ethanol production with biotechnological purposes and a better understanding of cancer etiology due to its similarity with the Warburg effect. Snf1p/Hxk2p/Mig1p pathway has been linked with the transcriptional regulation of the hexose transporters and phenotypes associated with the Crabtree effect. Nevertheless, direct evidence linking the genetic control of the hexose transporters with modulation of the Crabtree effect phenotypes by the Snf1p/Hxk2p/Mig1p pathway is still lacking. In this sense, we provide evidence that SNF1 and HXK2 genes deletion affects exponential growth, mitochondrial respiration, and transcript levels of hexose transporters in a glucose-dependent manner. The Vmax of the hexose transporters with the high transcript levels was correlated positively with the exponential growth and negatively with the mitochondrial respiration. HXT2 gene transcript levels were the most affected by the deletion of the SNF1/HXK2/MIG1 pathway. Deleting the orthologous genes SNF1 and HXK2 in Kluyveromyces marxianus (Crabtree negative yeast) has an opposite effect compared to Saccharomyces cerevisiae in growth and mitochondrial respiration. Overall, these results indicate that the SNF1/HXK2/MIG1 pathway regulates transcript levels of the hexose transporters, which shows an association with the exponential growth and mitochondrial respiration in a glucose-dependent manner.

Acute negative-pressure hydrocephalus: Management algorithm and value of early endoscopic ventriculostomy.

INTRODUCTION: Acute negative-pressure hydrocephalus is an uncommon, underrecognized patology with a high morbidity and mortality. We propose an algorithm to facilitate the management of these patients, promoting the early diagnosis and the use of endoscopic third ventriculostomy as initial therapeutic option. METHODS: We performed an observational retrospective study in which patients diagnosed with acute negative-pressure hydrocephalus were included. Patient age and symptoms, primary etiology of hydrocephalus, previous shunt, infection and surgical procedures, time from clinical deterioration to endoscopic procedure, definitive treatment and patient outcomes were recorded. Our management algortihm is exposed and justified. RESULTS: We identified five patients with diagnosis of acute negative-pressure hydrcephalus. In four of them the management algorithm was applied and early diagnosis and endoscopic ventriculostomy were performed. We observed complete succes of the endoscopic procedure in two patients (50%); the other two required permanent shunt, nevertheless resolution of the low-pressure state was achieved. One patient died after systemic infection (20%), 80% of the patients experienced good outcome. CONCLUSIONS: The early identification of a negative-pressure hydrocephalic state is essential to reduce complications. Application of a specific management algortihm and early endoscopic third ventriculostomy could be advantageous to achieve better outcomes.

Myelopexy: A novel technique in posttraumatic syringomyelia.

Posttraumatic syringomyelia (PTS) is a well-reported phenomenon that usually takes place in the long-term course of patients following spinal cord injury. Different surgical procedures have been described: spinal cordectomy is usually a last option technique, but might be an excellent choice in patients with severe spinal cord injuries. We present a young patient with complete spinal cord injury after spine trauma, who developed posttraumatic syringomyelia with progressive motor deterioration twelve years after fixation. We performed a novel surgical technique (myelopexy) with excellent resolution of syringomyelia, sparing the negative implications of complete cord transection. Some artistic illustrations made by one of the corresponding authors are included, to better understanding of operative details.

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.

A Meta-Omics Analysis Unveils the Shift in Microbial Community Structures and Metabolomics Profiles in Mangrove Sediments Treated with a Selective Actinobacterial Isolation Procedure.

Mangrove sediment ecosystems in the coastal areas of the Yucatan peninsula are unique environments, influenced by their karstic origin and connection with the world's largest underground river. The microbial communities residing in these sediments are influenced by the presence of mangrove roots and the trading chemistry for communication between sediment bacteria and plant roots can be targeted for secondary metabolite research. To explore the secondary metabolite production potential of microbial community members in mangrove sediments at the "El Palmar" natural reserve in Sisal, Yucatan, a combined meta-omics approach was applied. The effects of a cultivation medium reported to select for actinomycetes within mangrove sediments' microbial communities was also analyzed. The metabolome of the microbial communities was analyzed by high-resolution liquid chromatography-tandem mass spectrometry, and molecular networking analysis was used to investigate if known natural products and their variants were present. Metagenomic results suggest that the sediments from "El Palmar" harbor a stable bacterial community independently of their distance from mangrove tree roots. An unexpected decrease in the observed abundance of actinomycetes present in the communities occurred when an antibiotic-amended medium considered to be actinomycete-selective was applied for a 30-day period. However, the use of this antibiotic-amended medium also enhanced production of secondary metabolites within the microbial community present relative to the water control, suggesting the treatment selected for antibiotic-resistant bacteria capable of producing a higher number of secondary metabolites. Secondary metabolite mining of "El Palmar" microbial community metagenomes identified polyketide synthase and non-ribosomal peptide synthetases' biosynthetic genes in all analyzed metagenomes. The presence of these genes correlated with the annotation of several secondary metabolites from the Global Natural Product Social Molecular Networking database. These results highlight the biotechnological potential of the microbial communities from "El Palmar", and show the impact selective media had on the composition of communities of actinobacteria.

Effects of Three Different Combined Training Interventions on Jump, Change of Direction, Power Performance, and Inter-Limb Asymmetry in Male Youth Soccer Players.

BACKGROUND: This study compared the effects of performing different unilateral combined training interventions on diverse vertical and horizontal jumping performance parameters, change of direction, concentric and eccentric mean power, and their associated inter-limb asymmetries in young soccer players. METHODS: Forty-seven young male soccer players (age: 15.5 ± 0.9 years) were distributed into three groups. Two groups performed the same training volume with both legs, beginning with the weaker leg (Stronger Volume Weaker leg group (SVW), n = 14) or with the stronger leg (Stronger Volume Stronger leg group, (SVS), n = 15). The third group executed double the volume with the weaker leg and also commenced with such leg (Double Volume Weaker leg group (DVW), n = 16) during a 10-week period. Pre- and post-intervention tests included a single-leg hop, single-leg lateral hop, triple hop, bilateral and unilateral countermovement jumps, a change of direction speed test, concentric and eccentric mean power during the lateral squat test, and their corresponding asymmetries. RESULTS: Single-leg hop weaker leg, triple hop weaker leg, and bilateral countermovement jump improvements were achieved in the SVW (ES: 0.29 to 0.46) and DVW (ES: 0.55 to 0.73) groups. Between-groups analysis showed better results in single-leg hop in the SVW and DVW compared to group SVS. The DVW group achieved better improvements in countermovement jump in comparison to groups SVS and SVW. CONCLUSIONS: Groups that started with the weaker leg seemed to achieve a greater volume of significant changes than when starting with the stronger leg. Performing a double volume on the weaker limb does not guarantee further improved performance compared to other groups.

Comparison of Three Eccentric Overload Training Strategies on Power Output and Interlimb Asymmetry in Youth Soccer Players.

BACKGROUND: The present study compared the effects of performing the lateral squat exercise in three different formats from eccentric overload training on concentric/eccentric peak/mean power and inter-limb asymmetries in young soccer players. METHODS: Forty-five young male (U-17) soccer players were distributed into three groups. Two groups performed the same training volume with both legs, beginning with the weaker leg (SVW, n = 15) or with the stronger leg (SVS, n = 15). The third group executed double volume with the weaker leg and also commenced with such leg (DVW, n = 15) in the lateral squat during a 10-week period. Pre- and post-intervention metrics included concentric and eccentric peak/mean power during the lateral squat test and their corresponding asymmetries. RESULTS: All groups improved all power variables. Concentric mean and peak power asymmetry were substantially reduced in the SVW (ES: 0.89), DVW (ES: 0.43), and in SVW (ES: 1.60). Eccentric mean and peak power asymmetry were also substantially decreased in SVW (ES: 0.81) and in DVW (ES: 0.68). Between-group analyses showed substantially better performance in concentric and eccentric variables with stronger and weaker legs in SVW and DVW groups compared with SVS. CONCLUSIONS: Those groups which started with the weaker leg showed greater both power enhancements and reductions on inter-limb asymmetries.

Supracerebellar transtentorial approach for left parahippocampal cavernous malformation.

BACKGROUND: Lesions in the temporomesial region can be reached by various approaches: subtemporal, transsylvian, transcortical, interhemispheric parieto-occipital, or supracerebellar transtentorial (SCTT). The choice varies according to the characteristics of the lesion and neighboring structures. CASE DESCRIPTION: In this clinical case, it is presented a 56-year-old man with long-term evolution of drug-resistant epilepsy secondary to a cavernoma in the left parahippocampal gyrus. After assessing the lesion, it was decided a SCTT approach for its resection in a semi-sitting position, to avoid language disorders or visual damage. The surgery was uneventful and the patient did not present epileptic seizures during 6-month follow-up. CONCLUSION: Performing a SCTT is safe and feasible option for resection of lesions located in the basal temporomesial region without causing damage to neighboring structures, especially those located in the middle and posterior two-thirds of temporal region.

Quadrigeminal Cistern Epidermoid Cyst: Neuroendoscopy and Endoscope-Assisted Supracerebellar Infratentorial Approach.

The pineal region is a complex anatomical location with multiple surrounding important neurovascular structures.1,2 Several approaches to this region have been described, including posterior interhemispheric, transchoroidal, infratentorial supracerebellar, supracerebellar and infracerebellar trans-sinus, and their modifications. Neuroendoscopy and endoscope-assisted surgery have been widely applied to aid resection of pineal region lesions.3-5 A 40-year-old man presented with tonic-clonic seizures and bilateral papillary edema on fundus examination. Computed tomography showed a midline lesion at the level of the quadrigeminal cistern with mass effect on the aqueduct of Sylvius and posterior wall of the third ventricle, triggering obstructive triventricular hydrocephalus. As a first intervention, a third ventriculostomy was attempted unsuccessfully owing to unfavorable third ventricle floor anatomy. This approach was used to obtain a biopsy specimen, which showed an epidermoid cyst. Ventriculoscopy showed a communication of the pineal recess and quadrigeminal cistern owing to tumor invasion. An external ventricular drain was placed to control the hydrocephalus until complete resection was performed (Video 1). Several days later, tumor resection was carried out via the median supracerebellar infratentorial approach with the patient in semisitting position. After near-total resection under microscope, the third ventricle and both lateral recesses were explored with the endoscope. A small tumor remnant (visible only with endoscope) was identified and removed. This step was essential to achieve complete resection, confirmed by magnetic resonance imaging. The patient was discharged 6 days later without complications. During follow-up, the patient remains asymptomatic. The combination of microneurosurgery, neuroendoscopy, and endoscope-assisted surgery improves management of pineal region lesions and facilitates complete resection.