[Multimodal neuromonitoring in traumatic brain injury: contribution of PTiO2]. / Neuromonitorización multimodal en el TCE: aportación de la PTiO2.

The main goal of exhaustively monitoring neurocritical patients is to avoid secondary injury. In the last few years we have witnessed an increase in brain monitoring tools, beyond the checking of intracranial and brain perfusion pressures. These widely used systems offer valuable but possibly insufficient information. Awareness and correction of brain hypoxia is a useful and interesting measure, not only for diagnostic purposes but also when deciding treatment, and to predict an outcome. In this context, it would be of great interest to use all the information gathered from brain oxygenation monitoring systems in conjunction with other available multimodal monitoring devices, in order to offer individualized treatment for each patient.

[Intraneural cysts of the peroneal nerve in childhood: report of 2 cases and literature review]. / Quistes intraneurales del nervio ciatico popliteo externo en edad pediatrica presentacion de 2 casos revision de la literatura.

Intraneural cysts are benign lesions filled with mucinous content and located inside the epineurum of the peripheral nerves. Peroneal nerve is the most affected nerve. The entity is rare and its ethiopathology still remains to be definitely elucidated. In 2003 Spinner et al published their articular theory, implicated in the formation and frequent recurrence of these lesions after surgical treatment. The practical application of this theory, nowadays almost universally accepted, generated an important diminution in the recurrence rate after surgical evacuation of this lesions, previously very elevated. Most of the cases of this entity are described in adults. In the present paper we describe two pediatric cases and analyze the clinical aspects of these cysts in pediatric and adults patients. Peroneal intraneural cysts are one of the differential diagnoses in foot drop, and an adequate treatment concludes in a complete remission of the symptoms.

[Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 2: intraplexal nerve transfers]. / Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizadoParte 2: Transferencias nerviosas intraplexuales.

After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact number of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In a previous paper extraplexual nerve transfers were analyzed; this literature review complements the preceding paper analyzing intraplexual nerve transfers, and thus completing the analysis of the nerve transfers available in brachial plexus surgery.

[Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 1: extraplexal nerve transfers]. / Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizadoParte 1: Transferencias nerviosas extraplexuales.

After the great enthusiasm generated in the '70s and '80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact number of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to limit the long-term devastating effects of this injury. Given the large amount of reports that has been published in recent years regarding brachial plexus traumatic injuries, the present article has been written in order to clarify the concerned readers the indications, results and techniques available in the surgical armamentarium for this condition. Since the choice of either surgical technique is usually taken during the course of the procedure, all this knowledge should be perfectly embodied by the surgical team before the procedure. In this first part extraplexual nerve transfers are analyzed, while intraplexual nerve transfers will be analyzed in the second part of this presentation.

Neuromonitorización multimodal en el TCE: aportación de la PTiO2 / Multimodal neuromonitoring in traumatic brain injury: Contribution of PTiO2

La monitorización exhaustiva del enfermo neurocrítico tiene como principal objetivo la prevención de la lesión secundaria. En los últimos años hemos asistido a un incremento en las herramientas de monitorización cerebral, más allá de la observación de la presión intracraneal y la presión de perfusión cerebral, toda vez que parece que estos sistemas, ampliamente empleados, proporcionan una información valiosa, pero posiblemente insuficiente. El reconocimiento y corrección de la hipoxia cerebral, cuya etiología puede ser muy variada, se postula como una medida interesante y útil, tanto desde el punto de vista diagnóstico como para orientar el tratamiento y vislumbrar un pronóstico. Sería deseable utilizar la información obtenida con los sistemas de monitorización de la oxigenación cerebral de forma integrada con el resto de dispositivos de la monitorización multimodal, para intentar proporcionar a cada paciente un tratamiento lo más individualizado posible

The main goal of exhaustively monitoring neurocritical patients is to avoid secondary injury. In the last few years we have witnessed an increase in brain monitoring tools, beyond the checking of intracranial and brain perfusion pressures. These widely used systems offer valuable but possibly insufficient information. Awareness and correction of brain hypoxia is a useful and interesting measure, not only for diagnostic purposes but also when deciding treatment, and to predict an outcome. In this context, it would be of great interest to use all the information gathered from brain oxygenation monitoring systems in conjunction with other available multimodal monitoring devices, in order to offer individualized treatment for each patient

Quistes intraneurales del nervio ciático poplíteo externo en edad pediátrica: presentación de 2 casos y revisión de la literatura / Intraneural cysts of the peroneal nerve in childhood: report of 2 cases and literature review

Los quistes intraneurales son lesiones benignas de contenido mucinoso que se ubican dentro del epineuro de algunos nervios periféricos. El ciático poplíteo externo es el nervio más afectado por esta entidad, de incidencia muy baja y cuya etiopatogenia ha sido motivo de controversia. Spinner et al. en el año 2003 publican su teoría articular, que explica la formación de estas lesiones y la causa de su recidiva frecuente tras su evacuación quirúrgica. Esta teoría, a día de hoy, es la más aceptada, y desde su aplicación ha demostrado ser importante en la reducción de las recidivas y la mejora de los resultados del tratamiento de los quistes intra­neurales. La mayoría de las series de casos publicadas describen las características clínicas, radiológicas y el pronóstico de esta entidad en adultos. A través de la revisión de los casos pediátricos existentes en la litera­tura, y junto con 2 nuevos casos que presentamos, este trabajo revisa los aspectos clínicos de los quistes intra­neurales en su presentación pediátrica y las diferencias con su presentación en adultos. Es importante conocer esta entidad ya que es uno de los diagnósticos diferen­ciales que deben ser tenidos en cuenta al estudiar un paciente con un pie caído, y su tratamiento correcto en tiempo y forma redunda muchas veces en una remisión completa de la sintomatología (AU)

Intraneural cysts are benign lesions filled with muci­nous content and located inside the epineurum of the peripheral nerves. Peroneal nerve is the most affected nerve. The entity is rare and its ethiopathology still remains to be definitely elucidated. In 2003 Spinner et al published their articular theory, implicated in the formation and frequent recurrence of these lesions after surgical treatment. The practical application of this theory, nowadays almost universally accepted, gene­rated an important diminution in the recurrence rate after surgical evacuation of this lesions, previously very elevated. Most of the cases of this entity are described in adults. In the present paper we describe two pedia­tric cases and analyze the clinical aspects of these cysts in pediatric and adults patients. Peroneal intraneural cysts are one of the differential diagnoses in foot drop, and an adequate treatment concludes in a complete remission of the symptoms (AU)

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizadoParte 1: Transferencias nerviosas extraplexuales / Nerve reconstruction techniques in traumatic brachial plexus surgery. Part 1: Extraplexal nerve transfers

Tras el gran entusiasmo generado en las décadas de los años ´70 y ´80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de axones. De acuerdo a la cantidad viable de las mismas, se recurre a las transferencias de nervios que no forman parte del plexo (extraplexuales) como pueden ser el (..) (AU)

After the great enthusiasm generated in the ´70s and ´80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of absence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase (AU)

Técnicas de reconstrucción nerviosa en cirugía del plexo braquial traumatizadoParte 2: Transferencias nerviosas intraplexuales / Nerve Reconstruction Techniques in Traumatic Brachial Plexus Surgery. Part 2: Intraplexal nerve transfers

Tras el gran entusiasmo generado en las décadas de los ´70 y ´80 del siglo pasado, como consecuencia entre otras de la incorporación de las técnicas de microcirugía, la cirugía del plexo braquial se ha visto sacudida en las últimas dos décadas por la aparición de las técnicas de transferencia nerviosa o neurotizaciones. Se denomina así a la sección de un nervio que llamaremos dador, sacrificando su función original, para unirlo con el cabo distal de un nervio receptor, cuya función se ha perdido durante el trauma y se busca restablecer. Las neurotizaciones se indican cuando un nervio lesionado no posee un cabo proximal que pueda ser unido, mediante injerto o sin él, con el extremo distal. La ausencia de cabo proximal se produce en el plexo braquial cuando una raíz cervical se avulsiona de su origen a nivel de la médula espinal. Sin embargo, en los últimos años, y dados los resultados francamente positivos de algunas de ellas, las técnicas de transferencia nerviosa se han estado empleando inclusive en algunos casos en los que las raíces del plexo estaban preservadas. En las lesiones completas del plexo braquial, se recurre al diagnóstico inicial de la existencia o no de raíces disponibles (C5 a D1) para utilizarlas como dadores de (..) (AU)

After the great enthusiasm generated in the ´70s and ´80s in brachial plexus surgery as a result of the incorporation of microsurgical techniques and other advances, brachial plexus surgery has been shaken in the last two decades by the emergence of nerve transfer techniques or neurotizations. This technique consists in sectioning a donor nerve, sacrificing its original function, to connect it with the distal stump of a receptor nerve, whose function was lost during the trauma. Neurotizations are indicated when direct repair is not possible, i.e. when a cervical root is avulsed at its origin in the spinal cord. In recent years, due to the positive results of some of these nerve transfer techniques, they have been widely used even in some cases where the roots of the plexus were preserved. In complete brachial plexus injuries, it is mandatory to determine the exact numer of roots available (not avulsed) to perform a direct reconstruction. In case of bsence of available roots, extraplexual nerve transfers are employed, such as the spinal accessory nerve, the phrenic nerve, the intercostal nerves, etc., to increase the amount of axons transferred to the injured plexus. In cases of avulsion of all the roots, extraplexal neurotizations are the only reinnervation option available to (..) (AU)