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1.
Childs Nerv Syst ; 39(2): 451-462, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-35933521

RESUMEN

OBJECTIVE: Subcortical band heterotopia is a rare X-linked neuronal migration disorder primarily in females often associated with drug-resistant epilepsy. The aim of this study is to review the literature for non-pharmacological treatment options of drug-resistant epilepsy in subcortical band heterotopia. MATERIAL AND METHODS: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review. Entering the keywords "double cortex," "subcortical band heterotopia," and "subcortical laminar heterotopia," we searched Scopus and PubMed databases. We paid particular attention to type of invasive and non-invasive treatment, radiological presentation, and outcome. We also describe a related case report, managed at Alder Hey Children's Hospital, Liverpool. RESULTS: The systematic literature review yielded 25 patients with subcortical band heterotopia and drug-resistant epilepsy who underwent non-pharmacological treatment. Including our patient, 26 patients were reported. The patients' mean age at seizure onset was 6.5 years (range 0.2-23) with a female sex predilection (5.25:1). The patients' mean age at invasive or non-invasive treatment was 21.5 years (range 6.5-51). The 26 patients underwent 29 non-pharmacological treatments. Ten patients underwent corpus callosotomy; 8 patients had a formal temporal lobectomy. Three patients had focal cortical resection. Two patients respectively had multiple subpial transections, insertion of a vagal nerve stimulator, or deep brain stimulation of the bilateral anterior nuclei of the thalamus. One patient underwent responsive focal neurostimulation. Another patient had transcutaneous stimulation of the vagal nerve. Sixteen patients reported a reduction or the disappearance of the seizures; 1 patient had no improvement. The outcome of 2 patients was classified class I, of 1 patient class II, of 1 patient class III, and of 5 patients class IV according to the Engel Epilepsy Surgery Outcome Scale. CONCLUSION: Mainly corpus callosotomy and formal temporal lobectomy have been performed as non-pharmacological treatment with few cases published overall. Several other invasive procedures and one non-invasive technique are based on case reports. The small number of reported cases prevents drawing a firm conclusion as to which non-pharmacological treatment is the best treatment option for refractive epilepsy in patients with subcortical band heterotopia.


Asunto(s)
Lisencefalias Clásicas y Heterotopias Subcorticales en Banda , Epilepsia Refractaria , Epilepsia , Niño , Humanos , Femenino , Lactante , Preescolar , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Epilepsia/cirugía , Convulsiones , Tálamo , Resultado del Tratamiento
2.
Postgrad Med J ; 95(1128): 524-530, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31431519

RESUMEN

Academic neurosurgery encompasses basic science and clinical research efforts to better understand and treat diseases of relevance to neurosurgical practice, with the overall aim of improving treatment and outcome for patients. In this article, we provide an overview of the current and future directions of British academic neurosurgery. Training pathways are considered together with personal accounts of experiences of structured integrated clinical academic training and unstructured academic training. Life as an academic consultant is also described. Funding is explored, for the specialty as a whole and at the individual level. UK academic neurosurgical organisations are highlighted. Finally, the UK's international standing is considered.


Asunto(s)
Neurocirugia/organización & administración , Universidades , Humanos , Edición , Apoyo a la Investigación como Asunto , Sociedades Médicas , Reino Unido
3.
Childs Nerv Syst ; 31(11): 2055-62, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26216059

RESUMEN

INTRODUCTION: Optic pathway/hypothalamic gliomas (OPHGs) are generally benign but situated in an exquisitely sensitive brain region. They follow an unpredictable course and are usually impossible to resect completely. We present a case series of 10 patients who underwent surgery for OPHGs with the aid of intra-operative MRI (ioMRI). The impact of ioMRI on OPHG resection is presented, and a role for ioMRI in partial resection is discussed. METHODS: Ten patients with OPHGs managed surgically utilising ioMRI at Alder Hey Children's Hospital between 2010 and 2013 were retrospectively identified. Demographic and relevant clinical data were obtained. MRI was used to estimate tumour volume pre-operatively and post-resection. If ioMRI demonstrated that further resection was possible, second-look surgery, at the discretion of the operating surgeon, was performed, followed by post-operative imaging to establish the final status of resection. Tumour volume was estimated for each MR image using the MRIcron software package. RESULTS: Control of tumour progression was achieved in all patients. Seven patients had, on table, second-look surgery with significant further tumour resection following ioMRI without any surgically related mortality or morbidity. The median additional quantity of tumour removed following second-look surgery, as a percentage of the initial total volume, was 27.79% (range 11.2-59.2%). The final tumour volume remaining with second-look surgery was 23.96 vs. 33.21% without (p = 0.1). CONCLUSIONS: OPHGs are technically difficult to resect due to their eloquent location, making them suitable for debulking resection only. IoMRI allows surgical goals to be reassessed intra-operatively following primary resection. Second-look surgery can be performed if possible and necessary and allows significant quantities of extra tumour to be resected safely. Although the clinical significance of additional tumour resection is not yet clear, we suggest that ioMRI is a safe and useful additional tool, to be combined with advanced neuronavigation techniques for partial tumour resection.


Asunto(s)
Glioma/cirugía , Neoplasias Hipotalámicas/cirugía , Monitorización Neurofisiológica Intraoperatoria , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos/métodos , Glioma del Nervio Óptico/cirugía , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Registros Médicos/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento
4.
Br J Neurosurg ; 29(5): 678-84, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25968327

RESUMEN

BACKGROUND: To examine tumour control, via volume changes, and the complications of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) treatment of vestibular schwannomas (VSs) on medium-term follow-up. METHODS: Between September 2003 and November 2009 fifty consecutive patients with VSs treated with SRS using a marginal dose of 12.5 Gy utilizing a LINAC equipped with a micro-multileaf collimator were identified. Evaluation included serial magnetic resonance imaging (MRI), and neurological and hearing examinations. RESULTS: The median tumour volume at treatment was 2.4 (range: 0.24-10.59) cm3. The intracranial diameter of the tumours ranged between 7.7 and 28.7 (median: 15.8) mm. Follow-up MRI was available for analysis on 49 patients. The median radiological follow-up period was 5.8 (range: 1.4-9.2) years. The median tumour volume at last follow-up was 1.1 (range: 0.03-5.3) cm3. VS decreased in size in 45 (90%) patients, with a median reduction in tumour volume of 1.46 (range: 0.06-9.29) cm3 or a median tumour size reduction of 59% of the baseline (range: 6-90%) in these patients. VS remained stable in 2 patients and increased in size in 2 patients. Only 1 patient (2%) required additional intervention (surgery). 15 patients had useful hearing pre-treatment; 10 post-treatment pure-tone audiograms of these patients were available. 5 (50%) patients still had useful hearing post treatment. Non-auditory adverse radiation effects included new (House-Brackmann grade II) or worsened facial nerve palsy (House-Brackmann grade II to grade V) in 2 (4%) patients and trigeminal sensory disturbance in 2 (4%) patients. CONCLUSIONS: At medium term, the vast majority of VSs treated with LINAC-based SRS exhibit tumour shrinkage. The slightly higher rate of facial nerve palsy compared with Gamma Knife surgery (GKS) results may be related to the learning curve. Other complications were similar to reported GKS results for VSs of comparable sizes.


Asunto(s)
Neoplasias del Oído/cirugía , Neurilemoma/cirugía , Radiocirugia/métodos , Vestíbulo del Laberinto/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Neoplasias del Oído/patología , Traumatismos del Nervio Facial/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Dosis de Radiación , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Vestíbulo del Laberinto/patología , Adulto Joven
5.
Br J Neurosurg ; 28(2): 247-51, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23957779

RESUMEN

STUDY DESIGN. Retrospective audit of consecutive patients. OBJECTIve. To investigate the re-operation rate following elective primary lumbar microdiscectomy and to determine whether principal surgeon grade and/or disc space lavage is a factor in recurrence. SUMMARY OF BACKGROUND DATA. Recurrent herniation of disc material following lumbar microdiscecomy surgery is one of the commonest complications of the procedure. Any reduction in the number of revision microdiscectomies performed per year would have a significant impact on patients' lives and on the health service economy. We undertook this study to ascertain whether principal surgeon grade and/or disc space lavage has an impact in reducing the re-operation rate. METHODS. We undertook a retrospective audit of patients who underwent elective primary lumbar microdiscectomy, over a 3-year period (n = 971). RESULTS. The overall re-operation rate for primary elective microdiscectomy was 3.8%, consistent with the published literature. The relative risk of re-operation in patients primarily operated by registrar surgeons was 1.2 fold the risk in patients operated by consultants (95% CI: 0.62, 2.35) although not statistically significant (p = 0.568). The risk of re-operation in the 'non lavage' group was 2.15 times the risk in the 'lavage' group (95% CI: 0.63, 7.34), but it did not reach significance (p = 0.222). CONCLUSIONS. Principal surgeon grade and intervertebral disc lavage have not been found conclusively to be factors in the rate of recurrence. This information is useful to reassure patients that their outcome from such surgery is not dependent on the grade of surgeon performing the operation. There is a possible trend towards intervertebral disc lavage reducing the rate of recurrence.


Asunto(s)
Discectomía/estadística & datos numéricos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Microcirugia/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Competencia Clínica , Interpretación Estadística de Datos , Humanos , Desplazamiento del Disco Intervertebral/epidemiología , Quirófanos/organización & administración , Recurrencia , Derivación y Consulta , Estudios Retrospectivos , Factores de Riesgo , Irrigación Terapéutica/estadística & datos numéricos , Resultado del Tratamiento
7.
Eur Spine J ; 22 Suppl 3: S399-403, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23014740

RESUMEN

BACKGROUND: Dorsal herniation of the spinal cord through the dura is an uncommon phenomenon and this is only the fifth reported case in the thoracolumbar spine, the first following surgery at the thoracolumbar junction. CASE: A 57-year-old male underwent marsupialisation of a benign intramedullary cyst at the T12-L1 level and subsequently returned with symptoms of dorsal column compromise. He was found to have a posterior herniation of the cord into a pseudomeningocele at the level of the previous surgery. CONCLUSION: The hernia was reduced surgically and the defect closed directly without the need for a dural patch leading to a full recovery. Posterior cord herniation, its possible aetiologies and management strategies are discussed.


Asunto(s)
Quistes/cirugía , Meningocele/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Enfermedades de la Médula Espinal/cirugía , Humanos , Vértebras Lumbares , Masculino , Meningocele/cirugía , Persona de Mediana Edad , Vértebras Torácicas
8.
J Clin Neurosci ; 51: 6-11, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29483013

RESUMEN

Endoscopic third ventriculostomy (ETV) is increasingly used in place of shunt revision for shunt malfunction (secondary ETV). This review provides a comprehensive overview of preoperative, operative and postoperative considerations for patients undergoing a secondary ETV. Preoperatively, patient selection is vital and there is evidence that secondary ETV is more effective than primary ETV in certain hydrocephalic aetiologies. Operative considerations include use of neuronavigation and consideration of surgeon technical experience due to anatomical differences that are likely to accompany chronic shunting, management of existing shunt hardware and the use of temporary external ventricular drains or short/long-term ventricular access devices. Postoperatively, there are varying institutional practices with regards to ICP monitoring and length of follow-up after discharge. Finally, this review examines the slit ventricle syndrome as a special case requiring a different approach.


Asunto(s)
Derivaciones del Líquido Cefalorraquídeo , Neuroendoscopía/métodos , Reoperación/métodos , Ventriculostomía/métodos , Niño , Preescolar , Femenino , Humanos , Hidrocefalia/cirugía , Masculino , Selección de Paciente , Periodo Posoperatorio , Tercer Ventrículo/cirugía , Resultado del Tratamiento
9.
J Clin Neurosci ; 31: 30-4, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27369088

RESUMEN

Post-haemorrhagic hydrocephalus (PHH) is the most common neurological complication of preterm birth and can result in severe and life-long psychomotor and cognitive sequelae. Cerebrospinal fluid diversion is often required but the optimum time for intervention is unclear. Numerous neurosurgical procedures exist to temporise PHH but it is not clear which is the optimum method. Approximately 15% of preterm infants who suffer intraventricular haemorrhage (IVH) will require permanent cerebrospinal fluid diversion with a ventriculoperitoneal shunt. It is likely that earlier intervention may result in reduced neurological disability and ventriculoperitoneal shunt dependency. In this review we discuss the current methods of PHH management.


Asunto(s)
Ventrículos Cerebrales , Hidrocefalia/terapia , Recien Nacido Prematuro , Hemorragias Intracraneales/complicaciones , Humanos , Hidrocefalia/epidemiología , Lactante , Recién Nacido , Hemorragias Intracraneales/epidemiología , Derivación Ventriculoperitoneal
10.
World Neurosurg ; 94: 386-393, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27436208

RESUMEN

OBJECTIVE: To describe long-term outcomes of endoscopic third ventriculostomy (ETV) in adults with hydrocephalus. METHODS: Single-institution retrospective review of adults treated with ETV between 1998 and 2006. Patient demographic, treatment, and follow-up data were collected. The patients were divided into 2 groups: primary ETV for patients with previously untreated or newly diagnosed hydrocephalus and secondary ETV for patients with a previous shunt presenting with shunt malfunction. ETV outcome was deemed successful if the patient remained shunt-free after ETV. Multivariate analysis was performed using Cox regression. RESULTS: The study population comprised 190 patients, with a median age of 43 years (range, 16-79 years). The median duration of follow-up was 112 months (range, 1-190 months). The primary ETV group contained 129 patients; the secondary ETV group, 61 patients. Operative complications occurred in 11 patients (6%). A successful outcome was obtained in 139 patients (73%). ETV failure occurred in 51 patients, with a median time to failure of 2 months (range, 0-124 months). Although the majority (86%) of ETV failures occurred within 2 years postoperatively, failure was noted in 3 cases between 5 and 10 years after intervention, including in 1 patient at a 124-month follow-up. In multivariate analysis, only previous shunt was found to influence outcomes (P = 0.021), with shorter ETV survival noted in patients with a previous shunt. Age, indication, and ETV success did not influence outcome. CONCLUSIONS: ETV is a safe procedure with excellent rates of long-term efficacy; however, late failure can occur, and patients should be instructed to seek medical advice if symptoms recur. A previous shunt is associated with a higher ETV failure rate.


Asunto(s)
Hidrocefalia/epidemiología , Hidrocefalia/cirugía , Neuroendoscopía/estadística & datos numéricos , Tercer Ventrículo/cirugía , Derivación Ventriculoperitoneal/estadística & datos numéricos , Ventriculostomía/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Hidrocefalia/diagnóstico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Tercer Ventrículo/patología , Resultado del Tratamiento , Reino Unido/epidemiología , Adulto Joven
11.
J Neurosurg Pediatr ; 17(6): 734-8, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26870897

RESUMEN

OBJECTIVE Endoscopic third ventriculostomy (ETV) is an effective treatment for obstructive hydrocephalus and avoids the risk for foreign-body infection associated with ventriculoperitoneal (VP) shunts. The short-term failure rate of ETV strongly depends on the indications for its use but is generally thought to be lower in the long term than that of VP shunts. However, few studies are available with long-term follow-up data of ETV for hydrocephalus in children. The authors reviewed the long-term success of ETV at their institution to investigate the rate of any late failures of this procedure. METHODS Between April 1998 and June 2006, 113 children (including neonates and children up to 16 years old) had primary or secondary ETV for different causes of hydrocephalus. The patients' medical records and the authors' electronic operation database were reviewed for evidence of additional surgery (i.e., repeat ETV or VP shunt insertion). These records were checked at both the pediatric and adult neurosurgical hospitals for those patients who had their care transferred to adult services. RESULTS The median length of follow-up was 8.25 years (range 1 month to 16 years). Long-term follow-up data for 96 patients were available, 47 (49%) of whom had additional ETV or VP shunt insertion for ETV failure. Twenty patients (21%) had a second procedure within 1 month, 17 patients (18%) between 1 and 12 months, 7 patients (7%) between 1 and 5 years, and 3 patients (3%) between 5 and 8 years. CONCLUSIONS In the authors' series, ETV had an initial early failure rate for the treatment of pediatric hydrocephalus as reported previously, and this rate significantly depended on patient age and hydrocephalus etiology. Once stabilized and effective, ETV appeared to be durable but not guaranteed, and some late decline in effectiveness was observed, with some ETV failures occurring many years later. Thus, successful ETV in children cannot be guaranteed for life, and some form of follow-up is recommended long term into adulthood.


Asunto(s)
Hidrocefalia/cirugía , Tercer Ventrículo/cirugía , Ventriculostomía/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Estudios Retrospectivos
12.
CNS Oncol ; 4(5): 307-15, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26478219

RESUMEN

Oligodendroglial tumors are chemosensitive with a favorable prognosis compared with other histological subtypes. The genetic hallmark of co-deletion of 1p and 19q determines both treatment response and prognosis. While this test now forms part of routine histopathology diagnosis in many laboratories, alternative noninvasive imaging biomarkers of tumor genotype remain an attractive proposition. This review will focus on imaging biomarkers of molecular genetics in oligodendroglial tumors.


Asunto(s)
Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Neuroimagen , Oligodendroglioma/genética , Oligodendroglioma/patología , Deleción Cromosómica , Cromosomas Humanos Par 1/genética , Cromosomas Humanos Par 9/genética , Humanos
13.
J Clin Neurosci ; 21(2): 360-3, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24139137

RESUMEN

Some of the more unusual patterns of recurrence in previously treated low grade gliomas are demonstrated. As treatment choices develop and life expectancy is prolonged, patterns of tumour recurrence are likely to change within such a heterogeneous group of tumours, including metastatic spread via cerebrospinal fluid pathways.


Asunto(s)
Astrocitoma/patología , Neoplasias Encefálicas/patología , Recurrencia Local de Neoplasia , Oligodendroglioma/patología , Neoplasias de la Columna Vertebral/secundario , Adulto , Astrocitoma/terapia , Encéfalo/patología , Neoplasias Encefálicas/terapia , Resultado Fatal , Humanos , Imagen por Resonancia Magnética , Masculino , Oligodendroglioma/terapia , Columna Vertebral/patología
14.
J Neurosurg Pediatr ; 14(4): 409-13, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25084089

RESUMEN

Intrathecal baclofen (ITB) is a reversible treatment that reduces muscle tone to ameliorate spasticity and dystonia in patients with cerebral palsy (CP). The resulting decrease in energy expenditure allows patients to gain much-needed weight, albeit temporarily. Modern techniques require sufficient abdominal musculature and subcutaneous fat to permit the implantation of an indwelling pump. In patients with extremely low muscle bulk, visceral pumps may be impractical or impossible, with increased risks of dehiscence and infection. The authors describe a variation of the classical procedure in a young patient with severe cachexia. A 10-year-old boy with spastic-dystonic quadriplegic CP was admitted to the neuromedical unit. Numerous drug trials had failed, and surgical intervention was deemed necessary but was complicated by his cachectic body habitus. The authors inserted a lumbar intrathecal catheter and subcutaneously tunneled it to the anterolateral abdomen, where it was connected to a subcutaneous injection port. Baclofen was continuously infused into the subcutaneous port using a noncoring needle connected to an external pump. The needle and line were changed every 5 days to minimize the risk of sepsis. Although other techniques, such as intraventricular baclofen delivery, have been described, these are largely dependent upon sufficient musculature to support a visceral pump. A subcutaneous injection port system represents an alternative approach that reduces the risk of sepsis and may be better tolerated in cachectic patients.


Asunto(s)
Baclofeno/administración & dosificación , Caquexia/etiología , Parálisis Cerebral/complicaciones , Distonía/tratamiento farmacológico , Bombas de Infusión Implantables , Relajantes Musculares Centrales/administración & dosificación , Espasticidad Muscular/tratamiento farmacológico , Cuadriplejía/complicaciones , Catéteres de Permanencia , Niño , Distonía/etiología , Humanos , Bombas de Infusión Implantables/efectos adversos , Inyecciones Espinales , Inyecciones Subcutáneas , Vértebras Lumbares , Masculino , Espasticidad Muscular/etiología , Cuadriplejía/etiología , Resultado del Tratamiento
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