[Quality of life in intracranial aneurysm: surgery versus endovascular treatment]. / Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular.

BACKGROUND: Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. METHODS: The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization (n=37). RESULTS: The quality of life of some patients was impaired but 50% of patients treated with surgery and 40.5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. CONCLUSIONS: Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment.

[Neuropsychological impairment in patients with intracranial aneurysms: surgical versus endovascular treatment]. / Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular.

OBJECTIVES: To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. MATERIAL AND METHODS: Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. RESULTS: Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better in patients treated by embolization. CONCLUSIONS: Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments.

Plasmatic beta-endorphin levels and thalamic surgery for pain.

Plasma beta-endorphin levels were found to be significantly lower in patients suffering from chronic pain of malignant etiology than in a control group. After a bilateral stereotactic cryothalamotomy in Centrum Medianum and Parafascicularis nuclei, a good clinical result and a significant increase in plasma beta-endorphin levels were obtained.

Correlation between plasmatic and CSF beta-endorphin levels.

Fifty-four concomitant pairs of plasma and ventricular CSF samples were obtained in eighteen patients taking advantage of some neuroradiological or therapeutical procedures. A significant linear correlation between plasma and CSF beta-Endorphin levels has been found. The results obtained and those of other papers on the subject are discussed.

False positive thallium-201 SPECT imaging in brain abscess.

Three cases of intracranial 201Tl uptake, reported as positive tumour activity in patients with a final diagnosis of abscess, are described. 201Tl has been proposed as a useful oncotropic radiotracer in the diagnosis of brain tumour activity. These cases suggest a note of caution in the interpretation of 201Tl brain images in the differential diagnosis of an intracranial expanding mass.

Isolated primary Langerhans' cell histiocytosis of central nervous system.

Solitary eosinophilic granuloma that involves the CNS is an uncommon lesion and most frequently affects the hypothalamus. We report a new and rare case of solitary eosinophilic granuloma of the left temporal lobe in a patient without systemic disease. The diagnosis was confirmed by electron microscopy and immuohistochemical techniques. The treatment of choice is surgical resection. There is a better prognosis in comparison with cases accompanied by systemic disease.

[Cerebellopontine angle lipoma: clinical case]. / Lipoma del ángulo pontocerebeloso: caso clínico.

Lipomas of the cerebellopontine angle are extremely rare. These tumors are probably maldevelopment lesions which can cause slowly progressive neurological symptoms. Including the present case, 90 lipomas in this localization have been described in the literature. The authors report a case of cerebellopontine angle lipoma in a 44-year-old male patient who suffered right hearing loss and tinnitus during seven months. The literature concerning this rare cerebellopontine angle tumor is review. The symptoms, radiological features and surgical management are discussed.

[Melanocytic schwannoma. A case report and review of the literature]. / Schwannoma melanocítico. A propósito de un caso y revisión de la literatura.

INTRODUCTION AND CLINICAL CASE: We report a new unusual case of a patient without known familiar history of melanocytic schwannoma or Carney complex with multiple melanocytic schwannoma in the spinal canal. Histologically, the tumor was composed of irregular interlacing spindle-shaped cells with pigments. The diagnosis is made by immunohistochemical techniques and electron microscopy findings. CONCLUSION: We review the literature, and the different theories on the origin of these tumors are discussed.

[Central neurocytoma: analysis of three cases and review of the literature]. / Neurocitoma central: a propósito de tres casos y revisión de la literatura.

INTRODUCTION AND CLINICAL CASES: Three cases of central neurocytoma, confirmed by immunohistochemical study are reported. The central neurocytoma has recently been added to the differential diagnosis of intraventricular tumors. It is more frequent than previously thought, with high incidence in young patients. The positivity for synaptophysin and neuron specific enolase, the negativity for neurofilament protein and glial fibrillary acid protein, and the finding of elements of neuronal differentiation on electron microscopy, are the main pathological features of these tumors. CONCLUSION: The surgical treatment is the election, and radiotherapy is reserved for malignant cases or recurrence.

[The preservation of hearing in surgery for acoustic neurinoma]. / Conservación de la audición en la cirugía del neurinoma del acústico.

The surgical result in one patient with unilateral tumor of the cerebellopontine angle and internal auditory canal is presented. Total tumor removal and preservation of hearing was possible in spite of the size of the tumor. The authors make some considerations about the possibility to preserve a useful hearing in patients with this type of tumors.

Different patterns of medication change after subthalamic or pallidal stimulation for Parkinson's disease: target related effect or selection bias?

BACKGROUND: Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is favoured over bilateral globus pallidus internus (Gpi) DBS for symptomatic treatment of advanced Parkinson's disease (PD) due to the possibility of reducing medication, despite lack of definitive comparative evidence. OBJECTIVE: To analyse outcomes after one year of bilateral Gpi or STN DBS, with consideration of influence of selection bias on the pattern of postsurgical medication change. METHODS: The first patients to undergo bilateral Gpi (n = 10) or STN (n = 10) DBS at our centre were studied. They were assessed presurgically and one year after surgery (CAPIT protocol). RESULTS: Before surgery the Gpi DBS group had more dyskinesias and received lower doses of medication. At one year, mean reduction in UPDRS off medication score was 35% and 39% in the Gpi and STN groups, respectively (non-significant difference). Dyskinesias reduced in proportion to presurgical severity. The levodopa equivalent dose was significantly reduced only in the STN group (24%). This study high-lights the absence of significant differences between the groups in clinical scales and medication dose at one year. In the multivariate analysis of predictive factors for off-state motor improvement, the presurgical levodopa equivalent dose showed a direct relation in the STN and an inverse relation in the Gpi group. CONCLUSION: Differences in the patterns of medication change after Gpi and STN DBS may be partly due to a patient selection bias. Both procedures may be equally useful for different subgroups of patients with advanced PD, Gpi DBS especially for patients with lower threshold for dyskinesia.

The fine structure of choroid plexus carcinoma.

The ultrastructural findings of two cases of choroid plexus carcinoma occurring in infants 11 and 24 months old are discussed. Both had a similar ultrastructural pattern which demonstrated a clear polygonal cytoplasm, cell polarity towards the lumina, junctional complexes and evidence of a basement membrane, all of which point to an epithelial origin for the proliferating cells. Abundant immature cellular characters such as polyribosomes, glycogen granules and hypertrophied rough endoplasmic reticulum were found. The importance of the differential diagnosis from ependymoblastoma and benign choroid plexus papilloma is emphasized. In the former, the major differentiating features are the existence of abundant glial neuropil and cellular characters of glial differentiation, whilst in the latter, cytoplasmic features demonstrate cellular maturity.

[Clinical utility of deep brain stimulation in an advanced Parkinson's disease]. / Utilidad clínica de la estimulación cerebral profunda en la enfermedad de Parkinson avanzada.

INTRODUCTION: Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) have demonstrated efficacy in advanced Parkinson's disease (PD). We aimed to assess the clinical utility of these procedures in terms of the quality of life, and to determine the pre and postsurgical characteristics related to the outcome. METHOD: A prospective study was conducted on a cohort of 20 patients with advanced PD who underwent bilateral DBS: 14 in STN and 6 in GPi. They were assessed according to the CAPSIT-PD protocol before and after surgery, with a mean follow-up of 9 and 11 months, respectively. The main outcome variables were change in the UPDRS III score in off efficacy and the PDQ-39 quality of life questionnaire score (clinical utility). RESULTS: The STN group improved their UPDRS III in off by a mean of 35% (p = 0.001) and their PDQ-39 by 21% (p = 0.026). The GPi group improved their UPDRS III in off by 21% (p = 0.028) and their PDQ-39 by 37% (p = 0.116). The presurgical levodopa-equivalent dose was a positive predictor of the efficacy and clinical utility of STN DBS and a negative predictor of the efficacy of GPi DBS. In both groups, the clinical utility was determined by improvement in functional disability in off scales. CONCLUSIONS: Bilateral DBS demonstrated middle-term efficacy and clinical utility in the treatment of advanced PD. The presurgical levodopa-equivalent dose was a predictor of the efficacy and clinical utility of DBS.

Linear accelerator radiosurgery in treatment of central neurocytomas.

OBJECTIVES: The purpose of this report was to review our experience with stereotactic radiosurgery in the management of patients with residual neurocytomas after initial surgery. METHODS: Between October 1996 and December 2001, four patients with central neurocytoma were treated by surgery and subsequently underwent linear accelerator (LINAC) radiosurgery. RESULTS: Two of the patients were cured, one exhibited a significant reduction in tumour size and the fourth remains stable. All four patients are alive and well. CONCLUSIONS: In cases of small residual tumours or recurrences radiosurgery allows open surgery to be avoided and is a safe and potentially effective approach.

Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular / Quality of life in intracranial aneurysm: surgery versus endovascular treatment

Objetivo. Basados en estudios anteriores, nuestro propósito es determinar la calidad de vida de los pacientes con aneurismas intracraneales después de haber sido intervenido mediante cirugía o embolización y comparar la calidad de vida de estos dos grupos. Material y métodos. El cuestionario SF-36 fue aplicado retrospectivamente a 93 pacientes con aneurismas tratados mediante cirugía (n=56) o embolización (n=37). Resultados. La calidad de vida de los pacientes tratados con cirugía estaba deteriorada en el 50% y en los pacientes tratados por embolización el 40,5% no mostraron ningún deterioro en ninguno de los dominios delSF-36. Los análisis muestran que el dominio de la función física está menos deteriorada en los pacientes que han sido embolizados que los que han sido intervenidos quirúrgicamente. Conclusiones. Los pacientes con aneurismas intracraneales tratados mediante cirugía o embolización tienen afectada la calidad de vida. El tratamiento endovascular puede causar menos limitaciones en la función física. En la calidad de vida de estos pacientes influyen varios factores, además del tipo de tratamiento

Background. Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. Methods. The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization(n=37).Results. The quality of life of some patients was impaired but 50% of patients treated with surgery and40,5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. Conclusions. Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment

Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular / Neuropsychological impairment in patients with intracraneal aneurysms: surgical versus endovascular treatment

Objetivos. Describir el rendimiento neuropsicológico de pacientes con aneurismas cerebrales que han sido tratados mediante cirugía o embolización, y determinarla existencia de diferencias en función de la modalidad de tratamiento. Material y métodos. Serie clínica compuesta por 93pacientes voluntarios, con aneurismas cerebrales, tratados mediante cirugía (n = 56) o embolización (n = 37). A ambos grupos se les realizó una evaluación neuropsicológica retrospectiva, al menos un año después de realizar el tratamiento. Resultados. En ambos grupos se encontraron pacientes con déficit neuropsicológicos. En el grupo de pacientes tratados quirúrgicamente el porcentaje de pacientes sin ninguna afectación neuropsicológica es del 35.7%, mientras que en el grupo de pacientes embolizados este porcentaje asciende al 43.2%. Los análisis muestran una ejecución mejor en el grupo de tratamiento endovascular, respecto al quirúrgico, sólo en memoria visual y en el recuerdo con claves de la memoria verbal. Conclusiones. Años después del tratamiento, un importante porcentaje de pacientes presenta alteraciones neuropsicológicas. El tratamiento endovascular se asocia con un mejor rendimiento en memoria visual yen el recuerdo con claves de la memoria verbal, aunque explica un porcentaje muy escaso de la varianza. Por lo tanto, en la explicación del deterioro neuropsicológico parece más importante el propio efecto de la hemorragia que la modalidad de intervención

Objectives. To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. Material and methods. Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. Results. Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better inpatients treated by embolization. Conclusions. Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments