[Isocitrate dehydrogenase type I mutation as a prognostic factor in glioblastoma and a literature review]. / Importancia de la mutación de la isocitrato deshidrogenasa tipo I como factor pronóstico en pacientes con glioblastomas y revisión de la literatura.

OBJECTIVE: Treatment response and prognosis in glioblastoma (GBM) tumours can differ among patients, highlighting the growing relevance of genetic biomarkers to differentiate glioblastoma sub-types. The biomarker isocitrate dehydrogenase (IDH1) is currently receiving considerable attention. The objective of this work was to analyse the clinical and prognostic differences between glioblastomas with and without the IDH1 mutation. METHODS: A retrospective study was performed on patients with GBM who underwent surgery between 2007 and 2012. The inclusion criteria were: patient age between 18-85 years who underwent surgery for the first time with complete macroscopic resection, complete adjuvant treatment with chemotherapy and radiotherapy, and a Karnofsky performance score>70. RESULTS: A total of 61 patients (36 males/25 famales) were included and with a mean age of 62.3 years. An IDH1mutation was found in 14 patients (23%). Median survival in patients with the IDH1 mutation (IDH1-m) was 23.6 months compared with 11.9 months in those with the wild type IDH1 (IDH1-wt) (P=.028). Disease onset in IDH1-m patients tended to be at a younger age, 58.7 vs. 63.4 years, but this difference was not statistically significant. CONCLUSION: Glioblastomas with IDH1-m should be considered a different entity from the IDH1-wt, as their natural history and prognosis differ. In the near future we should be classified glioblastomas based on the presence of the IDH1 mutation.

[Spinal cord metastasis from gliosarcoma. Case report and review of the literature]. / Metástasis medulares de gliosarcoma. Presentación de un caso y revisión de la literatura.

INTRODUCTION: Gliosarcoma is a rare neoplasm of the central nervous system, similar to glioblastoma multiforme. In contrast to glioblastoma, it is characterised by its propensity for extracranial metastasis (11% of the cases) due to its sarcomatous component. Intramedullary metastasis from primary gliosarcoma is extremely rare. CASE REPORT: A patient who had surgery for primary cerebral gliosarcoma developed paraparesis during the course of the disease. A magnetic resonance image showed an intramedullary spinal cord metastasis requiring surgical treatment. This article reviews the literature on intramedullary spinal cord metastasis from gliosarcoma, and highlights the characteristics, treatment and overall survival. CONCLUSIONS: Only 4 cases of intramedullary gliosarcoma metastasis are described in the literature. This extremely rare entity should be suspected with the onset of spinal cord symptoms during the course of primary cerebral gliosarcoma.

[Sclerosing epithelioid fibrosarcoma of the paravertebral column. Case report and literature review]. / Fibrosarcoma epitelioide esclerosante a nivel paraespinal. Caso clínico y revisión de la literatura.

Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low-grade fibrosarcoma, with specific histological and immunohistochemical features and a poor prognosis. We report a case of SEF of the paravertebral column in a 49-year old male who presented a paraspinal mass with extension into the L4-L5 neural foramen and invasion of the L5 nerve root. Histology of the tumourectomy specimen and its immunohistochemical study led to the diagnosis of SEF. This case was particularly unusual due to its paravertebral column location and, despite its low grade, illustrates the malignant potential of SEF.

Long-term outcomes of deep brain stimulation for treatment-resistant schizophrenia: Exploring potential targets.

BACKGROUND: Schizophrenia is a complex and disabling disorder. Around 30% of patients have treatment-resistant schizophrenia (TRS). OBJECTIVE: This study summarizes the outcomes after three years follow-up of the first series of patients with TRS treated with deep brain stimulation (DBS) and discuss surgical, clinical and imaging analysis. METHODS: Eight patients with TRS treated with DBS in the nucleus accumbens (NAcc) or the subgenual cingulate gyrus (SCG) were included. Symptoms were rated with the PANSS scale and normalized using the illness density index (IDI). A reduction in IDI-PANSS of ≥25% compared to baseline was the criterion of good response. The volume of activated tissue was calculated to perform a connectomic analysis for each patient. An estimation of the tracts and cortical areas modulated was generated. RESULTS: Five women and three men were analyzed. After 3 years' follow-up, positive symptoms improved in 50% of the SCG group and 75% of the NAcc group (p = 0.06), and general symptoms improved in 25% and 50% respectively (p = 0.06). The SCG group showed activation of the cingulate bundle and modulation of orbitofrontal and frontomesial regions; in contrast, the NAcc group showed activation of the ventral tegmental area projections pathway and modulation of regions associated with the "default mode network" (precuneus) and Brodmann areas 19 and 20. CONCLUSIONS: These results showed a trend toward improvement for positive and general symptoms in patients with TRS treated with DBS. The connectomic analysis will help us understand the interaction of this treatment with the disease to pursue future trial designs.

The big data era: The usefulness of folksonomy for natural language processing.

BACKGROUND: A huge amount of clinical data is generated daily and it is usually filed in clinical reports as natural language. Data extraction and further analysis requires reading and manual review of each report, which is a time consuming process. With the aim to test folksonomy to quickly obtain and analyze the information contained in media reports we set up this study. METHODS AND OBJECTIVES: We have used folksonomy to quickly obtain and analyze data from 1631 discharge clinical reports from the Nephrology Department of Hospital del Mar, without the need to create a structured database. RESULTS: After posing some questions related to daily clinical practice (hypoglycaemic drugs used in diabetic patients, antihypertensive drugs and the use of renin angiotensin blockers during hospitalization in the nephrology department and data related to emotional environment of patients with chronic kidney disease) this tool has allowed the conversion of unstructured information in natural language into a structured pool of data for its further analysis. CONCLUSIONS: Folksonomy allows the conversion of the information contained in clinical reports as natural language into a pool of structured data which can be further easily analyzed without the need for the classical manual review of the reports.

Long-Term Results of Deep Brain Stimulation for Treatment-Resistant Depression: Outcome Analysis and Correlation With Lead Position and Electrical Parameters.

BACKGROUND: Long-term efficacy and mechanisms of action of deep brain stimulation (DBS) for treatment-resistant depression (TRD) are under investigation. OBJECTIVE: To compare long-term outcomes with active electrode's coordinates and its electrical parameters in patients with TRD treated with DBS in the subgenual cingulate gyrus (SCG-DBS). METHODS: Seventeen patients with TRD underwent SCG-DBS. Demographic and baseline characteristics were recorded. The 17-item Hamilton Depression Rating Scale was used to measure the response to the therapy. The anterior commissure-posterior commissure coordinates of the active contacts and the total electrical energy delivered were calculated and correlated with clinical outcomes. Patient-specific tractographic analysis was performed to identify the modulated pathways in responders. RESULTS: Twelve women (70.6%) and 5 men (29.4%) with a median age of 48 yr (34-70 years) were included. Along the 5-year follow-up, 3 main clinical trajectories were observed according to symptom's improvement: great responders (≥80%), medium responders (≥50%-79%), and poor responders (<50%). Active contacts' coordinates and total electrical energy delivered showed no correlation with clinical outcomes. Brodmann area 10 medial was the most frequently stimulated area and the forceps minor, the most frequently modulated tract. CONCLUSION: SCG-DBS for TRD is clearly effective in some patients. Active contacts' coordinates were highly variable within the region and, like electrical parameters, did not seem to correlate with clinical outcomes. In the current series, Brodmann area 10 medial and the forceps minor were the most frequently targeted area and modulated pathway, respectively.

Neuronavigated Ultrasound in Neuro-Oncology: A True Real-Time Intraoperative Image.

OBJECTIVE: Ultrasound is considered a real-time imaging method in neuro-oncology because of its highly rapid image acquisition time. However, to our knowledge, there are no studies that analyze the additional surgical time that it requires. METHODS: A prospective study of 100 patients who underwent intra-axial brain tumor resection with navigated intraoperative ultrasound. The primary outcomes were lesion visibility grade on ultrasound and concordance with preoperative magnetic resonance imaging (MRI) scan, intraoperative ultrasound usage time, and percentage of tumor resection on ultrasound and comparison with postoperative MRI scan. RESULTS: The breakdown of patients included the following: 53 high-grade gliomas, 26 metastases, 14 low-grade gliomas, and 7 others. Ninety-six percent of lesions were clearly visualized. The tumor border was clearly delimited in 71%. Concordance with preoperative MRI scan was 78% (P < 0.001). The mean time ± SD for sterile covering of the probe was 2.16 ± 0.5 minutes, and the mean image acquisition time was 2.49 ± 1.26 minutes. Insular tumor location, low-grade glioma, awake surgery, and recurrent tumor were statistically associated with an increased ultrasound usage time. Ultrasound had a sensitivity of 94.4% and a specificity of 100% for residual tumor detection. CONCLUSIONS: Neuronavigated ultrasound can be considered a truly real-time intraoperative imaging method because it does not increase surgical time significantly and provides optimal visualization of intra-axial brain lesions and residual tumor.

Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time.

OBJECTIVE: Occipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments. METHODS: The authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications. RESULTS: The ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31-61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7-70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29-64 years). The median NAw before surgery was 56 (range 14-140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253). CONCLUSIONS: ONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

Application of a Thrombin-Gelatin Matrix in the Management of Intractable Hemorrhage During Stereotactic Biopsy.

BACKGROUND: Few studies have been published about percutaneous techniques for management of surgical bed hemorrhage during a stereotactic biopsy, a serious complication that may affect patient outcome. We describe the injection of a thrombin-gelatin matrix through the biopsy cannula as an effective method to arrest surgical bed bleeding that does not respond to conventional methods of hemostasis. METHODS: We prospectively documented image-guided stereotactic brain biopsy procedures in 30 awake patients between July 2014 and July 2017 at our center. Among patients presenting with intractable surgical bed bleeding, a thrombin-gelatin matrix injection through the biopsy cannula was performed. Details of the injection technique, surgical outcome, and complications were recorded. RESULTS: Among 30 documented stereotactic brain biopsies, 3 (10%) had intractable surgical bed bleeding during the procedure. In all 3 cases, thrombin-gelatin matrix was injected, and an immediate arrest of hemorrhage was achieved. None of the patients required a craniotomy or further invasive measure to achieve hemostasis. No postoperative complications were recorded. CONCLUSIONS: Our preliminary results suggest that thrombin-gelatin matrix injection is a simple, safe, and effective stereotactic practice to manage persistent surgical bed bleeding that cannot be arrested by standard, conventional hemostatic methods.

Efficacy of Sphenopalatine Ganglion Radiofrequency in Refractory Chronic Cluster Headache.

BACKGROUND: In the literature, there are only short series of radiofrequency of the sphenopalatine ganglion (SPG) to treat chronic refractory cluster headache (CCHr) with variable results. Furthermore, there is no consensus on which methodology to use: radiofrequency ablation (RFA) or pulsed radiofrequency (PRF). METHODS: We conducted a prospective analysis of 37 patients with CCHr who underwent RFA or PRF of the SPG in our center between 2004 and 2015. RESULTS: The mean age of the patients was 40 years (range, 26-59 years). PRF was performed in 24 patients, and RFA was performed in 13 patients. A total of 5 patients (13.5%) experienced complete clinical relief of both pain and parasympathetic symptoms, 21 patients (56.8%) had partial and transient relief, and 11 patients (29.7%) did not improve. There was no evidence of significant superiority of one radiofrequency modality over the other (P = 0.48). There were no complications associated with the technique. The passage of time tended to decrease the efficacy of both techniques (P < 0.001). The mean follow-up was 68.1 months (range, 15-148 months). To our knowledge, this is the series with the largest number of patients and the longest follow-up period published in the literature. CONCLUSIONS: Radiofrequency of the SPG is a safe, fast, and partially effective method for the treatment of CCHr. Given its low rate of complications and its low economic cost, we think it should be one of the first invasive treatment options, prior to techniques with greater morbidity and mortality, such as neuromodulation.

Extradural anterior clinoidectomy in the management of parasellar meningiomas: Analysis of 13 years of experience and literature review. / Clinoidectomía anterior extradural en el manejo de meningiomas paraselares: análisis de 13 años de experiencia y revisión de la literatura.

BACKGROUND AND AIM: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. MATERIALS AND METHODS: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done. A total of 53 patients were recorded. We analized our series focusing on visual outcomes, resection rates and complications. Through an extensive bibliographic research, we discussed the advantages and disadvantages of the EAC, technical considerations, comparison with the intradural clinoidectomy and its visual impact. RESULTS: The most frequent tumors were anterior clinoidal meningiomas (33.9%). The most common initial symptoms were decreased visual acuity (45.3%) and headache (22.6%). A gross total resection was achieved in 67.9%, being subtotal in the remaining 32.1%. Regarding the visual deficits 67.9% of the patients presented clinical stability, 22.6% improvement and 9.4% worsening. The degree of tumor resection did not significantly influence post-surgical visual outcomes, either visual acuity (P=.71) or campimetric alterations (P=.53). 24.5% of the patients experienced iiinerve transient paresis and 1.9% permanent. The postoperative cerebrospinal fluid leak rate was 3.8%. Mortality rate was 0%. The mean follow-up was 82.3 months. CONCLUSIONS: In our experience, EAC is a safe technique that facilitates the resection of the meningiomas located in the parasellar area, helps to achieve early tumor devascularization, reduces the need for retraction of the cerebral parenchyma and could play a positive role in the preservation of visual function and the appearance of tumor recurrences in the anterior clinoid process (ACP).

Absence of neurovascular conflict during microvascular decompression while treating essential trigeminal neuralgia. How to proceed? Systematic review of literature. / Ausencia de conflicto neurovascular durante la microdescompresión vascular en el manejo de la neuralgia trigeminal esencial: ¿qué hacer? Revisión sistemática de la literatura.

INTRODUCTION: Neurovascular conflict is the most accepted hypothesis for the cause for trigeminal neuralgia. Microvascular decompression of the trigeminal nerve is the most common surgical treatment for these patients. However, despite advances in diagnostic techniques, neurovascular conflict is sometimes not detected during surgery. The aim of this paper is to systematically review all the options available to best manage this scenario. RESULTS: Several techniques that could be used during microvascular decompression for trigeminal neuralgia in the absence of neurovascular conflict have been described. The success rates of these techniques, pain recurrence rates and rates of complications are also reported. Finally, we provide suggestions based on our experience. CONCLUSIONS: There is no gold standard, but several techniques could be successfully used in the absence of neurovascular conflict. The use of destructive techniques, such as PSR, should be held as treatments of last resort.

La era del big data: análisis del lenguaje natural mediante la aplicación de folksonomía / The big data era: The usefulness of folksonomy for natural language processing

Antecedentes y objetivo: Gran parte de la información médica que se deriva de la práctica clínica habitual queda recogida en forma de lenguaje natural en los informes médicos. Clásicamente, la extracción de información clínica para su posterior análisis a partir de los informes médicos requiere de la lectura y revisión manual de cada uno de ellos con la consiguiente inversión de tiempo. El objetivo de este proyecto piloto ha sido evaluar la utilidad de la folksonomía para la extracción y análisis rápido de los datos que contienen los informes médicos. Material y métodos: En este proyecto piloto hemos utilizado la folksonomía para el análisis y la rápida extracción de datos de 1.631 informes médicos de alta de hospitalización del Servicio de Nefrología del Hospital del Mar sin necesidad de crear una base de datos estructurada previamente. Resultados: A partir de determinadas preguntas sobre la práctica médica habitual (tratamiento hipoglicemiante de los pacientes diabéticos, tratamiento antihipertensivo y manejo de los inhibidores del sistema renina angiotensina durante el ingreso en nefrología y análisis de datos relacionados con la esfera emocional de los pacientes renales) la herramienta ha permitido estructurar y analizar la información contenida en texto libre en los informes de alta. Conclusiones: La aplicación de folksonomía a los informes médicos nos permite transformar la información contenida en lenguaje natural en una serie de datos estructurados y analizables de manera automática sin necesidad de proceder a la revisión manual de los mismos. (AU)

Background: A huge amount of clinical data is daily generated and it is usually filed in clinical reports as natural language. Data extraction and further analysis requires reading and manual review of each report, which is a time consuming process. With the aim to test folksonomy to quickly obtain and analyze the information contained in medial reports we set up this study. Methods and objectives:We have used folksonomy to quickly obtain and analyse data from 1631 discharge clinical reports from Nephrology Department of Hospital del Mar, without the need to create an structured database. Results: After posing some questions related to daily clinical practice (hypoglycaemic drugs used in diabetic patients, antihypertensive drugs and the use of renin angiotensin blockers during hospitalisation in the nephrology department and data related to emotional environment of patients with chronic kidney disease) this tool has allowed the conversion of unstructured information in natural language into a structured pool of data for its further analysis. Conclusions: Folksonomy allows the conversion of the information contained in clinical reports as natural language into a pool of structured data which can be further easily analysed without the need of the classical manual review of the reports. (AU)

[Complications related with implanted devices in patients with Parkinson's disease treated with deep brain stimulation. A study of a series of 124 patients over a period of 16 years]. / Complicaciones relacionadas con dispositivos implantados en pacientes con enfermedad de Parkinson tratados con estimulacion cerebral profunda. Estudio de una serie de 124 pacientes durante 16 años.

INTRODUCTION: Establishing protocols of the best candidates for deep brain stimulation in patients with Parkinson's disease and a greater knowledge of the technique have increased its safety profile. Yet, the complications related with implanted devices still occur with a far-from-negligible frequency and have both an economic and clinical impact. AIM: From a broad series of patients undergoing deep brain stimulation included consecutively for the treatment of their Parkinson's disease, data concerning the complications related with implanted devices were gathered and compared with those in the literature. PATIENTS AND METHODS: Altogether 124 patients with a total of 242 implanted electrodes and 252 generator replacements were included in the study. Mean follow-up time was 8.4 years (range: 3-16 years). Data on all the complications related with implanted devices were collected retrospectively. RESULTS: Findings showed that 23 implanted device-related complications occurred (17.7% of the patients): 12 (9.6%) had culture-positive ulcers, five (4%) had culture-negative ulcers, four (3.2%) were left with infections following generator replacement, one (0.8%) had a generator malfunction, and electrode migration took place in one (0.8%). Significant differences were observed as regards the effectiveness of the treatment involving surgical revision of the ulcers, which suggests that the culture-negative ulcers responded to the surgical revision better than the culture-positive ulcers (80% healing versus 16.6%; p = 0.028). CONCLUSIONS: The results observed in the series were comparable to those in the existing literature. The presence of culture-positivity in the ulcers is a factor forecasting surgical revision.

TITLE: Complicaciones relacionadas con dispositivos implantados en pacientes con enfermedad de Parkinson tratados con estimulacion cerebral profunda. Estudio de una serie de 124 pacientes durante 16 años.Introduccion. La protocolizacion de los mejores candidatos para la estimulacion cerebral profunda en pacientes con enfermedad de Parkinson y el mayor conocimiento de la tecnica han aumentado su perfil de seguridad. Sin embargo, las complicaciones relacionadas con los dispositivos implantados siguen teniendo una frecuencia no menospreciable y presentan un impacto tanto clinico como economico. Objetivo. En una serie amplia de pacientes con estimulacion cerebral profunda incluidos consecutivamente para el tratamiento de su enfermedad de Parkinson, se recogieron las complicaciones relacionas con los dispositivos implantados y se compararon con la bibliografia. Pacientes y metodos. Se incluyeron en el estudio 124 pacientes con un total de 242 electrodos implantados y 252 recambios de generador. Seguimiento medio de 8,4 años (rango: 3-16 años). Se recogieron de forma retrospectiva todas las complicaciones relacionadas con los dispositivos implantados. Resultados. Se produjeron 23 complicaciones relacionadas con los dispositivos implantados (el 17,7% de los pacientes): 12 (9,6%) ulceras con cultivo positivo, cinco (4%) ulceras con cultivo negativo, cuatro (3,2%) infecciones tras recambio de generador, una (0,8%) malfuncion de generador y una (0,8%) migracion del electrodo. Se observaron diferencias significativas respecto a la efectividad del tratamiento de la revision quirurgica de las ulceras, lo que indica que las ulceras con cultivo negativo respondieron mejor que las ulceras con cultivo positivo a la revision quirurgica (80% frente a 16,6% de curacion; p = 0,028). Conclusiones. Se observan en la serie unos resultados comparables a la bibliografia existente. La presencia de positividad en el cultivo de las ulceras constituye un factor pronostico a la revision quirurgica.

Hemorragia subaracnoidea no aneurismática secundaria a panarteritis nodosa en edad pediátrica: caso clínico / Non-aneurysmal subarachnoid haemorrhage secondary to panarteritis nodosa at paediatric age: a case report

Introducción. La panarteritis nodosa es una vasculitis necrotizante que afecta de manera predominante a arterias de pequeño y mediano calibre de la piel y los órganos internos. La afectación neurológica sucede en un 25% de casos: los ictus isquémicos son relativamente frecuentes, pero las lesiones hemorrágicas resultan extremadamente raras. La hemorragia subaracnoidea es una expresión poco común de la enfermedad, asociada la inmensa mayoría de las veces a patología aneurismática. En nuestro conocimiento, sólo existe otro caso descrito de panarteritis nodosa con hemorragia subaracnoidea en la edad pediátrica sin patología aneurismática subyacente. Caso clínico. Niña de 7 años que presentó una hemorragia subaracnoidea no aneurismática con extensión intraparenquimatosa a los ganglios basales izquierdos. Previamente se había diagnosticado panarteritis nodosa y enfermedad protrombótica, en tratamiento con fármacos inmunodepresores y antiagregantes en ese momento. Conclusiones. Las características clínicas de la panarteritis nodosa, junto con el tratamiento antiagregante para prevenir la enfermedad tromboembólica en nuestra paciente, podrían haber predispuesto al evento hemorrágico en el proceso de la vasculitis cerebral. El manejo estándar de la hemorragia subaracnoidea es necesario en estos casos debido a que los aneurismas cerebrales son la causa más común de hemorragia subaracnoidea en un contexto de panarteritis nodosa

Introduction. Polyarteritis nodosa is a necrotizing vasculitis that mainly affects small and medium-sized arteries in skin and internal organs. Neurological involvement is reported in around 25% of cases: ischemic stroke is relatively common, but haemorrhagic lesions are extremely rare. Subarachnoid haemorrhage in polyarteritis nodosa is an uncommon expression of this disease, mostly associated with aneurism rupture. To the best of the authors’ knowledge, there is just one published case in pediatric age with polyarteritis nodosa and subarachnoid haemorrhage with no underlying aneurismal disease. Case report. A 7-year-old girl, who presented a non-aneurismal subarachnoid haemorrhage with intraparenchymal extension in the left basal ganglia. She was previously diagnosed with polyarteritis nodosa and prothrombotic condition, being under immunosuppressive and anti-platelet treatment at that moment. Conclusions. The clinical features of polyarteritis nodosa together with continued anti-platelet therapy to prevent thromboembolic disease in this patient could have predisposed to the haemorrhagic event in the process of cerebral vasculitis. Standard subarachnoid haemorrhage management is initially required in such cases as cerebral aneurysms are the most common cause of haemorrhage in the context of polyarteritis nodosa disease

Endoscopic surgery in the skull base unit: experience in the first 72 cases.

INTRODUCTION: A multidisciplinary team is essential to develop and expand the indications in endonasal endoscopic skull base surgery. The aim of this study was to present our experience in a group of patients with skull base lesions treated using endonasal endoscopic approach. METHODS: From January 2008 to January 2012, 72 patients with skull base involvement were diagnosed and treated in our centre. RESULTS: The mean patient age was 53 years. The different pathologies included 36 pituitary adenomas, 10 cerebrospinal fluid leaks and 5 inverted papillomas as the most frequent pathologies. We performed a transsphenoidal transellar approach in 45 cases, a transmaxillary transpterygoid approach in 4 cases and a transnasal expanded approach in 6 cases. We performed an ethmoidal/sphenoidal approach in 12 patients and a Draf IIb/III procedure in four cases. Total resection was achieved in 61% of patients with pituitary adenomas, subtotal in 22% and partial in 17%. Successful repair was achieved in 86% of CSF leaks. No recurrences were observed in patients with inverted papilloma. Complications were observed in 21 patients (29%), 6 being major complications. CONCLUSIONS: Our centre stresses the importance of multidisciplinary collaboration in endoscopic endonasal skull base surgery.

[Stimulation of the occipital nerve in the treatment of drug-resistant cluster headache]. / Estimulación del nervio occipital para la cefalea en racimos refractaria al tratamiento farmacológico.

AIM: To evaluate the occipital nerve stimulation therapy in as a treatment for drug-resistant cluster headache. PATIENTS AND METHODS: Prospective study of four patients, three males and one female. Mean age of 42 years. Patients complained of a cluster headache lasting between one and 16 years, with suboptimal control of the attacks with medication. In all cases octopolar electrodes were placed percutaneously in the occipital region bilaterally. Follow-up of 6 months. RESULTS: At 6 months, there was a 56% (range: 25-95%) reduction in the frequency, a 48.8% (range: 20-60%) decrease in the intensity and a 63.8% (range: 0-88.8%) reduction in the duration of the attacks. Worsening or progression of the illness was not observed in any case. All patients referred a 15.4% (range: 6-31.5%) improvement in their quality of life compared to their previous basal situation in SF-36. In all cases but one there was a significant reduction in the amount and dosage of medication required. Postoperative complications were not observed. All patients would recommend the procedure. CONCLUSIONS: Occipital nerve stimulation may be considered a safe and effective therapeutic option in the drug-resistant cluster headache. However, studies with more patients and a longer follow-up are required to evaluate the efficacy of the technique.

Ausencia de conflicto neurovascular durante la microdescompresión vascular en el manejo de la neuralgia trigeminal esencial: ¿qué hacer? Revisión sistemática de la literatura / Absence of neurovascular conflict during microvascular decompression while treating essential trigeminal neuralgia. How to proceed? Systematic review of literature

Introducción: La presencia de conflicto neurovascular es la hipótesis aceptada en el desarrollo de la neuralgia trigeminal y la microdescompresión vascular, la técnica quirúrgica más empleada en su tratamiento. Sin embargo, pese a los avances diagnósticos, en ocasiones dicho conflicto es indetectable intraoperatoriamente. El objetivo de este trabajo es revisar sistemáticamente las opciones de manejo ante dicha situación. Resultados: Existen diversas técnicas descritas que se pueden emplear ante la ausencia de conflicto neurovascular durante una microdescompresión vascular. Describimos dichas técnicas, sus tasas de éxito, la recurrencia del dolor y de complicaciones, y damos nuestras recomendaciones sobre la materia. Conclusiones: No existe un consenso terapéutico, pero se dispone de diversas opciones quirúrgicas ante la ausencia de conflicto neurovascular. Creemos que las técnicas destructivas como la RPS deben relegarse a última línea terapéutica

Introduction: Neurovascular conflict is the most accepted hypothesis for the cause for trigeminal neuralgia. Microvascular decompression of the trigeminal nerve is the most common surgical treatment for these patients. However, despite advances in diagnostic techniques, neurovascular conflict is sometimes not detected during surgery. The aim of this paper is to systematically review all the options available to best manage this scenario. Results: Several techniques that could be used during microvascular decompression for trigeminal neuralgia in the absence of neurovascular conflict have been described. The success rates of these techniques, pain recurrence rates and rates of complications are also reported. Finally, we provide suggestions based on our experience. Conclusions: There is no gold standard, but several techniques could be successfully used in the absence of neurovascular conflict. The use of destructive techniques, such as PSR, should be held as treatments of last resort