Meningoencephalitis due to Mycobacterium lentiflavum in an immunocompromised patient: Case report.

The first case of meningoencephalitis due to Mycobacterium lentiflavum in an immunocompromised patient is reported. Clinical and radiological characteristics are described, as well as the treatment and prognosis of the patient.

Gamma Knife radiosurgery and refractory glossopharyngeal neuralgia: a single-center series with long-term follow-up.

We present our experience with Gamma Knife surgery (GKS) and refractory glossopharyngeal neuralgia (GPN), analyzing its usefulness and safety in patients with or without previous surgeries, another concomitant neuralgia, or retreats. In addition, we study some factors that could condition the outcome of this technique. According to our review, our follow-up is the longest in the literature. We performed the prospective study of 8 patients submitted to GKS between 2008 and 2020. We employed the Leksell radiosurgery Gamma Knife system. The cases were evaluated before and after surgery (3, 6, 12 months and then annually). The VAS (Visual Analogue Scale) and BNI (Barrow Neurological Institute) scale were used. The data were assessed with SPSS25. Our series was composed of 6 (75%) women and 2 (25%) men, with an average age of 59.5 ± 14.04 years. Six patients (75%) had one or more than one previous surgeries. The median follow-up time was 7.22 ± 3.66 years (1.08-12.5 years). In the short-term postoperative period (1 year), eight patients (100%) experienced significant pain relief (VAS, p = 0.012; BNI I-IIIb). After the last interview, 5 patients felt pain relief (62.5%) (BNI grade I = 3; BNI grade IIIa = 2); 3 patients (37.5%) (BNI grade IV) were retreated (MVD, 2; GKS, 1). We found no association between patients with long evolution time of disease (p = 0.356), previous surgeries (p = 0.206), or vascular contact (p = 0.673) and worse clinical results after GKS. Both morbidity and mortality were 0%. Our results suggest that GKS for treating drug-resistant GPN with high initial doses is both a minimally invasive and useful and effective therapeutic strategy, without permanent complications. It presents good results even in patients with one or more previous surgical interventions. These findings encourage us to use this non-invasive technique as initial therapy against the invasive options.

Polyunsaturated Fatty Acid-Enriched Lipid Fingerprint of Glioblastoma Proliferative Regions Is Differentially Regulated According to Glioblastoma Molecular Subtype.

Glioblastoma (GBM) represents one of the deadliest tumors owing to a lack of effective treatments. The adverse outcomes are worsened by high rates of treatment discontinuation, caused by the severe side effects of temozolomide (TMZ), the reference treatment. Therefore, understanding TMZ's effects on GBM and healthy brain tissue could reveal new approaches to address chemotherapy side effects. In this context, we have previously demonstrated the membrane lipidome is highly cell type-specific and very sensitive to pathophysiological states. However, little remains known as to how membrane lipids participate in GBM onset and progression. Hence, we employed an ex vivo model to assess the impact of TMZ treatment on healthy and GBM lipidome, which was established through imaging mass spectrometry techniques. This approach revealed that bioactive lipid metabolic hubs (phosphatidylinositol and phosphatidylethanolamine plasmalogen species) were altered in healthy brain tissue treated with TMZ. To better understand these changes, we interrogated RNA expression and DNA methylation datasets of the Cancer Genome Atlas database. The results enabled GBM subtypes and patient survival to be linked with the expression of enzymes accounting for the observed lipidome, thus proving that exploring the lipid changes could reveal promising therapeutic approaches for GBM, and ways to ameliorate TMZ side effects.

Comparison of commercial 5-aminolevulinic acid (Gliolan®) and the pharmacy-compounded solution fluorescence in glioblastoma.

BACKGROUND: 5-Aminolevulinic acid (5-ALA) has become an important assistant in glioblastoma (GB) surgery. Unfortunately, its price affects its widespread use. OBJECTIVE: The aim of this study was to compare commercial 5-ALA with the pharmacy-compounded solution. METHODS: Using first an in vitro experimental approach, different concentrations of the pharmacy-compounded solution and commercial 5-ALA were tested in U87MG, LN229, U373, and T98G commercial glioblastoma cell lines. Fluorescence intensity was compared for each concentration by flow cytometry. Mean fluorescence of culture supernatant and lysate samples were analyzed. In a second phase, both preparations were used for surgical glioblastoma resection and tumor samples were analyzed by confocal microscopy. Mean fluorescence intensity was analyzed for each preparation and compared. RESULTS: There was a high variability of fluorescence intensity between cell lines, but each cell line showed similar fluorescence for both preparations (compounded preparation and commercial 5-ALA). In the same way, both preparations had similar fluorescence intensity in glioblastoma samples. CONCLUSION: Both, compounded and commercial 5-ALA preparations produce equivalent fluorescent responses in human glioblastoma cells. Fluorescence intensity is cell line specific, but fluorescent properties of both preparations are undistinguishable.

A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures.

PURPOSE: Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. METHODS: The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. RESULTS: The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. CONCLUSIONS: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.

Ileal signet-ring cell carcinoma with brain metastases: A case report.

Background: Signet-ring cell carcinoma (SRCC) is a rare subtype of adenocarcinoma that frequently originates in the stomach. Uncommonly, this tumor can lead to brain metastases; an event rarely reported in the literature. Case Description: A 76-year-old man with a history of cognitive impairment was diagnosed with two brain space-occupying lesions. A whole-body 18F-FDG PET/computed tomography scan revealed a hypermetabolic lesion in a segment of the ileum corresponding to mural thickening and an ulcerated lesion detected on colonoscopy. A brain biopsy, using an immunohistochemistry protocol, showed signet-ring cells with a pattern that suggested an intestinal origin. The diagnosis of SRCC brain metastases with an ileal origin was made, and a treatment protocol was designed. However, the patient rapidly deteriorated, and passed away shortly afterward. Conclusion: To the best of our knowledge, this is the first case report of an ileal SRCC with brain metastases.

Refractory anorexia nervosa in adulthood and nucleus accumbens deep brain stimulation.

Background: Anorexia Nervosa is a life-threatening mental illness with numerous consequences. Some cases are chronic and refractory to multiple treatments. Consequently, there is great interest in therapeutic alternatives that may improve severe patients. We present an adult patient with anorexia nervosa that underwent to bilateral nucleus accumbens deep brain stimulation (NAc-DBS). Case description: The patient was a healthy 46-year-old woman with higher education and an adequate premorbid socio-labour situation. Her disease had a late onset (25 years). The patient never presented clinical remission or weight stability. In recent years, the patient's body mass index (BMI) was 13.16 (32kg). The case was evaluated with multiple neuropsychological tests as well as the BMI before and after surgery. The clinical follow-up was 50 months. After bilateral NAc-DBS the patient experienced an important clinical benefit and significant improvement in neuropsychological tests and weight (BMI 17.28, 42 kg; 50th month) Programming: 4,5V, 130Hz, 210 µs. Conclusion: Despite the patient´s age and the long duration of the disease, our results suggest that bilateral nucleus accumbens stimulation may be a useful and effective therapeutic strategy for cases such as the one presented. Additionally, this case presents a surgical midlife patient with both the latest disease onset and the longest follow-up after treatment in the literature.

Related factors with diagnostic yield and intracranial hemorrhagic complications in frame-based stereotactic biopsy. Review.

The frame-based stereotactic biopsy is a minimally invasive technique that allows us to obtain a sample of brain tissue for subsequent diagnosis and treatment. The scope of this article is to review the published data related to the factors that could condition its diagnostic yield, and the appearance of post-biopsy hemorrhagic complications. PubMed search, last updated June 2020, was conducted using the terms "stereotactic biopsy", "diagnostic yield" and "intracranial post-biopsy hemorrhage". A total of 38 studies, that showed descriptive or analytical results, were included, and reviewed. Our literature review show that some characteristics of the lesion and surgical procedure peculiarities are significantly related with the effectiveness and safety of the technique. In this way, they must be taken into account in order to optimize its results.

Related factors with diagnostic yield and intracranial hemorrhagic complications in frame-based stereotactic biopsy. Review. / Factores condicionantes del rendimiento diagnóstico y las complicaciones hemorrágicas intracraneales en la biopsia estereotáctica con marco. Revisión.

The frame-based stereotactic biopsy is a minimally invasive technique that allows us to obtain a sample of brain tissue for subsequent diagnosis and treatment. The scope of this article is to review the published data related to the factors that could condition its diagnostic yield, and the appearance of post-biopsy hemorrhagic complications. PubMed search, last updated June 2020, was conducted using the terms "stereotactic biopsy", "diagnostic yield" and "intracranial post-biopsy hemorrhage". A total of 38 studies, that showed descriptive or analytical results, were included, and reviewed. Our literature review show that some characteristics of the lesion and surgical procedure peculiarities are significantly related with the effectiveness and safety of the technique. In this way, they must be taken into account in order to optimize its results.

Symptomatic intracranial hemorrhages and frame-based stereotactic brain biopsy.

BACKGROUND: Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the emergence of postbiopsy symptomatic intracranial hemorrhage. Based on our findings, we suggest recommendations to improve its usual clinical practice. METHODS: We made a retrospective study of 429 cases with stereotactic biopsies performed in the past 37 years. The surgical procedure-was adapted in terms of the stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs available in the hospital. Fifty-three variables were analyzed for each patient (SPSS.23). RESULTS: The diagnostic yield was 90.7%. Forty-one patients (9.5%) suffered a symptomatic postbiopsy hemorrhage; only 17 (3.9%) had permanent morbidity. The mortality was 0.93% (n = 4). A postsurgical CT scan was requested only in 99 patients (23%) of our series. Lesion mass effect, cystic component, contrast enhancement, histological nature, or number of targets were not associated with a greater risk of symptomatic postbiopsy hemorrhage (P > 0.05). On the other hand, the biopsies made by nonexpert neurosurgeons (P = 0.01) or under general anesthesia (P = 0.02) resulted in a greater risk of symptomatic postbiopsy hemorrhage. Anesthetic type was the clearest predictive factor of bleeding with this technique (OR: 0.24). CONCLUSION: Stereotactic biopsy is a very valuable tool. To optimize its safety and minimize the risk of intracranial bleeding, it requires both a knowledge of stereotactic techniques and very careful surgical planning. While the patient's stay in intensive vigilance units after the procedure is a useful strategy, the request for control CT scans should be conditioned by the clinical evolution of each patient.

Evolution of patients with surgically treated drug-resistant occipital lobe epilepsy.

BACKGROUND: This study was to describe the evolution of patients who underwent surgical treatment of drug- resistant occipital lobe epilepsy (OLE) at our institution. METHODS: We performed a retrospective analysis of data collected from electronic and paper clinical records of 20 patients who were diagnosed of OLE and underwent epilepsy surgery at our institution between 1998 and 2018. We also contacted patients by telephone and asked them to fill out a questionnaire about quality of life in epilepsy (QOLIE-10). Assembled data were analyzed using descriptive statistics. RESULTS: The age at surgery ranged between 19 and 55 years. The period encompassing epilepsy onset and the date of surgery was variable. Semiology of seizures included visual symptoms in 75% of patients. In 90% of cases subdural grids, depth electrodes or a combination of both were used to plan the surgery. The most frequent neuroimaging and histopathological finding was cortical dysplasia (55%). The postoperative follow-up period was up to 15 years. The most common score on the Engel scale was I (70%). Visual deficits increased after surgery. Median score on QOLIE-10 questionnaire was 82.5 (interquartile range: 32.5). CONCLUSION: Surgical treatment of drug-resistant OLE offers hopeful results to those patients who have run out of pharmacological options and leads to postoperative deficits that are deemed expectable and occasionally acceptable.

Frame-based Stereotactic Biopsy: Description and Association of Anatomical, Radiologic, and Surgical Variables with Diagnostic Yield in a Series of 407 Cases.

BACKGROUND AND STUDY AIMS: Stereotactic biopsy is a versatile, minimally invasive technique to obtain tissue safely from intracranial lesions for their histologic diagnosis and therapeutic management. Our objective was to determine the anatomical, radiologic, and technical factors that can affect the diagnostic yield of this technique. We suggest recommendations to improve its use in clinical practice. METHODS: This retrospective study evaluated 407 patients who underwent stereotactic biopsies in the past 34 years. The surgical methodology changed through time, distinguished by three distinct periods. Different stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs were used. Using SPSS software v.23, we analyzed a total of 50 variables for each case. RESULTS: The series included 265 men (65.1%) and 142 women (34.9%) (average age 53.8 years). The diagnostic yield was 90.4%, morbidity was 5.65% (n = 17), and mortality was 0.98% (n = 4). Intraoperative biopsy improved accuracy (p = 0.024). Biopsies of deep lesions (p = 0.043), without contrast enhancement (p = 0.004), edema (p = 0.036), extensive necrosis (p = 0.028), or a large cystic component (p = 0.023) resulted in a worse diagnostic yield. Neurosurgeons inexperienced in stereotactic techniques obtained more nondiagnostic biopsies (p = 0.043). Experience was the clearest predictive factor of diagnostic yield (odds ratio: 4.049). CONCLUSIONS: Increased experience in stereotactic techniques, use of the most suitable magnetic resonance imaging sequences during biopsy planning, and intraoperative evaluation of the sample before finalizing the collection are recommended features and ways to improve the diagnostic yield of this technique.

WITHDRAWN: Frame-Based Stereotactic Brain Biopsy and Symptomatic Intracranial Hemorrhages: Associated Factors in a Series of 407 Patients.

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Open Door Laminoplasty: Creation Of A New Vertebral Arch.

BACKGROUND: We describe the carrying out of our open door laminoplasty technique by reproducing a posterior vertebral arch using a local originating autologous bony graft and titanium plates. METHODS: We designed a prospective study and present our first 16 patients. The clinical results were evaluated with the JOA score, Nurick scale and the VAS. The functional and radiological evaluation was performed with radiographs, CT and MRI, and the measurements of the dimensions of the spinal canal were carried out with the MIPAV programme ( Johns Hopkins University). All the variables were statistically analysed by means of SPSS23.0. RESULTS: After following up the cases for two years, the clinical evaluation showed, amongst other findings, a 75% improvement in the JOA score, while the radiological controls showed an appropriate range of motion (ROM) along with the stability of the construction. The rate of complete arthrodesis of the cervical neo-arch reached was approximately 92%. CONCLUSIONS: Our results show that the modifications that we performed on the technique originally described have made it into a simpler, more efficacious and safer procedure, without lessening its essential objectives.

Posterior lumbar interbody fusion with instrumented posterolateral fusion in adult spondylolisthesis: description and association of clinico-surgical variables with prognosis in a series of 36 cases.

BACKGROUND: We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. METHOD: We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. RESULTS: The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. CONCLUSION: Although a higher level of training is necessary, we believe that the described technique is a very effective decision in cases of spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery.