Palabras clave: Metástasis Cerebral; Metástasis Solitaria; Metástasis Única; Tratamiento Multimodal; Radiocirugía; Radioterapia Holocraneal; Resección Quirúrgica
ABSTRACT
The treatment of Isolated Cerebral Metastatic Disease is both multimodal and palliative. At present, the optimal treatment protocol is unknown. The objective of the present study was to determine outcome differences between Whole Brain Radiotherapy (WBRT), Radiosurgery (RS), and Surgical Resection (SR) or a combination of them, regarding Global Survival, Functional Independent Survival, Local Control, Neurological Death & Cognitive Status in patients with a unique cerebral metastasis and a controlled primary tumor. A retrospective study with a systematic qualitative literature review was performed. Randomized clinical trials comparing surgery (with or without whole brain radiotherapy), disregarding the localization of the primary tumor, were searched, resulting in 971 studies, only 19 of them being randomized. After applying Cochrane´s Risk of Bias Tool, only 14 studies showed a low risk of bias. The combination of SR & WBRT showed a longer survival, while WBRT & RS showed a better local control when compared with SR & WBRT. No statistical differences where found between WBRT & RS versus RS alone. Results regarding Cognitive Status & Functional Independent Survival were inconsistent. The optimal treatment in Isolated Metastatic Cerebral Disease still remains controversial.
Key words: Cerebral metastasis, Isolated Metastasis, Unique Metastasis, Multimodal treatment, Radiosurgery, Whole Brain Radioterapia, Surgical Resection.
]]>Palabras clave: Abordaje Pterional; Base de Cráneo; Fisura Silviana; Microcirugía
ABSTRACT
Objective: the aim of this study is to describe, step by step, the pterional approach.
Description: position: the patient is placed supine, and the head rotated and also deflected. Incision: from the midline to de zygomatic arch, 1 cm in front of the tragus. Interfascial dissection: the landmarks: superficial temporal artery, orbital rim and zygomatic arch. The incision started at the level of the superior temporal line, 2 cm posterior to the orbital rim, and is pointed to the middle portion of the zygomatic arch. Temporal muscle displacement: after a transversal section of the upper portion of the muscle, it is detached in a subperiosteal fashion. Craniotomy: the osseous removal should expose the sylvian fissure and the middle and inferior frontal gyrus and also the superior temporal giri. Dural opening: in two flaps (frontal and temporal).
Conclusion: the pterional approach is still, nowadays, a valid and current technique. This approach allows treating many lesions located in the anterior and middle cranial fossa.
Keywords: Microsurgery; Pterional Approach; Skull Base; Sylvian Fissure
]]>Palabras Claves: Osteotomías Cervicales; Osteotomía De Ponte; Osteotomía 3D; Deformidad Cervical
ABSTRACT
Objective: To perform cervical osteotomies in cadaveric specimens, following the new classification of Ames et al. 3D pictures were taken to show the amount of bone resection on each subtype.
Material & methods: Using two formolized cadaveric specimens with vascular injection, we took 3D pictures of osteotomies following the Ames et al classification of cervical osteotomies. The pictures were taken with a Nikon D90 camera, with a 50 mm lens Af 1.8G, Nikon SB700 flash, and an adjustable titanium frame designed to take 3D pictures. Anterior cadaveric dissections were made based on the Smith & Robinson technique. We also performed a posterior approach to expose laminar surfaces, spinous processes, facets complexes, ligaments, discs, uncovertebral joints and vertebral bodies. With the aid of a pneumatic drill, 8 osteotomies (4 anterior and 4 posterior) were progressively made and pictured.
Results: The anterior osteotomies were: discectomy, corpectomy, discectomy with uncovertebral resection and spondilectomy. Posterior osteotomies were: partial facetectomy, complete facetectomy (Ponte), open wedge osteotomy and closing wedge osteotomy (pedicle substraction). Pictures were processed and fused with Anaglyph Maker 1.08 and StereoPhoto Maker 4.54.
Conclusions: Cervical osteotomies are useful surgical maneuvers to correct spinal deformities. 3D anatomy helps to understand the degree of bone resection needed to make each osteotomy, exposing nervous and vascular structures at risk in these procedures.
Key Words: Cervical Osteotomies; Ponte Osteotomy; 3D Osteotomies; Cervical Deformities
]]>Palabras Claves: Aneurisma Cerebral; Aneurisma PICA; Abordaje Extremo Lateral; Circuito Posterior; Tratamiento Neuroquirúrgico
ABSTRACT
Objective: To describe the surgical treatment for complex, giant, embolized, PICA aneurysm and the follow up.
Description: 48 years old, female patient with clinical history of obstructive hydrocephalus and posterior fossa´s hipertension. The treatment was endovascular surgery with coils and venricular shunt with posterior fossa´s deccompresive surgery 4 years ago. The clinical evolution was poor. Due to low cranial nerves déficit and progressive posterior fossa´s hipertension, we performed microsurgical treatment
Intervention: We performed extreme lateral approach with partial drilling of occipital condile, wiht proper proximal vascular vertebral control, and vascular parietal artery reconstruction in the vertebral-posterior inferior cerebellar artery (PICA) aneurysmatic segment,with microsurgery, posterior opening of the dome and coils remotion.
Conclusion: Microsurgical treatment with reconstruction parietal technique, proximal vascular control and skull base approaches are the definitive and more adecuated treatment for giant PICA aneurysms.
Key Words: Cerebral Aneurysm; Pica Aneurysm; Extreme Lateral Approach; Posterior Circulation; Neurosurgical Treatment
Palabras Claves: Neurorrafia con Tensión; Experimentación en Sistema Nervioso Periférico; Puntos Epineurales Distales; Injertos Nerviosos
ABSTRACT
Objective: To analyze, in a prospective way, the viability of a neurorraphy by a microsurgical technique, in an experimental model with different increasing grades of peripheral nerve tissue loss.
Introduction: In order to repair a peripheral nerve that has experienced some grade of substance loss, autologous grafts have been used by most neurosurgeons. However, comorbidities in the donor site are produced, and the results obtained are always inferior compared to the ones achieved by using a direct suture without tension. There is an option to avoid using grafts when the defect is scarce, which is the confection of distal epineural sutures (DES) to the neurorraphy, discarding any tension in this junction site.
Materials and methods: We have used 40 Wistar rats, randomly separated into 4 groups. In ‘Group A’, under complete anesthesia, the sciatic nerve was dissected and transversely sectioned and then sutured with a 10.0 nylon suture. Furthermore we made a 2 mm extirpation in ‘Group B’, a 4 mm one in ‘Group C’ and a 6 mm one in ‘Group C’, in order to perform a DES technique. Our group also ran a sciatic nerve function test (footprint analysis), conduction speed (by electrophysiology), and even determined the nerve regeneration index (histopathology) to estimate the viability of the neurorraphy. The different groups were confronted with ANOVA, considering a value of p<0.05 as statistically significative.
Conclusions: Simple neurorraphy exposed no statistically significative differences in comparison to the reparation of a 2 mm tissue loss with DES technique, in the Wistar rat model.
Key Words: Tension Neurorraphy; Peripheral Nervous System Experimentation; Distal Epineural Sutures; Nervous Grafts
]]>Palabras clave: Abordaje; Anatomía; Cavernoma; Cuerno Temporal; Lóbulo Temporal
ABSTRACT
Objective: To describe the microsurgical anatomy and approaches to the mesial temporal region (MTR), in relation with cavernomas.
Material and Method: Five adult cadaveric heads, fixed in formol and injected with colored silicon were studied. Since January 2007 and June 2014, the author operated 7 patients with cavernomas located in the MTR.
Results: Anatomy: the MTR was divided in 3 portions: anterior, middle and posterior. Patients: the author operated 7 patients with MTR cavernomas. Four cavernomas were located in the anterior portion, 2 were located in the middle portion, and 1 cavernoma was located in the posterior portion. The transsylvian-transinsular approach was used for the anterior portion of the MTR; the transtemporal approach (anterior temporal lobectomy) was used for the middle portion of the MTR; and the supracerebellar-transtentorial approach was used for the posterior portion of the MTR.
Conclusion: The idea of divide the MTR in 3 portions help to select the correct approach.
Key words: Anatomy; Approach; Cavernoma; Temporal Horn; Temporal Lobe
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