morfométrico con enfoque quirúrgico del hueso temporal]]> requiriendo en ocasiones la realización de petrosectomías anteriores, posteriores o abordajes combinados para la resección de
tumores en dichas regiones. El propósito del presente estudio es realizar análisis morfométrico con enfoque quirúrgico del hueso
temporal, en cráneos adultos, con énfasis en el tubérculo suprameatal (TSM) teniendo en consideración sus relaciones anatómicas.
Material y métodos: El presente estudio se realizó en las instalaciones de la Facultad de Medicina de la Universidad Nacional
Autónoma de México (UNAM). Se analizaron 200 huesos temporales de 100 cráneos humanos adultos. Se dio énfasis al TSM de
acuerdo a su ubicación y tamaño, clasificándolo en: anterior medio o posterior y en tipo I (0-1 mm), tipo II (2-3 mm) y tipo III (>3 mm).
Además, se realizaron mediciones con enfoque quirúrgico de la porción petrosa del hueso temporal y de la cresta supramastoidea.
Resultados: El TSM se observó en 171 especímenes estudiados (85.5%). Entre ellos, la posición posterior fue la más frecuente
85 de 171 (49.70%), seguida de la posición media 43 (25.14%) y por último la posición anterior 43 (25.14%). En cuanto al
tamaño, se encontró con mayor frecuencia el tipo II en 99 de los especímenes (49.5%), el tipo I en 82 especímenes (41%)
y tipo III en 19 (9.5%). El asterion se reflejó dentro de la impresión de los senos en la mayoría 48.5%, la unión de la cresta
supramastoidea con sutura escamosa se reflejaba en 98.5% de los casos a la fosa media.
Discusión: En nuestra búsqueda de información no se cuenta con datos para realizar comparación con la obtenida en
este estudio del tubérculo suprameatal, el hallazgo encontrado parece indicar que se encuentra una relación directa con la
presencia de la impresión del surco del seno petroso superior. La distribución de acuerdo a su posición reviste importancia
cuando se encuentra en grado III puesto que plantea una dificultad técnica, en abordajes como en petrosectomías, o bien, al
cavum de Meckel desde un abordaje retrosigmoideo.
Conclusión: La observación anatómica y clasificación que realizamos del tubérculo suprameatal, una estructura muy poco
evaluada, nos da una consideración preoperatoria y transoperatoria cuando realizamos abordaje que involucra la cara
posterior de la porción petrosa del hueso temporal]]> fossa. Sometimes requiring the performance of petrosectomies or combined approaches for the resection of tumors in these
regions. The purpose of this study is to perform morphometric analysis in adult skulls with a surgical approach to the temporal
bone, with emphasis on the suprameatal tubercle (SMT) taking into account their anatomical relationships.
Material and methods: The present study was carried out in the facilities of the Faculty of Medicine of the National Autonomous
University of Mexico (UNAM). 200 temporal bones from 100 adult human skulls were analyzed. The SMT was emphasized according to
its location and size, classifying it as: anterior, middle, or posterior and type I (0-1 mm), type II (2-3 mm) and type III (> 3mm). In addition,
measurements were made with a surgical approach of the petrosal portion of the temporal bone and the supramastoid crest.
Results: The SMT was observed in 171 specimens studied (85.5%). Among them, the posterior position was the most frequent
85 of 171 (49.70%), followed by the middle position in 43 (25.14%) and finally the anterior position in 43 (25.14%). In terms of
size, type II was more frequently found in 99 of the specimens (49.5%), type I in 82 specimens (41%) and type III were found in
19 (9.5%). The asterion was reflected within the impression of the sinuses in the majority 48.5%, the union of the supramastoid
crest with squamous suture was reflected in 98.5% of the cases to the middle fossa.
Discussion: In our search for information, there is no data to make a comparison with that obtained in this study of the
suprameatal tubercle. The findings seems to indicate that there is a direct relationship with the presence of the impression of
the groove of the upper petrosal sinus. The distribution according to its position is important when it is in grade III since it poses
a technical difficulty, in approaches such as petrosectomies, or approach to Meckel’s cave from a retrosigmoid approach.
Conclusion: The anatomical observation and classification that we perform of the suprameatal tubercle, a very poorly evaluated
structure, gives us a preoperative and transoperative consideration when we perform an approach that involves the posterior
aspect of the petrosal portion of the temporal bone.]]> 1. Blaser SI, Padfield N, Chitayat D, Forrest CR. Skull base
development and craniosynostosis. 2015;45. doi:10.1007/s00247-
015-3320-1.
2. Bayraktar B, Polat G, Gurel I. Surgical Anatomy of the Temporal
Bone and Measurements of the Skull Base for Transpetrosal
Approaches. 1998;75(1):33-39.
3. Rhoton AL. The Temporal Bone and Transtemporal Approaches.
2000;47(3).
4. Muren C. THE INTERNAL ACOUSTIC MEATUS Anatomic
variations and relations to other temporal bone structures.
1986;27(January):505-512.
5. Peris-celda M, Perry A, Carlstrom P, Graffeo CS. Intraoperative
Management of an Enlarged Suprameatal Tubercle During
Microvascular Decompression of the Trigeminal Nerve , Surgical
and Anatomical Description : 2-Dimensional. 2019;0(0):2019.
doi:10.1093/ons/opz027.
6. Day, J. Diaz, M.D.; Kellogg, Jordi X. MS., Fukushima, Takanori,
M.D., D.M.Sc.; Giannotta, Steven L. MD, Department.
Microsurgical Anatomy of the Inner Surface of the Petrous Bone:
Neuroradiological and Morphometric Analysis as an Adjunct to
the Retrosigmoid Transmeatal Approach Surgical Anatomy and
Technique AUTHOR(S): 1994;34(6).
BIBLIOGRAFÍA
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7. Adams Pérez J, Rassier Isolan G, Pires De Aguiar PH, Antunes AM.
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11. R. Chopra, N. Fergie, D. Mehta LL. The middle cranial fossa
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12. Pareschi R, Danesi G, Stefini R, Bivona R, Valera CI. The
Transpetrosal Approaches System in Posterior Fossa Meningiomas
Surgery : Rationale and Results. 2019.]]> cerebrales no rotos, en la región de Coquimbo, Chile]]> series, la indicación quirúrgica en estos casos es discutible y generalmente esta en relación a su riesgo de sangrado por
características morfológicas y ubicación del aneurisma. Este trabajo tiene como objetivo, determinar si en nuestra región,
el tratamiento microquirúrgico de los aneurismas cerebrales no rotos es seguro y así poder dar una recomendación de
tratamiento a nuestros pacientes.
Materiales y métodos: Treinta y un pacientes, 33 aneurismas cerebrales no rotos fueron tratados, En clínica Elqui y Hospital
San Pablo de la Región de Coquimbo, entre mayo del 2017 y marzo del 2019, se hizo un seguimiento al total de los pacientes
y se evaluó su resultado neurológico según la escala de Rankin modificado.
Resultado: 97% de los pacientes obtuvieron un resultado neurológico favorable (Rankin < 3), solo un 3% de los pacientes, un
caso, obtuvo un resultado desfavorable (Rankin > 2).
Conclusión: El tratamiento microquirúrgico de los aneurismas cerebrales no rotos en nuestra región es seguro, obteniendo una
muy baja morbilidad y 0% de mortalidad.]]> the surgical indication in these cases is debatable and is generally related to the risk of bleeding due to morphological
characteristics and location of the aneurysm. The objective of this work is to determine if in our region the microsurgical
treatment of unruptured cerebral aneurysms is safe and thus be able to give a recommendation of treatment to our patients.
Materials and methods: 31 patients, 33 unruptured cerebral aneurysms were treated. At the Elqui clinic and San Pablo
Hospital in the Coquimbo Region, between may 2017 and March 2019, the total number of patients was monitored and their
Neurological outcome according to the modified Rankin scale.
Result: 97% of the patients obtained a favorable neurological outcome (Rankin <3), only 3% of the patients, one case, obtained
an unfavorable outcome (Rankin> 2).
Conclusion: The microsurgical treatment of unruptured cerebral aneurysms in our region is safe, obtaining a very low morbidity
and 0% mortality.]]> Evaluation and Management. Scientific World Journal. 2015.
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2. Britz GW, Salem L, Newell DW, Eskridge J, Flum DR. Impact of
surgical clipping on survival in unruptured and ruptured cerebral
aneurysms: a population-based study. Stroke. 2004. 35: 1399-1403.
3. Brown R. D, Broderick J. P. Unruptured intracranial aneurysms:
Epidemiology, natural history, management options, and familial
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4. Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G,
Kouznetsov E. Safety and occlusion rates of surgical treatment of
unruptured intracranial aneurysms: a systematic review and meta
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Neurosurgery Psychiatry. 2013. 84: 42-48.
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6. Naggara ON, White PM, Guilbert F, Roy D, Weill A, Raymond
J. Endovascular treatment of intracranial unruptured aneurysms:
systematic review and meta-analysis of the literature on safety and
efficacy. Radiology. 2010. 256: 887-897.
7. Pandey A. S, Gemmete J. J, Wilson T. J, Chaudhary N, Thompson B.
G, Morgenstern L. B, Burke J. F. High Subarachnoid Hemorrhage
Patient Volume Associated with Lower Mortality and Better
Outcomes. Neurosurgery. 2015. 77(3): 462–470.
8. Raaymakers TW, Rinkel GJ, Limburg M, Algra A. Mortality and
morbidity of surgery for unruptured intracranial aneurysms: a metaanalysis.
Stroke. 1998. 29: 1531-1538.
9. Ruan C, Long H, Sun H, He M, Yang K, Zhang H. Endovascular
coiling vs. surgical clipping for unruptured intracranial aneurysm: a
meta-analysis. British Journal Neurosurgery. 2015. 29: 485-492.
10. Spetzler R, McDougall C, Zabramski JM, Albuquerque F, Hills
N, Russin J. The Barrow Ruptured Aneurysm Trial: 6-year results.
Journal Neurosurgery. 2015. 123: 609-617.
11. Thines L, Bourgeois P, Lejeune JP. Surgery for unruptured
intracranial aneurysms in the ISAT and ISUIA era. Canadian
Journal Neurological Sciences. 2012. 39:174-179.
12. Whisnant J, Forbes G. International Study of Unruptured
Intracranial Aneurysms Investigators. Unruptured intracranial
aneurysms risk of rupture and risks of surgical intervention. New
England Journal of Medicine. 1998. 339:1725-1733.
13. Wiebers D. O, Whisnant J. P, Huston J. Unruptured intracranial
aneurysms: natural history, clinical outcome, and risks of surgical
and endovascular treatment. The Lancet. 2003. 362: 103-110.
14. Williams L. N, Brown R. D, Management of unruptured intracranial
aneurysms. Neurology: Clinical Practice. 2013. 3: 99–108.
15. Zheng J, Xu R, Guo Z, Sun X. Small ruptured intracranial
aneurysms: the risk of massive bleeding and rebleeding. Neurological
Research. 2019. 41: 1-7.]]> de lesiones intrínsecas de tronco cerebral en adultos]]> críticas. La mayoría de las publicaciones son descripciones anatómicas; existiendo pocas sobre su aplicación. En este
escenario, nuestro trabajo puede sumar información para el manejo quirúrgico en casos seleccionados.
Material y Métodos: De una serie de 13 pacientes, se presentan 9 que no eran candidatos para biopsia estereotáctica y
recibieron microcirugía. Las localizaciones fueron: mesencéfalo (3), tectum (1), protuberancia (2) y bulbo (3). Cinco pacientes
tuvieron KPS => 70; y 4, KPS <70. Diferentes ZES fueron utilizadas según la topografía lesional. El grado de resección se basó
en la biopsia intraoperatoria y el monitoreo neurofisiológico.
Resultados: Los hallazgos patológicos fueron: astrocitoma pilocítico (1), glioma de bajo grado (1), hemangioblastoma (1),
subependimoma (1), disgerminoma (1), y lesiones pseudotumorales (3 cavernomas y 1 pseudotumor inflamatorio). El grado de
resección fue completo (4), subtotal (3), y biopsia fue considerada suficiente en (2). Un paciente falleció en el postoperatorio.
Discusión: Las lesiones del tronco cerebral son infrecuentes en adultos. Las controversias surgen cuando se balancean los
beneficios de obtener diagnóstico histopatológico y los riesgos potenciales de procedimientos invasivos. La amplia variedad
de hallazgos en esta localización exige una precisa definición histopatológica, que no solamente determinará la terapéutica
adecuada, sino que advierte sobre las consecuencias potencialmente catastróficas de los tratamientos empíricos. Las ZES
ofrecen un acceso posible y seguro, aunque es más realista considerarlas como áreas para abordar lesiones intrínsecas con
baja morbilidad más que como zonas completamente seguras.]]> Most publications correspond to anatomic research; few papers report their application in surgery. In this scenario, our report
could add information to the surgical management in selected cases.
Material and Methods: Out of a series of 13 patients, 9 were non-candidates for stereotactic biopsy and received
microsurgery. Localizations of the lesions were: mesencephalus (3), tectal plate (1), pons (2) and medulla oblongata (3). Five
patients had KPS => 70; 4, KPS <70. Different SEZ were used according to lesional topography. The extent of resection were
based on the frozen pathology findings and neurophysiological monitoring.
Results: A variety of pathological findings were found: low-grade glioma (1); pilocytic astrocytoma (1); hemangioblastoma
(1); subependimoma (1); disgerminoma (1); pseudotumoral lesions (cavernomas 3 and inflammatory pseudotumor 1). The
extent of resection was complete (4), subtotal (3), and biopsy was considered sufficient in 2 cases. One patient died 96-hourspostoperative
due to brainstem edema.
Discussion: Brainstem structural lesions are uncommon in adults. Controversies arise regarding the need of histologic
diagnosis, weighing benefits of a reliable diagnosis and the potential disadvantages of the invasive procedures. The accurate
histopathological definition could not only determine an adequate therapy, but also can prevent the disastrous consequences
of empiric treatments. The SEZ provides a feasible and safe access, although it is more realistic to consider them as areas to
approach intrinsec lesions with less morbidity than to consider them as completely safe entrances.]]> different infratentorial supracerebellar approaches to the posterior
and middle incisural spaces: a cadaveric study. J Neurosurg 2002; 97
(4): 922-8.
2. Boviatsis EJ, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE.
CT-guided stereotactic biopsies of brain stem lesions: personal
experience and literature review. Neurol Sci 2003; 24: 97-102.
3. Bricolo A, Turazzi S. Surgery for gliomas and other mass lesions
of the brainstem. In: Bricolo A, Turazzi S, editors. Advances and
technical standards in neurosurgery. New York (NY): Springer;
1995. p. 261-341.
4. Cavalcanti DD, Preul MC, Kalani MYS, Spetzler RF. Microsurgical
anatomy of safe entry zones to the brainstem. J Neurosurg 2016;
124:1359–1376.
5. Chen X, Weigel D, Ganslandt O, Buchfelder M, Nimsky C.
Diffusion tensor imaging and white matter tractography in patients
with brain stem lesions. Acta Neurochir (Wien) 2007; 149 (11):
1117-31.
6. Iwanaga J, Granger A, Vahedi P, Loukas M, Oskouian RJ, Fries
FN, et al Mapping the internal anatomy of the lateral brainstem:
anatomical study with application to far lateral approaches to
intrinsic brainstem tumors. Cureus 2017; 9:2.
7. Kondziolka D, Lundsford LD. Stereotactic biopsy for intrinsec
lesions of the medulla through the long-axis of the brain stem:
technical considerations. Acta Neurochir (Wien) 1994; 129 (1-2):
89-91.
8. Kyoshima K, Sakai K, Goto T, Tanabe A, Sato A, Nagashima H,
Nakayama J. Gross total surgical removal of malignant glioma from
the medulla oblongata: report of two adult cases with reference to
surgical anatomy. Journal of Clinical Neuroscience 2004; 11:1, 75-80.
9. Massager N, Davi P, Goldman S. Combined magnetic resonance
imaging and positron emission tomography-guided stereotactic
biopsy in brainstem mass lesions: diagnostic yield in a series of 30
patients. J Neurosurg 2000; 93: 951-957.
10. Morota N, Deletis V. The importance of brainstem mapping
in brainstem surgical anatomy before the fourth ventricle and
implication for intraoperative neurophysiological mapping. Acta
Neurochir (Wien) 2006; 148: 499-509.
11. Mursch K, Halatsch ME, Markakis E et al. Intrinsec brain stem
tumors in adults: results of microneurosurgical treatment of 16
consecutive patients. Br J Neurosurg 2005; 19 (2): 128-36.
12. Rabadán AT, Campero A, Hernández D. Surgical application of the
suboccipital subtonsillar approach to reach the inferior half of medulla
oblongata tumors in adult patients. Front Surg. 2016 13, 2: 72.
13. Rabadán AT, Hernández D. Importancia del diagnóstico
histopatológico en el tratamiento de las lesiones del tronco cerebral
en adultos. MEDICINA (Buenos Aires) 2018; 78: 305-310.
14. Rachinger W, Grau S, Holtmannspotter M, Herms J, Tonn JC,
Kreth FW. Serial stereotactic biopsy of brainstem lesions in adults
impacting diagnostic accuracy compared with MRI only. J Neurol
Neurosurg Psychiatry 2009; 80: 1134-9.
15. Recalde R, Figueiredo EG, de Oliveira E. Microsurgical anatomy of
the safe entry zones on the anterolateral brainstem related to surgical
approaches to cavernous malformations. Neurosurgery 2008;
62:509-517.
16. Rhoton A. The Rothon’s Collection. http://www.rothon.ineurodb.org.
17. Sala F. A spotlight on intraoperative neurophysiological monitoring
of the lower brainstem. Clinical Neurophysiology 2017; 128 (2017)
1369–1371 .
18. Salmaggi A, Fariselli L, Milanesi I, Lamperti E, Silvani A, Bizzi
A, et al. Natural history and management of brainstem gliomas in
adults. A retrospective Italian study. J Neurol 2008; 255: 171-177.
19. Schumacher M, Schulte-Monting J, Stoeter P, Warmuth-Metz
M, Solymosi L (2007) Magnetic resonance imaging compared
with biopsy in the diagnosis of brainstem diseases of childhood: a
multicenter review. J Neurosurg 106: 111-119.
20. Ziyal IM, Sehkar LN, Salas E, Subtonsillar-transcerebellomedullary
approach to lesions involving the fourth ventricle, the
cerebellomedullary fissure and the lateral brainstem. Br J Neurosurg
1999 Jun;13(3):276-84.]]> fracturas tóracolumbares]]> Material y métodos: Analizamos una serie de 26 pacientes con fracturas traumáticas tóraco-lumbosacras entre 2010-2017.
Las imágenes pre-operatorias fueron clasificadas usando la clasificación AO. Analizamos en forma pre y post operatoria:
escala visual analógica, volumen de pérdida sanguínea, duración de la hospitalización, complicaciones, cirugías asociadas en
otros órganos, extracción de implantes en el largo plazo, estado neurológico pre y post quirúrgico y mortalidad.
Los pacientes con historias clínicas completas, TAC pre-operatoria y un seguimiento mínimo de 12 meses fueron incluidos (18
hombres y 8 mujeres). La edad promedio fue de 28.7 años (21-84 años); seguimiento promedio de 28 meses (13-86 meses).
Dieciocho pacientes fueron manejados con instrumentaciones percutáneas, 8 recibieron vertebroplastias, y en 5 casos se
realizó además algún gesto de artrodesis.
Resultados: La EVA mejoró 7 puntos promedio respecto al pre-operatorio; el promedio de sangrado fue de 40 mL, no
observamos ningún caso de empeoramiento neurológico. La duración promedio de la hospitalización fue de 3.9 días. Cuatro
enfermos necesitaron alguna cirugía en otro órgano producto de sus politraumatismos.
Los tornillos percutáneos fueron removidos en 9 casos luego de la consolidación. Como complicaciones tuvimos: 1 hematoma
retroperitoneal autolimitado, una fractura pedicular y una cánula de cementación rota adentro de un pedículo.
Conclusión: La cirugía mínimamente invasiva en trauma espinal es una alternativa válida que permite estabilización,
movilización precoz y logra buenos resultados en términos de control del dolor con baja tasa de complicaciones]]> invasive surgery.
Methods: We retrospectively review the charts and images of 26 patients with thoracolumbar spine fractures between 2010-2017.
Pre-op images were assessed and fractures were classified according to the thoraco-lumbar trauma AO Spine classification. We
analyzed pre and post-surgical visual analog scale (VAS), blood loss during surgery, hospital length of stay, complications, associated
surgical procedures, long term post-op implant removal, pre and post neurological status and mortality.
Patients with a complete case record, pre-op CT scans and minimum 12-month follow up were included (18 males and 8 females).
Mean age was 28.7 years (21-84 years); mean post-op follow up was 28 month (13-86 months). Eighteen patients were managed
with percutaneous instrumentation, 8 patients also received percutaneous vertebroplasty, and 5 patients underwent also some
arthrodesis procedure.
Results: VAS improved 7 points as compared to the pre-op score; mean blood loss was 40 mL, we did not observed any
neurological deficit worsening. Mean hospital length of stay was 3.9 days. Four patients needed surgical procedures involving other
organs due to politrauma.
Percutaneous screws were removed in 9 cases after fracture consolidation. Complications were: one case of self-limiting
retroperitoneal hematoma, one case of pedicle screw fracture and one cement broken cannula into the pedicle.
Conclusion: Minimally invasive surgery in spine trauma is a valid option allowing stabilization, early mobilization, and leading to good
outcomes in terms of pain control and a lower complication rate.]]> ]]> technique, fracture reduction, and review of current spine trauma
applications. J Am Acad Orthop Surg 2018; 0:1-10.
2. Bakhsheshian J, Dahdaleh N, Fakurnejad S, Scheer J, Smith Z. Evidencebased
management of traumatic thoracolumbar burst fractures: a systematic
review of nonoperative management. Neurosurg Focus 2014; 37 (1):E1.
3. Bose D, Tejwani NC. Evolving trends in the care of polytrauma patients.
Injury, Int. J. Care Injured 2006; 37, 20-28.
4. Denis F. The three column spine and its significance in the classification of
acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817–831.
5. Hitchon P, Abode-Iyamah K, Dahdaleh N, Shaffrey C, Noeller J, He
W, Moritani T. Nonoperative management in neurologically intact
thoracolumbar burst fractures: clinical and radiographic outcomes. Spine
2016;41:483–489.
6. Laghmouche N, Prost S, Farah K, Graillon T, Blondel B, Fuentes S.
Minimally invasive treatment of thoracolumbar flexion-distraction fracture.
Orthop Traumatol Surg Res. 2019 Apr;105(2):347-350.
7. Landi A, Marotta N, Mancarella C, Meluzio M, Pietrantonio A, Delfini R.
Percutaneous short fixation vs conservative treatment: comparative analysis
of clinical and radiological outcome for A.3 burst fractures of thoracolumbar
junction and lumbar spine. Eur Spine J 2014; 23 (Suppl 6):S671–
S676.
8. Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in
polytrauma patients: relevance of damage control orthopedic surgery. The
American Journal of Surgery 183. 2002; 622–629.
9. Pape H et al. The poly-traumatized patient with fractures: a multidisciplinary
approach. 2016. Springer-Verlag Berlin Heidelberg. DOI
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10. Resnik DK, Weller SJ, Benzel EC. Biomechanics of the thoracolumbar
spine. Neurosurg Clin North Am 8:455-469, 1997.
11. Rodríguez Boto G, Vaquero Crespo J. Traumatismo raquimedular. Pág 1-2.
ISBN 978-84-7978-905-3.
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intramedullary nailing for patients with multiple injuries and with femur
fractures: damage control orthopaedics. J Trauma 2000;48: 613–23.
13. Stahel P, VanderHeiden T, Flierl M, Matava B, Gerhardt D, Bolles G,
Beauchamp K, Burlew C, Johnson J, Moore E. The impact of a standardized
‘‘spine damage-control’’ protocol for unstable thoracic and lumbar spine
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14. Tian F, Tu LY, Gu WF, Zhang EF, Wang ZB, Chu G, Ka H, Zhao J.
Percutaneous versus open pedicle screw instrumentation in treatment of
thoracic and lumbar spine fractures, a systematic review and metaanalysis.
Medicine (Baltimore). 2018 Oct; 97(41):e12535.
15. Vaccaro A, Oner C, Kepler C, Dvorak M, Schnake K et al. AOSpine
Thoracolumbar Spine Injury Classification System. Spine 2013;38:2028–
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16. Wang X, Liu Y, Wang X, Chen H, Cao P, Tian Y, Wu X, Chen Y, Yuan
W. Beneficial effects of percutaneous minimally invasive surgery for patients
with fractures in the thoracic spine. Exp Ther Med. 2018 Dec;16(6):5394-
5399.
17. Yaszemski MJ, White AA, Panjabi MM. Biomechanics of the spine. En:
Fardon DF, Garfin SR, Abitbol J-J, Boden SD, Herkowitz HN, Mayer TG
(Eds.), Orthopaedic Knowledge Update: Spine 2, American Academy of
Orthopaedic Surgeons, Illinois, 2002, pp. 15-23, Cap. 3.]]> en paciente pediátrico]]> quirúrgicos, el tratamiento ideal es la exéresis completa.
Descripción del caso: Paciente pediátrica con antecedentes de neurofibromatosis que consulta por dolor leve y parestesias
episódicas. Presenta masa palpable en región supraclavicular izquierda de consistencia duro elástica con signo de Tinel
negativo. Se realiza una exéresis completa del neurofibroma mediante una cervicotomía anterior.
Discusión: La indicación quirúrgica fue realizada en base al crecimiento tumoral y su efecto de masa sobre estructuras
contiguas, los trastornos sensitivos y su antecedente de NF1, que predispone a variantes malignas. La clavícula suele ser el
elemento anatómico que define las principales vías de abordaje al plexo braquial.
Conclusión: Dejamos reportado un caso de neurofibroma de plexo braquial en una paciente pediátrica con neurofibromatosis.
Describimos como la cervicotomía anterior fue una excelente vía a una masa extensión cervico torácica.]]> complete removal.
Case report: A pediatric patient with a history of neurofibromatosis consults for mild pain and episodic paresthesias. The patient
presented to the hospital for an elastic palpable mass in the left supraclavicular region testing negative for Tinel's sign. Complete
removal of the neurofibroma was performed through an anterior cervicotomy.
Discussion: The surgical indication was made based on the growth of the tumor and its mass effect on contiguous structures, the
patient’s sensory disorders and her neurofibromatosis history, which predisposes to malignant variants. The clavicle is usually the
anatomical element defining the main approaches to the brachial plexus.
Conclusion: The purpose of this article was to present a case of a of brachial plexus neurofibroma in a pediatric patient with
neurofibromatosis. The anterior cervicotomy it would seem to be an excellent approach to a cervical thoracic extension mass.]]> al. Management of Intrathoracic Benign Schwannomas of the Brachial
Plexus. Case Rep Surg. 2014;2014:1-3.
2. Courvoisier LG. Die Neurome eine Klinische Monographie. Basel,
Switzerland: B Schwode; 1886.
3. Das S, Ganju A, Tiel RI, Kline DG. Tumors of the brachial plexus.
Neurosurg Focus 2007;22(6):1-6.
4. Hirbe AC, Gutmann DH. Neurofibromatosis type 1: a multidisciplinary
approach to care. Lancet Neurol 2014; 13: 834–43.
5. Jia X, Yang J, Chen L, Yu C, Kondo T. Primary Brachial Plexus Tumors:
Clinical Experiences of 143 Cases. Clin Neurol Neurosurg. 2016;148:91-5.
6. Lee HJ, Kim JH, Rhee SH, Gong HS, Baek GH. Is surgery for brachial
plexus schwannomas safe and effective?. Clin Orthop Relat Res.
2014;472:1893-8.
7. Lwu S, Midha R. Clinical examination of brachial and pelvic plexus tumors.
Neurosurg Focus. 2007;22(6):1-5.
8. Millan G, Casal D. Brachial plexus tumors in a tertiary referral center: a case
series and literature review. Acta Reumatol Port. 2015;40:372-7.
9. Oré Acevedo JF, La Torre Caballero M, Urteaga Quiroga R. Neurofibroma
cervical pediátrico. Reporte de caso. An Fac med. 2016;77(3):287-9.
10. Tschoe C, Holsapple JW, Binello E. Resection of primary brachial
plexus tumor via a modified supraclavicular approach. J Neurol Surg Rep
2014;75:133-5.]]> bien diferenciada del sistema nervioso central de origen neuroectodermico, ubicado más comúnmente a nivel del sistema
ventricular, típicamente adyacente al foramen de Monro. Cursa generalmente con síntomas de hipertensión intracraneal
secundaria a hidrocefalia no comunicante. Afecta generalmente a adultos jóvenes, con edad de presentación media de 29
años en las mayores series descriptas.
Objetivos: Describir y presentar un caso de tumor cerebral específico, cuya importancia se da debido a su baja prevalencia y
escasa casuística relatada en la literatura.
Descripción del caso: En el presente artículo describimos un caso de una paciente de 35 años diagnosticada incidentalmente con
una lesión ocupante de espacio a nivel del ventrículo lateral izquierdo redondeada, heterogénea, de bordes netos con dimensiones
de 40x30x30 mm. La paciente fue intervenida quirúrgicamente para su resección. Se realizó abordaje interhemisférico transcalloso
homolateral. Sin intercurrencias post-quirúrgicas fue dada de alta 4 días luego de la cirugía. El informe anatomo-patológico
demostró tratarse de un Neurocitoma Central. Se comparó nuestro caso con lo descripto en la literatura.
Conclusión: El neurocitoma central a pesar de no ser una patología prevalente, debe ser conocido en profundidad por los
neurocirujanos, ya que su correcto manejo afecta directamente al pronóstico de los pacientes.]]> of the central nervous system of neuroectodermal origin, located most commonly at the level of the ventricular system,
typically adjacent to the foramen of Monro. It usually presents with symptoms of intracranial hypertension secondary to noncommunicating
hydrocephalus. It generally affects young adults, with an average age of presentation of 29 years in the largest
series described.
Objetives: Describe and present one case of specific brain tumor, which is important due to its your low prevalence and scarce
casuistic in the literature.
Case presentation: In the present article, we describe a case of a female 35-year-old patient diagnosed incidentally with
a heterogeneus rounded space-occupying lesion at the level of the left lateral ventricle, with net edges and dimensions of
40x30x30mm. The patient was surgically intervened for tumoral resection. We opteded to use a homolateral transcallosal
interhemisferic approach. Without post-surgical complications, she was discharged 4 days after surgery. The anatomopathological
report proved to be a Central Neurocytoma. We compared our case with the existing publications.
Conclusion: Despite being an uncommon tumor, Central Neurocytoma must be well understood by every neurosurgeon,
considering that its adequated management influences the patient´s prognosis directly.]]> core cerebral. REV ARGENT NEUROC 2019 VOL. 33, N° 1: 1-13.
2. Figarella-Branger D, Söylemezoglu F, Kleihues P, Hassoun J. Cantral
neurocytoma. In Kleihues P, Cavenee WK. (ed). Pathology and genetics of
tumours of the nervous system. Lyon: IARCPress, 2000:107-109.
3. Hanel, Ricardo Alexandre et al. Neurocitoma central com apresentação
incomum por hemorragia intraventricular: relato de caso. Arq. Neuro-
Psiquiatr. [online]. 2001, vol.59, n.3ª.
4. Hassoun J, Gambarelli D, Grisoli F, Pellet W, Salamon G, Pelliser JF, Toga
M. Central neurocytoma. An electron-microscopic study of two cases. Acta
Neuropathol 1982;56:151-156.
5. Hassoun J, Söylemezoglu F, Gambarelli D, Figarella Branger D, von
Ammon K, Kleihues P. Central neurocytoma: a synopsis of clinical and
histological features. Brain Patholology 1993;3:297-306.
6. Katati MJ, Vílchez R, Ros B, Horcajadas A, Arráez MA, Arjona V. Central
neurocytoma: analysis of three cases and review of the literature. Rev Neurol
1999;28:713-717.
7. Koeller KK, Sandberg GD. From the archives of the AFIP. Cerebral
intraventricular neoplasms: radiologic-pathologic correlation.
Radiographics. 22 (6): 1473-505.
8. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK "WHO Classification
of Tumours of the Central Nervous System. 4th Edition Revised" ISBN:
9789283244929.
9. Mackenzie IR. Central Neurocytoma: histologic atypia, proliferation
potential, and clinical outcome. Cancer. 1999 Apr 1;85(7):1606-10.
10. Nishio S, Morioka T, Suzuki S, Fukui M. Tumours around the foramen of
Monro: clinical and neuroimaging features and their differential diagnosis. J
Clin Neurosci 2002; 9:137-141.
11. Rades D, Fehlauer F. Treatment options for central neurocytoma.
Neurology 2002;59:1268-1270.
12. Robbins P, SegalA, Narula S, et al. Central neurocytoma: a
clinicopathological, immunohistochemical and ultrastructural study of 7
cases. Pathol Res Pract 1995;191:100-111.
13. Smith A, Smirniotopoulos J, Horkanyne-Szakaly I. From the Radiologic
Pathology Archives: Intraventricular Neoplasms: Radiologic-Pathologic
Correlation. Radiographics. 2013;33 (1): 21-43.
14. Schild SE, Scheithauer BW, Haddock MG, Schiff D, Burger PC, Wong
WW, Lyons MK. Central neurocytomas. Cancer 1997;79:790-795.
15. Zhang B, Luo B, Zhang Z, Sun G, Wen J. Central neurocytoma:
a clinicopathological and neuroradiological study.Neuroradiology
2004;46:888-895.]]> de la vejiga, en pacientes con mielomeningocele y vejiga
neurogénica, 8 años de seguimiento, en adultos
Premio Senior. XV Jornadas Argentinas de Neurocirugía de AANC]]> través de la creación de reflejo sómato-visceral. Registrar complicaciones neuroquirúrgicas, urológicas y ortopédicas.
Evaluar dificultades técnico-quirúrgicas y los resultados de 5 casos realizados en Argentina.
Introducción: La vejiga neurogénica es una complicación secundaria al daño neurológico en los pacientes con
mielomeningocele (MMC). Para lograr vaciar la vejiga deben realizar cateterismo intermitente. La técnica Xiao se basa en
permitir la generación de un arco reflejo somato visceral por medio de una anastomosis entre una raíz eferente donante y la
raíz motora S2 S3 que permita el vaciado vesical sin cateterismo.
Material y métodos: Por medio de un estudio descriptivo retrospectivo, se analizan los
resultados obtenidos luego de realizar la técnica Xiao, en el año 2010, en 5 pacientes con MMC y vejiga neurogénica. Los
pacientes fueron operados en el Instituto de Rehabilitación (IREP). Fueron evaluados en forma multidisciplinaria tanto pre
como en el postoperatorio por neurocirujanos, neurólogos, urólogos, clínicos y kinesiólogos.
Resultados: Los pacientes que presentaron mejores resultados fueron los más jóvenes y los que no presentaban daño
estructural de la vejiga al momento de la cirugía, lo que coincide con los resultados compartidos por los demás centros donde
fue realizada esta técnica.
Conclusiones: La técnica de Xiao puede considerarse una opción para el tratamiento de la vejiga neurogénica. Aunque nuestra
serie es muy pequeña para dar conclusiones, los resultados globales de todas las series muestran resultados alentadores.]]> of somatic-visceral reflex. Record neurosurgical, urological and orthopedic complications. To evaluate technical-surgical
difficulties and the results of 5 cases performed in Argentina.
Introduction: Neurogenic bladder is a complication secondary to neurological damage in patients with myelomeningocele
(MMC). To achieve emptying of the bladder, intermittent catheterization must be performed. The “Xiao technique” is based on
allowing the generation of a visceral somatic-reflex arc by means of an anastomosis between a donor efferent root and the
motor root S2-S3 that allows bladder emptying without catheterization.
Material and methods: Through a retrospective descriptive study, the results obtained after performing the “Xiao technique”
in 5 patients with MMC and neurogenic bladder were analyzed. The patients were operated at the Rehabilitation Institute
(IREP). They were evaluated with a multidisciplinary team, both pre and post-surgery. The team was formed by neurosurgeons,
neurologists, urologists, clinicians and kinesiologists.
Results: The patients who presented the best results were the youngest and those who did not present structural damage of
the bladder at the time of surgery, which match the results shared by the other centers where this technique was performed.
Conclusions: “Xiao's technique” can be considered an option for the treatment of neurogenic bladder. Although our series is
too small to make conclusions, the overall results of all the series show encouraging results.]]> F. Diagnosis and clinical evaluation of neurogenic bladder. Eur J
Phys Rehabil Med. 2017 Dec;53(6):975- 980.
2. Bodner DR. How electrical stimulatio improves micturion.
Contemporary Urol 1990;3:39- 45.
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of mortality with lesion level in patients with myelomeningocele: a
population-based study. J Neurosurg Pediatr. 2017 Feb;19(2):227-
231.
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reinnervation. J Urol.1986;136: 964–969.
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1987;30: 89–96.
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reflex pathway for micturition after spinal cord injury and
its underlying mechanisms. J Urol 1999;162:936- 42.
14. Xiao CG, et al. An artificial somatic-autonomic reflex pathway
procedure for bladder control in children with spina bifida. J Urol
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143:356.
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W. C.: An artifcial somatic- central nerous system-autonomic
reflex pathway for controllable micturion after spinal cord injury:
preliminary results in 15 patients. J Urol. 2003; 170: 1237.]]> Nota técnica
Premio Junior. XV Jornadas Argentinas de Neurocirugía 2019]]> los pacientes recuperan espontáneamente, sin embargo en algunos casos debe realizarse una neurocirugía para reinervar
músculos y restablecer funciones. Las ramas mayoritariamente afectadas son C5-C6. Oberlin describió por primavera vez un
tipo de trasferencia nerviosa en 4 pacientes adultos, utilizando fascículos del nervio ulnar para reanimar el músculo bíceps. El
objetivo de este trabajo consiste en realizar una nota técnica sobre la cirugía de Oberlin, en el contexto de una PBO. Esta nota
técnica surge del análisis de 4 cirugías pediátricas y de las disecciones de 14 miembros superiores fetales.
Descripción técnica: Paciente en decúbito dorsal, con el brazo afectado extendido, en supinación y abducción de 90°. Se
incide piel 4cm de extensión en cara interna del brazo, hasta identificar la fascia braquial. Posteriormente se diseca la rama
motora del bíceps y fascículos del ulnar. Mediante magnificación se aproximan los cabos y se realiza la neurorrafia.
Discusión: Existen múltiples técnicas descriptas de transferencia nerviosa, escasa es la bibliografía en pacientes pediátricos.
La cirugía de Oberlin puede ser realizada en pediatría.
Conclusión: Presentamos los pasos de la cirugía de transferencia nerviosa descripta por Oberlin, la misma es reproducible
en pacientes lactantes en contexto de PBO, quedando expuestos los detalles técnicos y los reparos anatómicos para su
realización.]]> however, in some cases neurosurgery must be perform to re innervate muscles and restore functions. The most frequent
affected roots are C5-C6. Oberlin first described a type of nervous transfer in 4 adult patients, using fascicles of the ulnar nerve
to reanimate the biceps muscle. The objective of this paper is to make a technical note about Oberlin's surgery regarding
OBPP. This technical note emerges from the analysis of 4 pediatric surgeries and 14 fetal upper limbs dissections.
Technical description: Patient was place in dorsal decubitus, with the compromised upper limb extended in supination and
90 ° abduction. Skin incision of 4 cm long is made along the medial aspect of the arm, until the brachial fascia is identified.
Subsequently, the motor branch of the biceps muscle and fascicles of the ulnar nerve are dissect. Under microscopic
magnification, both nerves are approached and the neurorrhaphy is performed.
Discussion: There are multiple nerve transfer techniques described; but bibliography in pediatric patients is limited. Oberlin
surgery can be performed in pediatrics.
Conclusion: The steps of the nerve transfer surgery described by Oberlin presented can be applied in the case of obstetrical
brachial plexus palsy, the technical details and the anatomical repairs for its realization are outlined.]]> ]]> Erb's birth palsy. Plast Reconstr Surg. 2002;109(1):405-7.
2. Apel PJ, Garrett JP, Sierpinski P, Ma J, Atala A, Smith TL, Koman
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Ferguson MWJ, Robinson PP. Scarring impedes regeneration at
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9. Chang KWC, Thomas JW, Popadich M, Brown SH, Chung KC,
Yang LJS. Oberlin transfer compared with nerve grafting for
improving early supination in neonatal brachial plexus palsy. J
Neurosurg Pediatr. 2018;21(2):178-84.
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CIRUGÍA DE OBERLIN EN PARÁLISIS BRAQUIAL OBSTÉTRICA. NOTA TÉCNICA
Luciano Grisotto, Jorge Luis Bustamante, Gonzalo Colombo, Carolina Maldonado, Nicolas Tello, Fernando Torres
REV ARGENT NEUROC. | 2019 TRABAJO PREMIADO
129
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nerve transfers in the treatment of neonatal brachial plexus palsy. J
Hand Surg Am. 2015;40(6):1246-59.]]> al área temporomesial
Premio Video. XV Jornadas de Neurocirugía 2019]]> Materiales y métodos: Paciente femenina de 49 años que presenta hematoma protuberancial con hemiparesia izquierda. Tiene antecedentes de cavernomas cerebrales en familiares de primer grado. En Resonancia Magnética con secuencias de susceptibilidad magnética (SWI) se evidencian malformaciones cavernosas múltiples en protuberancia, cerebelo, región temporomesial derecha y lóbulo frontal derecho. Se plantea la exéresis microquirúrgica de la lesión protuberancial y cerebelosa combinado con resección transtentorial endoscópica del cavernoma temporomesial.
Resultados: Mediante abordaje supracerebeloso infratentorial se logró la exéresis del cavernoma cerebeloso y protuberacial. Se utilizó el área peritrigeminal derecha como área de acceso seguro al tronco. Con el uso de endoscopio rígido se realizó apertura del tentorio a nivel del conducto auditivo interno con posterior resección endoscópica del cavernoma temporomesial. La paciente curso el postoperatorio sin secuelas neurológicas.
Conclusión: La precisión del microscopio y la versatilidad del endoscopio nos permiten realizar resecciones de múltiples lesiones en distintas áreas.

]]> Objective: Present the surgical treatment of three ipsilateral cavernomas using a combined microsurgical and endoscopic technique. Methods: 49-years-old female patient attended to the emergency department with acute left hemiparesis and a pons bleeding. She had family history of cerebral cavernous malformation. Magnetic resonance with susceptibility weight imaging (SWI) shows multiple cavernous malformation in pons, cerebellum, right parahippocampal region and right frontal lobe. The surgical planning consisted of microsurgical excision of the cerebellar and pons lesions combined with a transtentorial endoscopic approach to the right parahippocampal cavernoma.
Results: We made a supracerebellar and infratentorial approach with satisfactory excision of cerebellar and pons cavernomas. We use the peritrigeminal zone as a safety entry to the pons. With a rigid skull base endoscope, we opened the tentorium just above the internal auditory meatus. Also, we achieved an endoscopic exeresis of the parahippocampal cavernoma. The patient did not have neurological deficits after surgery.
Conclusion: The precision of the microscope and the versatility of the endoscope let us attempt excision of multiple lesions in distant areas.

]]> Presentación de caso
Premio Póster. XV Jornadas de Neurocirugía 2019]]> conocidas y raramente publicadas en la bibliografía internacional, éstas se encuentran caracterizadas por la existencia de
múltiples formaciones nodulares o plexiformes con compromiso exclusivo de un solo nervio, todas con diagnóstico patológico
de schwannoma, excluyéndose a otras entidades tumorales y fuera del contexto de una neurofibromatosis. Aquí se presenta
un caso con compromiso del nervio plantar medial o interno.
Material y método: Se evaluó y analizo el caso clínico, a nivel semiológico y Neurorradiológico, Neurofisilógico. Se definió la
conducta terapéutica y quirúrgica. Se evaluaron resultados mediante: análisis semiológico y seguimiento con imágenes.
Descripción y resultados: Paciente sexo masculino de 45 años de edad consulta por presentar múltiples tumoraciones palpables
en región retromaleolar interna y plantar derecho y disestesias al apoyo, con antecedente de cirugía de schwannoma plantar. Al
examen neurológico: masas palpables en los sectores previamente indicados y Tinel a nivel retromaleolar interno y plantar.
RMN: múltiples nódulos con captación intermedia de contraste, hipertensos en T2.
Se practicó resección quirúrgica mediante amplio abordaje, se identificaron múltiples nódulos, uno de ellos de aspecto
plexiforme que involucraba la totalidad del nervio plantar interno imposibilitando la preservación del tronco por lo cual se
practicó microneurorrafia con interposición de puente de safeno interno.
Discusión y conclusión: Las Schwannomatosis Mononeurales de los Miembros son entidades extremadamente raras, se han
reportado con una frecuencia un poco mayor a aquellas que involucran a los nervios mediano y cubital, en sus características
macroscópicas las lesiones fueron publicadas como pertenecientes a la variante nodular para esa escasa mayoría. La
configuración plexiforme de los schwannomas es menos frecuente que la nodular per se y, en general. está asociada a
troncos menores, fuera de estos territorios, su rareza es extrema. Este caso clínico resulta aún más especial por tratarse de
una Schwannomatosis Mononeural del Plantar Medial con variante de tipo mixto, es decir nodular con una masa plexiforme
dominante. Esta entidad no la hemos encontrado en la bibliografía internacional.
Por otro lado, la resección quirúrgica de estos tumores, cuando son nodulares es compatible con la preservación del tronco
nervioso, sacrificando solamente, su fascículo de origen. Este caso, dada la configuración descripta del tumor principal, el cual
involucraba la totalidad del tronco, se hizo imposible la preservación del nervio, para lo cual debió realizarse microneurorrafia
con puente. Como consideración final, creemos que es de capital importancia la adecuada exploración y planificación pre e
intraoperatoria de estos pacientes.]]> poor, and there are just a few publications related to them. This articles make reference multiple nodular or plexiform lesions
with involvement oh only one nerve, every one whit diagnosis of schwannoma, excluding fibromatosis. In this article, we
describe a patient with who suffered the involvement of multiples tumours with nodular and plexiform configuration.
Material y method: The clinical case was analysed by different media, clinical, neuro physiological and by neuroimages. By this
approaches were defined and evaluated the surgical outcomes and results.
Clinical case: Male, 45 years old. Multiples tumours at plantar region. Tinel Sign with multiple palpable masses al retromaleolar
sulcus and plantar region, plantar schwannoma operated on previously.
RMN: multinodular configuration at level of medial plantar nerve, with intermediate contrast reinforcement.
An extended approach was performed, from retromaleolar sulcus to medial aspect of the foot, and finishing inside the digitalplantar
sulcus. Complete resection was performed, multiples nodulos were found, the bigger had a plexiform configuration, was
imposible the preservation of the nerve trunk and the, the interposition of sural nerve was realized. With good evolution
Conclusions: For this very rare entities, the bigger frequency was reported et limbs.
The most frequent locations was at medial nerve, second place occupied by the ulnar nerve, we didn’t find on international
literature a plexiform tumour inside the medial plantar nerve.
On the other hand, we think that the complete resection for this tumours when are nodular, the complete resection with
preservation of the main trunk, is feasible. Ehen the tumour has a plexiform pattern; complete resection is only feasible with
trunk nerve resection and interposition of nerve graft.]]> P.Schwannoma of the foot: report of four cases and literature review.
Acta Biomed. 2019 Jan 10;90(1-S):214-220. doi: 10.23750/abm.
v90i1-S.8079.
2. Li XN, Cui JL, Christopasak SP, Kumar A, Peng ZG.Multiple
plexiform schwannomas in the plantar aspect of the foot: case
report and literature review.BMC MusculoskeletDisord. 2014 Oct
11;15:342. doi: 10.1186/1471-2474-15-342.
3. Gosk J, Gutkowska O, Urban M, Wnukiewicz W, Reichert P,
Ziółkowski P.Results of surgical treatment of schwannomas
arising from extremities.Biomed Res Int. 2015;2015:547926. doi:
10.1155/2015/547926. Epub 2015 Feb 22.
4. MarkosIoannou, 1 Ioannis Papanastassiou,1 Ioanna
Iakowidou,2 Stamatios Kottakis,1 and NikolaosDemertzis.
Plexiformschwannoma of the posterior tibial nerve: a case report.
Published online 2009 Aug 17. doi: 10.4076/1757-1626-2-8392.
5. Touteréférence à cet article doit porter la mention :Valeyrie-Allanore
L., Wolkenstein P. Neurofibromatose 1 et formesvariantes. EMC
(ElsevierMassonSAS,Paris), Neurologie, 17-170-A-65, 2009.
6. Nafiseh Mortazavi, Kambiz Novin Farahnaz Bidari Zerehpoosh,
Managol Sadatsafavi. Plexiform Schwannoma of the Finger: A
Case Report and Literature Review.Departments of Pathology and
Clinical Oncology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran. July 4, 2019, IP: 181.167.224.166.]]> método costo-efectivo para reducir las complicaciones
Premio Beca Asociación Argentina de Neurocirugía. XV Jornadas Argentinas
de Neurocirugía 2019]]> la neurocirugía, tanto en pediatría como en adultos, sin embargo, no se encuentra exento de complicaciones. La tasa de
infección asociada al drenaje puede serdel 25%. En nuestro Hospital encontramos una incidencia del 22% anual.
Al ser sistemas que no cuentan con una regulación de la salida del líquido, el paciente debe permanecer en decúbito dorsal
estricto todo el tratamiento.
Nuestro objetivo es diseñar un nuevo sistema de drenaje ventricular al exterior de tunelización larga (DVET) que lidie con estos
problemas al mismo tiempo que reduzca los costos hospitalarios.
Material y métodos: Se realizó un ensayo clínico prospectivo en el que se colocaron 25 DVETL entre el 1/9/2018 al 1/5/2019
que se compararon con el sistema tradicional de DVE.
Resultados: La presencia de fístula se asoció más frecuentemente a los DVE en comparación con los DVETL, esta diferencia
fue estadísticamente significativa (30% vs 8% p=0,029). La presencia de infección asociada al drenaje fue significativamente
mayor en los DVE en comparación con los DVETL, esta diferencia fue estadísticamente significativa (22% vs 0% p=0,009). Los
pacientes con DVE tradicional utilizaron el doble de recursos y generaron el doble de costos que los pacientes con DVETL.
Conclusión: Se realizó una presentación detallada del nuevo sistema de DVETL que presenta una disminución en la incidencia
de fístula de LCR e infección asociada al drenaje. A su vez aparenta ser costo-efectiva en comparación con el sistema
tradicional de DVE.]]> pediatrics and in adults. The global rate of ventriculostomy-associated infections could rich 25%. In our Hospital, we found an
annual incidence of 22%.
In addition, since it does not have a regulation of cerebral spinal fluid (CSF) flow, the patient must remain in strict dorsal
decubitus throughout the entire treatment.
Our goal is to design a new long-tunneled external ventricular drain (LTEVD) that deals with these problems while reducing
hospital costs.
Material and method: A prospective clinical trial was conducted in which 25 LTEVD were placed between 1/9/2018 and
1/5/2019 that were compared with the traditional EVD system.
Results: The presence of CSF fistula was associated more frequently with EVD compared to LTEVD; this difference was
statistically significant (30% vs. 8% p = 0.029). The presence of associated infection was significantly higher in EVD compared
to LTEVD, and this difference was statistically significant (22% vs. 0% p = 0.009). Patients with traditional EVD used twice as
many resources and generated twice the cost as patients with DVETL.
Conclusion: A detailed presentation was made of the new LTEVD system that presents a decrease in the incidence of CSF
fistula and associated infection. At the same time, it appears to be cost-effective in comparison with the traditional DVE system.]]> infections: Incidence and risk factors. Am J Infect Control.
2005;33(3):137-143. doi:10.1016/j.ajic.2004.11.008.
2. Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM,
Jallo GI. Hospital Costs Associated With Shunt Infections in
Patients Receiving Antibiotic-Impregnated Shunt Catheters
Versus Standard Shunt Catheters. Neurosurg. 2010;66(2):284-289.
doi:10.1227/01.NEU.0000363405.12584.4D.
3. Bota DP, Lefranc F, Vilallobos HR, Brimioulle S, Vincent J-L.
Ventriculostomy-related infections in critically ill patients: a 6-year
experience. J Neurosurg. 2005;103(3):468-472. doi:10.3171/
jns.2005.103.3.0468.
4. Camacho EF, Boszczowski Í, Basso M, et al. Infection rate and risk
factors associated with infections related to external ventricular
drain. Infect. 2011;39(1):47-51. doi:10.1007/s15010-010-0073-5.
5. Cinibulak Z, Aschoff A, Apedjinou A, Kaminsky J, Trost HA,
Krauss JK. Current practice of external ventricular drainage: a survey
among neurosurgical departments in Germany. Acta Neurochir.
2016;158(5):847-853. doi:10.1007/s00701-016-2747-y.
6. Collins CDE, Hartley JC, Chakraborty A, Thompson DNP. Long
subcutaneous tunnelling reduces infection rates in paediatric
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analysis of antibiotic-impregnated shunts and external
ventricular drains in hydrocephalus. J Neurosurg. 2015;122(1):139-
147. doi:10.3171/2014.9.JNS131277.
8. González S, Carbonaro M, Fedullo AG, et al. Cerebrospinal
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26. Simpkins CJ. Ventriculoperitoneal shunt infections in patients with
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27. Smith RW, Alksne JF. Infections complicating the use of external
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28. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases
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29. Tunthanathip T, Kanjanapradit K, Sae-Heng S, Oearsakul T,
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Neurosurg Psychiatr. 2002;73(6):759-761.]]> dexmedetomidina y ketorolac en cirugía espinal:
Una estrategia para disminuir el consumo de opioides
2do Premio Beca Asociación Argentina de Neurocirugía.
XV Jornadas de Neurocirugía 2019]]> pacientes sometidos a instrumentación transpedicular dorsolumbar con técnica mini invasiva, en cuanto al consumo de
opioides durante la internación.
Materiales y métodos: Se recolectaron en forma retrospectiva los datos prospectivos de las historias clínicas de pacientes
con una instrumentación con tornillos transpediculares percutáneos operados entre Junio del 2016 y Diciembre del 2018. 32
pacientes cumplieron con los criterios de selección. Se infiltró en el momento del cierre quirúrgico con una solución preparada
con 150 mg de ropivacaína, 0,7 mcg/kg de dexmedetomidina y 60 mg de ketorolac, disuelto en solución fisiológica estéril para
completar 40ml (Grupo M) y se la comparó con pacientes en los cuales solo se infiltró con 150mg de ropivacaína (Grupo E).
Resultados: El consumo de equivalentes de morfina durante las primeras 72hs postoperatorias presentó en el grupo M una
mediana de 0mg, y el grupo E, una mediana de 9,5mg (RIQ de 13,35), con una p<0,000. Por el contrario el consumo de
morfina en la sala de recuperación presentó una mediana de 0mg (RIQ de 2) para el grupo M, y de 2mg (RIQ de 5) para el
grupo E, sin encontrarse una diferencia significativa, p=0,132.
Conclusión: Los resultados obtenidos en la comparación del consumo de opioides durante las primeras 72hs de la
internación permite inferir que esta combinación de fármacos es superior respecto a la infiltración estándar con ropivacaína,
independientemente de la estrategia analgésica utilizada durante el tiempo quirúrgico.]]> in reducing opioid consumption in patients with a transpedicular dorsolumbar instrumentation using a minimally invasive
technique.
Materials y methods: We retrospectively collected data from patient’s charts from June of 2016 to December of 2018. 32
patients with minimally invasive transpedicular dorsolumbar instrumentation, who met all criteria, were included in the analysis.
During wound closure a mixture of 150mg of ropivacaine, 0,7mcg/kg of dexmedetomidine and 60mg of ketorolac, diluted in
normal saline to achieve 40ml was injected (Group M). We compared them with patients in whom only 150mg of ropivacaine
and saline where injected in the surgical site (Group E).
Results: Morphine equivalents use during the first 72 hours postoperative had a median of 0mg for group M, and of 9,5mg (IQR
of 13.35), with a p<0,000. On the contrary, morphine use during post anesthesia care unit stance had a median of 0mg (IQR of
2) for group M and of 2mg (IQR of 5) for group E, without a statistically significant difference, p=0,132.
Conclusion: The result of the analysis of opioid consumption during the first 72 hours postoperative allows concluding that
the infiltration of these 3 drugs together its superior to the standard infiltration with ropivacaine, independently of the analgesic
strategy used during the surgery]]> total hip arthroplasty infiltration. Acta Orthop. 2007; 78(2): 187–92.
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RODEXKE. INFILTRACIÓN CON ROPIVACAÍNA, DEXMEDETOMIDINA Y KETOROLAC EN CIRUGÍA ESPINAL: UNA ESTRATEGIA PARA DISMINUIR EL CONSUMO
DE OPIOIDES
Sebastián Kornfeld, Hernan Bovery, Jorge Rasmussen, Federico Landriel, Santiago Hem, Claudio Yampolsky
REV ARGENT NEUROC. | 2019 TRABAJO PREMIADO
126
85(11): 2089–92.
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21(5): 645–50.]]> Utilización de un novedoso simulador de exoscopía
de bajo costo por residentes de neurocirugía
Premio Beca AANC-FLANC. XV Jornadas de Neurocirugía 2019 de AANC]]> por un grupo de residentes de neurocirugía.
Materiales y métodos: Se reclutaron 6 residentes de neurocirugía, todos ellos sin experiencia previa en exoscopía. Se
desarrolló una estación de simulación en exoscopía compuesta por una computadora, una webcam y una fuente de luz.
Todos los participantes realizaron un tutorial introductorio, un ejercicio inicial de 5 suturas (cada sutura fue clasificada en forma
binaria como correcta e incorrecta), evaluando el tiempo necesario para completar dicho ejercicio y la eficacia (definida como
la relación entre suturas correctas y el total). Posteriormente se realizaron 3 sesiones de entrenamiento semanal de 1 hora
cada una y una evaluación final con las mismas características que la inicial. Ambas evaluaciones fueron estudiadas por un
neurocirujano senior que realizó un análisis, así como la puntuación de cada ejercicio de los participantes.
Resultados: El tiempo promedio de realización del ejercicio inicial fue de 31 minutos con 59 segundos, con una eficacia
promedio del 70%. Luego del entrenamiento el promedio de tiempo fue 18 minutos y 12 segundos, con una eficacia del 80%.
Conclusión: El entrenamiento en este simulador demostró una notable mejoría en los tiempos y la calidad de la técnica
exoscópica si se compara el principio del entrenamiento con su final. Por los beneficios obtenidos y su bajo costo creemos
que será útil su implementación para acercar dicha técnica a todos los neurocirujanos que se encuentren interesados en ella.]]> Materials and methods: Six residents of neurosurgery were recruited, all of them having no previous experience in the use
of the exoscope. An exoscopy simulation station, including a computer, a webcam and a light source, was developed. All
the participants performed an introductory tutorial, an initial exercise of 5 sutures (each suture was classified as correct and
incorrect), evaluating the time to complete this exercise and the efficacy (defined as the relation between correct sutures and
the total). Posteriorly, 3 training sessions of 1 hour and a final evaluation with the same characteristics as the initial one were
performed by all the participants. Both evaluations were studied by a senior neurosurgeon who gave individualized punctuation
and feedback to the participant.
Results: The average time of the initial exercise was 31 minutes 59 seconds, with an average efficiency of 70%. After training,
the average time was 18 minutes, 12 seconds, with an efficiency of 80%.
Conclusion: The simulator training demonstrated the improvement of the exoscopic technique of the evaluated residents.
Because of the benefits that were observed, and also its low cost, we believe that the implementation of this device will be
useful to all neurosurgeons interested in this technique.]]> Clinical experience with a high definition exoscope system for
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