La técnica de primera elección ante la imposibilidad de reconstruir directamente la comunicación axonal mediante la unión de ambos cabos del nervio facial, sigue siendo, al igual que décadas atrás, la anastomosis hipogloso facial. Si bien no se consigue con ella la recuperación de los movimientos de la mímica, sí es posible restablecer la simetría de la cara, la oclusión palpebral y la adecuada reinserción social del paciente.
Las diversas variantes de esta técnica aguardan confirmación estadística respecto a su utilidad, pero deben ser tenidas en cuenta en casos determinados como una alternativa válida a la técnica clásica, como por ejemplo cuando coexisten con la parálisis facial, alteraciones deglutorias y fonatorias importantes.]]>
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311. Demarest G, Scannell G, Sanchez K, Dziwulski A, Qualls C, Schermer CR et al. In-house versus oncall attending trauma surgeons at comparable level I trauma centers: A prospective study. J Trauma1999; 46: 535-540.
312. Eastman B, Strauch G, Lucas C. Should trauma surgeons do general surgery? - Discussion. J Trauma 2000; 48: 437-438.
313. Fakhry S, Watts D. What's a trauma surgeon worth? A salary survey of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49: 833-838.
314. Gabram S., Esposito T, Monis R., Mendola R, Gamelli R. Trauma care fellowships: Current status and future survival. J Trauma 1998; 44: 86-91.
315. Grossman M, Schwab C, ChuRodgers S, Kestner
M. Time and motion: A study of trauma surgeons' work at the bedside during the first 24 hours of blunt trauma care. J Trauma 1999; 46: 757-763.
316. Hoff W, Reilly P, Rotondo M, Digiacomo J, Schwab W. The importante of the commandphysician in trauma resucitation. J Trauma 1997; 43: 772-777.
317. Hoyt D, Moore E. Shackford S, Holcroft J, Jurkovich G. Trauma surgeon's leadership role in the development of trauma systems. J Trauma 1999; 46: 1142.
318. Iserson K. Nonstandard advance directives: A pseudoethical dilemma. J Trauma 1998; 44: 139-142.
319. Fallon W. Surgical lessons learned on the battlefield. J Trauma 1997; 43: 209-213.
320. Hill D, Delaney L, Roncal S. A chi-square automatic interaction detection (CHAID) analysis of factors determining trauma outcomes. J Trauma 1997; 42: 62-66.
321. Hunt J, Cherr G, Hunter C, Wright MJ, Wang YZ, Steeb G et al. Accuracy of administrative data in trauma: Splenic injuries as an example. J Trauma 2000; 49: 679-686.
322. McCarthy M, Pasquale M, Barie P, Bergsein J, Trooskin S. Case-matching methodology as an adjunct to trauma performance improvement for evaluating lengths of stay and complications Discussion. J Trauma 1999; 47: 1026-1027.
323. Mueller C. Picture Archiving Communication System does not decrease the number of radiographs needed to evaluate the trauma patient - Comment. J Trauma 1998; 44: 170.
324. Pitts L, Brotman S, Cunningham P. Emergency craniotomy in a rural Level III trauma center - Discussion.J Trauma 1998; 44: 989-990.
325. Rinker C, MacMurry F, Groeneweg V, Bahnson FF, Banks KL, Gannon DM. Emergency craniotomy in a rural Level III trauma center. J Trauma 1998; 44: 984-989.
326. Rogers F, Reath D, Spain D. A prospective study of predictors or disability at 3 month after non-central nervous system trauma. J Trauma 1998; 44: 642-643.
327. Sicignano A, Giudici D. Probability model of hospital death for severe trauma patients based on the simplified acule physiology score I: Development and validation. J Trauma 1997; 43: 585589.
328. Richmond T, Kauder D, Schwab W. A prospective study of predictors or disability at 3 month after non-central nervous system trauma. J Trauma 1998; 44: 635-642.]]> Método. Veintitrés abordajes transcallosos fueron aplicados en dieciocho pacientes entre enero de 1995 y enero de 2003. Se revisaron las historias clínicas, partes quirúrgicos e imágenes obtenidas en el pre y postoperatorio (18 TAC y 13 IRM al diagnóstico); se evaluaron la extensión de callosotomía y los hallazgos quirúrgicos. Se compararon los resultados anatomopatológicos en casos de repetición del procedimiento.
Resultados. La edad promedio fue de :6 años (3-17 años). Se realizaron 23 procedimientos. En cuatro pacientes se repitió el abordaje (un astrocitoma pilocítico en dos oportunidades, un cavernoma también en dos y una MAV en una).
Nueve tumores sólidos, un quiste coloideo y un craneofaringioma ubicados en el III ventrículo fueron explorados por vía transforaminal. Tres tumores taiámicos se resecaron desde la cara ventricular, uno con la variante transcoroidea. Dos tumores de la prolongación frontal fueron resecados desde la callosotomía. En una MAV la callosotomía se utilizó para control y resección de drenajes profundos. Anatomía patológica: 7 astrocitomas pilocíticos, 3 glioblastomas, 1 papiloma de plexo coroideo, 1 neurocitoma, 1 ependimoma, 1 germinal mixto, 1 cavernoma, 1 quiste coloideo, 1 craneofaringioma y 1 MAV. Se realizaron:10 resecciones completas ,7 subtotales, 5 parciales. Dos pacientes presentaron deterioro neuropsicológico postquirúrgico: uno portador de un Astrocitoma talámico; el otro fue un niño con papiloma de plexos coroideos con hidrocefalia persistente.
Conclusión. La mínima incisión neural de la callosotomía permite resecciones amplias sin agregar lesión, aún con la repetición del procedimiento.
La extensión de la callosotomía resultó mayor en IRM que la estimación del cirujano. No se necesitaron secciones del fornix ni coagulación venosa ya que el agrandamiento del Foramen de Monro es suficiente para la exploración.]]>
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Resultados. Población pediátrica: se definió lateralidad y el área epileptogénica primaria (AEP) en 26 de 28 casos. El estímulo cortical permitió localizar el área motora en 4 pacientes. En 2 pacientes no pudo definirse lateralidad ni AEP. Población adulta: en 12 de 13 pacientes pudo establecerse lateralidad y localización del AEP; en un paciente no se logró. A pesar de la dificultad de localizar el AEP en el 14% de los niños y 16 % de los adultos esta metodología permitió tratar quirúrgicamente ambas poblaciones con una evolución en Engel I y II del 84% y 72% respectivamente. El seguimiento promedio fue en la población pediátrica de 6 años y en la población adulta de 6 años y 8 meses.
Conclusión. La cirugía en dos tiempos con implante de electrodos intracraneanos es muy útil para el diagnóstico y tratamiento de epilepsias refractarias complejas en las que la imagen, clínica y videoEEG son incongruentes.]]>
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