Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population — a prevalence study. J Clin Epidemtol 1991; 44: 1147-57.

Rasmussen BK. Epidemiology of headache. Cephalalgia 1995; 15: 45-68.

Rasmussen BK. Epidemiology of Headache. Ce phalalgia 2001; 21: 774-77.

Lampl C, Buzath A, Baumhackl U, Klingler D. Oneyear prevalence of migraine in Austria: a nationwide survey. Cephalalgia 2003; 23: 280-6.

Couturier EGM, Bomhof MAM, Neven AK, van Duijn NP. Menstrual migraine in a representative Dutch population sample: prevalence, disability and treatment. Cephalalgia 2003; 23: 302-8.

Dahltif C,Linde M. One-year prevalence of migraine in Sweden: a population-based study in adults. Cephalalgia 2001; 21: 664-71.

8. Rasmussen B, Jensen R and Olesen J. A population based analysis of the diagnostic criteria of the International Headache Society. Cephalalgia 1991; 11: 129.

Schwartz BS, Stewart WF, Simon D et alt. Epidemiology of tension-type headache. JAMA 1998; 279: 381-3.

Lavados P and Tenhamm E. Epidemiology of tension-type headache in Santiago, Chile a prevalence study. Cephalalgia 1998; 18: 552-8.

Scher AL, Stewart WF, Liberman J, Lipton RB. Prevalence of frequent headache in a population sample. Headache 1998; 38: 497-506.

McHorney C, Ware J, Raczek A.E. The MOS 36- item short form health survey (SF-36): II. Psycho­metric and clinical test of validity in measuring physical and mental health constructs. Med. Care 1993; 31: 247-63.

Hu X, Markson L, Lipton RB et al. Disability and economic costs of migraine in tha United States: A population based approach. Arch. Inter. Med. 1999; 159: 813-8.]]> Method: Between 1978 and 2003, 223 patients underwent surgery for cervical spondylotic myelopathy. 41 patients presented with degenerative subaxial subluxation. According to the Nurick scale, 26 were grade 2, 14 were grade 3 and 1 was grade 4. Those with degenerative subluxation were older compared to those who liad only spondylotic myelopathy (63 vs. 13 years). Theformer also corresponded to higher grades of the Nurick scale. All patients underwent static and dynamic plain radiographs, and MRI. We found 29 subluxations of one level, 11 patients wíth affection of two levels and 1 with three levels. 33 patients liad unstable subluxations. The most commonly affected levels were C3-C4 and C4-05. In all the cases, an anterior approach with autogenous bone graft and locking plate was performed.
Results: After surgical treatment, 21 grade 2 patients improved one grade, while 5 improved two grades; 9 grade 3 patients improved one grade and 1 two grades; the grade 4 patient improved one grade.
Conclusion: Cervical degenerative subluxation is seen in older patients, usually associated with severe myelopathy and spondylotic changes. The cervical instability is more common in the C3-C4 and C4-05 segments. In oil the cases of our group there was a loss of cervical lordosis or kyphosis with ankylosis of the lower cervical spine. The anterior approach with autogenous bone graft and locking Mate, allowed spinal cord decompression and cervical fusion.]]>
Pellengahr C, Pfahler M, Kuhr et al: Influence of facet joint angles and asymmetric disc collapse on degenerative olisthesis of the cervical spine. Orthopedics 2000; 23: 697-701

Boulos AS, Lovely TJ: Degenerative cervical spondylolisthesis: Diagnosis and management in five cases. J Spinal Disord 1996; 9: 241-5.]]> Descripción. Se han utilizado neuroendoscopios rígidos Wolf ®, Storz ® o Aesculap ® según los casos. El instrumental auxiliar utilizado ha consistido en pinza de biopsia, tijera, electrodo mono y/o bipolar y catéterbalón tipo Fogarty 3 F. El equipamiento complementario lo constituyen una videocámara de alta resolución, una fuente de luz fría y un monitor de alta definición, de acuerdo a su disponibilidad. Las imágenes han sido registradas por medio de un capturador fotográfico digital y de un videograbador.
Resultados. La técnica neuroendoscópica ha permitido el tratamiento quirúrgico de los quistes aracnoideos supratentoriales de línea media en forma mínimamente invasiva comunicando estas lesiones con las cisternas basales y/o el sistema ventricular. Conclusión. La vecindad de estas lesiones con el sistema ventricular resulta ideal para su fenestración endoscópica y comunicación con las vías de circulación del líquido cefalorraquídeo.]]>
Ciricillo SF, Cogen PH, Harsh GR, Edwards MSB. Intracranial arachnoid cysts in children. A comparison of the effects of fenestration and shunting. J Neurosurg 1991; 74; 230-5

Raffel C, McComb JG. To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients ? Neurosurgery 1988; 23: 338-2

Decq P, Brugieres P, Le Guerinel C, Djindjian M, Keravel Y, Nguyen J-P. Percutaneous endoscopic treatment of suprasellar arachnoid cysts: ventriculocystostomy or ventriculocystocystemostony? J Neurosurg 1996; 84: 696-1

Miyajima M, Arai H, Okuda O, Hishii M, Nakanishi H, Sato K. Possible origin of suprasellar arachnoid cysts: neuroimaging and neurosurgical observations in nine cases. J Neurosurg 2000; 93: 62-7.

Oberbauer RW, Haase L, Pucher R. Arachnoidcysts in children: a European co-operative study. Child's Nerv Syst 1992; 8: 281-6

Choi J-U, Kim D-S. Pathogenesis of arachnoid cysts: congenital or traumatic? Pediatr Neurosurg 1998; 29: 260-6

Pierre-Kahn A, Capelle L, Bruner R, Sainte-Rose C, Renier D, Rappaport R, Hirsch J-F. Presentation and management of suprasellar arachnoid cysts. Review of 20 cases. J Neurosurg 1990; 73: 355-9

Buxton N, Vloeberghs M, Punt J. Flexible neuroendoscopic treatment of suprasellar arachnoid cysts. Br J Neurosurg 1999; 13: 316-8

Choi J-U, Kim D-S, Huh R. Endoscopic approach to arachnoid cyst. Child's Nerv Syst 1999; 15: 285-1

Kirollos RW, Javadpour M, May P, Mallucci C. Endoscopic treatment of suprasellar and third ventricle-related arachnoid cysts. Child's Nerv Syst 2001; 17: 713-8]]> Description: We present 2 cases with vertebral artery dissecting aneurysms. The first patient liad spontaneous occlusion of the lesion, the second showed a persistent fusiform dilatation of the artery.
Intervention: Early treatment is recommended. The patient who showed spentaneous cure of the dissection was followed with angiography. The second case was occluded with coil.
Conclusion: The endovascular occlusion of these lesion is an efflcacious and safer procedure than surgical clipping.
]]>
Cecinano AR, Lemme-Plaghos LA, Garbugino SL, Schónholz CJ, Mendaro EE: Pseudoaneurismas por disección de la arteria vertebral intradural: tratamiento endovascular. Rey Argent Neuroc 1995; 9: 102-6.

Kitanaka C, Tanaki JL, Kuwahara M, Teraoka A, Sasaki T, Takakura K: Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg1994; 80: 667-74.

Lylyk P, Ceratto R, Cohen JE Ferrario A, Miranda C: Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 2001; 94: 427-32.

Pozzati E, Padovani R, Fabrizi A, Sabattini L, Gaist G: Benign arterial dissections of the posterior circulation. J Neurosurg 1991; 75: 69-72.

Yonas H, Agamanolis D, Takaoka Y, White RJ: Dissecting intracranial aneurysms. Surg Neurol 1977; 8: 407-15.]]> Descripción. Paciente de sexo femenino, cuadro progresivo de compresión medular dorsal, con antecedentes de neurocisticercosis. Las neuroirnágenes mostraron una lesión intradural-extramedular D5-D6.
Intervención. Se abordó quirúrgicamente en posición lateral, verificándose aracnoiditis reaccional y quiste de cisticerco que fue resecado, completándose el tratamiento con Albendazol oral, con regresión de la paraparesia severa preoperatoria y satisfactorio control imagenológico.
Conclusión. La forma espinal es infrecuente en el curso de la neurocisticercosis. La terapéutica implementada en nuestro caso fue concordante con los pocos casos descriptos en la literatura mundial
]]>
Corral I, Quereda C, Moreno A, López Vélez R, Martínez San Millan J, Guerrero A, et al. Intramedullary cysticercosis; Spine 1996; 21: 2284-7

Robertson H, Watson J. Neurocysticercosis with ceivical meningeal invovement; AJR 1978; 171: 877-88.

Leite C, Jinkins R, Escobar B, Magalhaes A, Gomes G, Dib G, et al. MRI imaging of spinal cysticercosis; AJR 1997; 169: 1713-7.

Corr P, Royston D, Naidoo HT. The role of imaging in diagnosis of unusual spinal infection; Int J Neuroradiol 1999; 5: 200-1.]]> Descripción. Una valva del retractor de Taylor se une al retractor de Yasargil para sostener y separar los músculos paravertebrales.
Conclusión. Esta variante de retractor expone el campo quirúrgico sin dañar las estructuras de la línea media.]]>
Caspar W: A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 1977; 4: 74-7.

Yasargil MG: Microsurgical operation of the herniated lumbar disc. Adv Neurosurg 1977; 4: 81-91.

Williams RW: Microlumbar discectomy: A conservative surgical approach to the virgin herniated lumbar disc. Spine 1978; 3: 175-82.

Bell WO, Lavyne MH: Retractor for lumbar microdiscectomy: Technical note. Neurosurgery 1984; 14: 69-70.

Goald HJ: Microlumbar discectomy: Follow-up of 477 patients. J Microsurg 1980; 2: 95-100.

Wilson DH, Harbaugh R: Microsurgical and standard removal of the protruded lumbar disc: A comparative study. Neurosurgery 1981; 8: 422-27.

Wilson DH, Kenning J: Microsurgical lumbar discectomy: Preliminary report of 83 consecutive cases. Neurosurgery 1979; 4: 137-40.

Taylor GM: A simple retractor for spinal surgery. J Bone Joint Surg 1946; 28A: 183-4.]]> Description: Case 1 (male, 24 years old), with headache, vomits, right homonymous hemianopsia and conductal disorder, in the last 2 months. MRI: left parieto-occipital cystic tumor. Case 2: (male, 56 years old) with left brachiocrural palsy, in the past year. CT scan: left parietal cystic tumor. Case 3: (female, 56 years old) with generalized siezure, in the last month. 114 R left parietal cystic tumor. In the three cases, the suspected diagnose was glioma.
Intervention: In the 3 cases a craniotomy was performed, with total (cases 2 and 3) or partial resection of the tumor (case 1). The cysts were intratumoral (case 2) and extratumoral (cases 1 and 3). Pathology informed meningioma. The outcome was favorable, with no complications.
Conclusion: It is very difficult to make a diagnosis of cystic meningioma before surgery procedure and pathological analysis. During surgery they behave as solid. meningiomas. Key words: craniotomy, cystic meningioma, cystic tumor.]]>
El-Filki M., El-Henawy Y, Abdel-Arman N. Cystic Meningioma. Acta Neurochir (Wien) 1996;138: 811-7.

Chen C Th, Zee Ch, Miller A C, Weiss H M, Tang G, Chin L, et al. Magnetic resonance imaging and pathological correlates of meningioma. Neurosurgery 1992; 31: 1015-9.

Suzuki Y., Sugimoto T., Shibuya M., Sugita K., Patel J S. Meningioma: Correlation between MRI characteristics and operative findings including consistency. Acta Neurochir (Wien) 1994; 129: 29-46.



]]> Descripción. Se presentan 2 casos de sexo femenino, 47 y 40 años, con una mielopatía cervical progresiva, causada por una hernia dura y blanda a nivel C5-6 respectivamente, diagnosticada con IRM. Se efectuó una discectomía anterior con autoinjerto tricortical. Evolucionaron favorablemente de su mielopatía, persistiendo dolores cervicales moderados en el segundo caso.
Intervención. Los controles postoperatorios con IRM mostraron en los distintos cortes, imágenes de intensidad mixta, contornos irregulares y bordes difusos, que simulaban patología residual. La radiografia simple (Rx) y la tomografia axial computada (TAC) postoperatorias fueron normales. Lafalta de coincidencia clínica-IRM e IRM-Rx-TAC hizo suponer que dichas imágenes eran artefactos, probablemente metálicos.
Conclusión: Las imágenes postoperatorias de intensidad mixta que ocupan el canal a nivel del disco operado pueden ser artefactos; la Rx y TAC suelen aclarar el diagnóstico. ]]>
Salazar JL, Misra MM, Bloom D, Dobben G. MRI artifacts following anterior cervical diskectomy. Surg Neurol 1997; 48: 23-9.

Arunkumar MJ, Rajshenkhar V. Artifacts in magnetic resonance images following anterior cervical discectomy and fusion: report of two cases. British J Neurosurg 1998; 12: 553-5.

Ruggieri PM. A practical approach to magnetic resonance physics in spinal imaging. En: Modic MT, Masaryk TJ & Ross JS, editors. Magnetic Resonance Imaging of the Spine. St. Louis: Mosby; 1994. pp.1-36.

Toro VE, Goodrich A, Lundy DW, Meeks L, Figueroa RE, Binet EF. MR artifacts after anterior cervical diskectomy and fusión: a cadaver study. J Comput Assist Tomogr 1993; 17: 696-9.

Tartaglino LM, Flanders AE, Vinitski S, Friedman DP. Metallic artifacts on MR images of the postoperative spine: reduction with fast spin-echo techniques. Radiology 1994; 190: 565-9.]]> Description: A32 year-old mole with decreasing visual acuity, headache and epistaxis. MRI: parasellar lytic lesion extending to nasal cavities. Transnasal biopsy: proltferation of S100 positive cells and eosinophilic granulocytes.
Intervention: Radiation therapy was followed by remission.
Conclusion: Langerhans' cell histiocytosis can present as a unifocal (eosinophilic granuloma) or multifocal disorder. Usually affects children. The skull base is rarely affected. Surgery with or without radiotherapy is the treatment of choice for solitary accessible lesions. Isolated radiotherapy and intralesional steroids are valid options. Systemic disease requires chemotherapy.]]>
Komp D. Langerhans cell (eosinophilic) granulomatosis. En: Bennet JC, Plum F, editores. Cecil Textbook of Medicine. 20th ed. Philadelphia: W.B. Saunders Company; 1996. p. 955-6.

Sampson JH, Rossitch E Jr, Young JN, Lane KN, Friedman AH. Solitary eosinophilic granuloma invading the clivus of an adult: case report. Neurosurgery 1992; 31:755-7.

Brisman JL, Feldstein NA, Tarbell NJ, Cohen D, Cargan AL, Haddad J Jr et al. Eosinophilic granuloma of the clivus: case report, follow up of two previously reported cases, and review of the literature on cranial base eosinophilic granuloma. Neurosurgery 1997; 41: 273-8.

Lederman CR, Lederman ME. Unifocal Langerhans cell histiocytocis in the clivus of a child with abducens palsy and diplopia. J AAPOS 1998; 2: 378-9.

Wirtschafter JD, Nesbit M, Anderson P, McClain K. Intralesional methylprednisolone for Langerhans' cell histiocitosis of the orbit and cranium. J Pediatr Ophthalmol Strabismus 1987; 24: 194-7.]]> Method. 176 patients with subacute or chronic subdural hematomas were operated between June 1998 and May 2003. Hospital records were used to ascertain data. We did a comparative analysis of the different types of surgical procedures performed.
Results. The surgical procedure commonly performed was a burrhole craniostomy with subdural closed-system drainage (66%). This procedure was associated with a low rate of complications and reoperations, in comparison with the burr hole craniostomy or the craniostomy without subdural closed-system drainge. Global recurrence rate was 13% and 20.4% of the cases required reoperation. Clinical improvement rate was 72.3%.
Conclusion. In our cases, burr hole craniostomy with closed-system drainge was the method of choice for the initial treatment in subacute and chronic subdural hematomas. Craniotomy should be reserved for those cases of recurrence or residual hematoma. Key words: chronic subdural hematoma, subacute subdural hematoma, subdural drainage]]>
Ernestus R, Beldzinski P, Lanfermann H, Klug N: Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 1997; 48: 220-5.

Tabaddor K, Shulman K: Definitive treatment of chronic subdural hematoma by twist-drill craniostomy and closed-system drainage. J Neurosurg 1977; 46: 220-6.

Voelker J, Sambasivan M: The role of craniotomy and trephination in the treatment of chronic subdural hematoma. Neurosurg Clin N Am 2000; 11: 535-40.

Markwalder T, Steinsiepe K, Rohner M, Reichenbach W, Markwalder H: The course of chronic subdural hematomas alter burr-hole craniostomy and closed-system drainage. J Neurosurg 1981; 55: 390-6.]]> Description: We report a case of a 47 year old patient with headache and Horner syndrome. The digital angiography (DA) showed a SCD. That was followed by a pseudoaneurysm. A 46 year old patient presented with a right amaurosis fugax and left hemiparesis. A SCD was diagnosed by magnetic resonance angiography. It presented with a pseudoaneurysm.
Intervention: Both pseudoaneurysm were treated with stents.
Conclusion: DA is the method of choicefor the diagnosis and evolutive dynamic control of SCD. Stents are useful pseudoaneurysm resolution.]]>
Biller J, Hingtgen WL, Adams HP, Smocker WR, Godersky JC, Toffol GJ. Cervicocephalic arterial dissections: A ten-year experience. Arch Neurol 1986; 43:1234-8.

Friedman WA, Day AL, Quisling RG, Sypert GW, Rhoton AL Jr. Cervical carotid dissecting Aneurysms. Neurosurgery 1980; 7: 207-214.

Kremer C, Mosso M, Georgiadis D, Stockli E, Benninger D, Arnold M et al: Carotid dissection whit permanent and transient occlusion or severe stenosis: Long-term outcome. Neurology 2003; 60: 271-275.

Malek AM, Higashida RT, Phatouros CC, Malek AM, Lempert TE, Dowd CF et al: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR 2000; 21: 1280-92.

Pozzati E, Gaist G, Poppi M: Resolution of occlusion in spontaneously dissected carotid arteries: Report of two cases. J Neurosurg 1982; 56: 857-60.]]> Description: mate, 53 years old, with a clinical presentation of dizziness and diplopia. MRI: posterior fossa tumor in the left cerebellar hemisphere, with an extension to the peduncle, brain stem and cerebellopontine angle.
Intervention: a subtotal ressection was performed through a suboccipital craniotomy. Pathology informed GBM. After surgery the patient completed the treatment with radiotherapy (60 Gy). The outcome was favorable.
Conclusion: the preoperative diagnosis of a posterior fossa GBM is difficult because its a extremely rare localization, nevertheless it must be suspected.
Key words: high grade glioma, glioblastoma multiforme, radiotherapy.]]>
Luccarelli G. Glioblastoma multiforme of cerebellum: Description of three cases. Acta Neurochir (Wien) 1980; 53: 107-16.

Russell D, Rubinstein L. Pathology ofTumors of the Central Nervous System. 5th ed. Baltimore, Williams & Wilkins, 1989, p. 1012.

Fiveash J, Spencer S. Role of radiation therapy and radiosurgery in glioblastoma multiforme. Cancer 2003; 9: 222-9.

Lacroix M, Abi-Said D. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95: 190-8.

Afra D, Baron B, Bonadonna G. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet 2002; 359:1011-8.]]> Method: Fourformalin-fixed adults heads were examined using X 6 to X 40 magnification. The vessels were filled with colored silicon.
Results: The ambient cistem is located in both sides of the mesencephalon; it is in relation with the crural cistem in front, the cuadrigeminal cistem behind and the cerebellopontine cistem bellow.The diferent approaches to the ambient cistem are: 1) transchoroidal approach, 2) infraoccipital transtentorial approach and 3) supracerebeIIar transtentoriaI approach.
Conclusion: The transchoroidal, infraoccipital transtentorial and supracerebellar trans­tentorial are options when there are a lesion in the ambient cistern.]]>
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Liliequist B: The anatomy of the subarachnoid cisterns. Acta Radiol 1956; 46: 61-71.

Ikeda K, Shoin K, Mohri M, Kijima T, Someya S,

Yamashita J. Surgical indications and microsurgical anatomy of the transchoroidal fissure approach for lesions in and around the ambient cistern. Neurosurgery 2002; 50: 1114-20.

Smith KA, Spetzler RF. Supratentorial-infraoccipital approach for posteromedial temporal lobe lesions. J Neurosurg 1995; 82: 940-4.

Yonekawa Y, Imhof HG, Taub E, Curcic M, Kaku Y, Roth P et al. Supracerebellar transtentorial approach to posterior temporomedial structures. J Neurosurg 2001; 94: 339-45.



]]> Descripción. Reportamos dos casos de pseudomeningocele crónico secundario a cirugía de columna lumbar diagnosticados por TAC/ RNM. La solución de continuidad dural en un caso fue objetivada por mielototomografia y en el otro por RNM con secuencia de dinámica de flujo de LCR.
Intervención. Ambos casos fueron tratados quirúrgicamente con cierre del defecto dural obteniéndose buenos resultados posoperatorios.
Conclusión. La presencia de dolor radicular en el contexto de un pseudomeningocele postquirúrgico es un signo indirecto de atropamiento radicular y herniación de la misma a través del defecto dural y / o aracnoideo lo que debe ser resuelto quirúrgicamente para evitar el déficit neurológico irreversible.]]>
Hadani M, Findler F, Knoler N, Tadmor R, Sahar A, Shacked I: Entrapped nerve root in pseudomeningocele after laminectomy: report of three cases. Neurosuergery 1986; 19: 405-7.

Shapiro SA, Scully T: Closed continuous drainage of CSF via a lumbar subarachnoid catheter for treatment or prevention of cranial/spinal cerebrospinal fluid fistula. Neurosurgery 1992; 30: 241-5

Schumacher HW, Wassman H, Podlinski C: Pseudomeningocele of the lumbar spine. Surg Neurol 1988; 29: 77-8.

O'Connor D, Maskery N, Griffiths G: Pseudomeningocele nerve root entrapment after lumbar discectomy. Spine 1998; 23: 1501-2.

Stambough JL, Templin CR, Collins J: Subarachnoid drainage of an established or chronic pseudomeningocele. J Spinal Disorders 2000; 12: 39-41.]]> ]]> ]]> Geijo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H. Serial changes in trunk muscles performance alter posterior lumbar surgery. Spine 24: 1023­1028, 1999.
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Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE. Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg 72: 378-382, 1990.
Porchet F, Chollet-Bornand A, de Tribolet N. Longterm follow up of patients surgically treated by the far lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg: Spine 90: 59-66, 1999.
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8.. Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg 50A: 919-926, 1968.
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Zonenshayn M, Edger MA, Lavyne MH. Removal of a lumbar melanotic schwanoma vía the far lateral approach in a patient with Carney complex. Case report. J Neurosurg: Spine 92: 241­245, 2000.]]> Selección del candidato y tratamiento quirúrgico]]> Barnett GH, Burgess R, Awad IA, Skipper GJ, Edwards CR, Lüders HO. Epidural PEG electrodes for presurgical evaluation of intractable epilepsy. Neurosurgery 27: 113-115, 1990.
Cahan LD, Sutherling W, Mc Coullogh AM, Rausch R, Engel J, Crandall PH, Review of 20 years UCLA experience with surgery for epilepsy. Cleve Clin Q 51: 313-318, 1984.
Cataltepe O, Comair Y. Complications of extratemporal epilepsy surgery in infants and children. En: Pediatric epilepsy syndrome and their surgical treatment. Cap 72 pág. 709-725. Editor: I. Tux­horn- H. Holthausen- H. Boenigk. John Libbey. London. England. 1997.
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Jean-Pierre Farmer. Operative strategies in the management of extratemporal epilepsy of childho­od. Chap 70 pág. 691-695. En: Paediatric Epilepsy Syndromes and their Surgical Treatment. I. Editors Tuxhorn, H. Holthausen, H. Boenigk. Published by John Libbey Company Ltd. London. England. 1997.
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]]> Nuestra experiencia en 53 casos operados en 3 años]]> Objetivos: analizar las relaciones entre la gradación de Hunt-Hess, la escala de Fisher tornográfica, la incidencia de vasoespasmo , la estrategia y la técnica quirúrgica como factores relevantes en la evolución.
Material y métodos: nuestros 53 pacientes se distribuyeron de la siguiente manera:
- Score de Hunt-Hess : grado O: un paciente ; grado I : 17 pacientes ; grado II: 25 pacientes; grado III: 8 pacientes; grado IV ninguno, y grado V :un paciente.
- Escala de Fisher: grado I: 3 casos ; grado II: 28 casos, grado III : 11 casos y grado IV: 11 casos.
- Vasoespasmo clínico y / o angiográfico : en 17 pacientes.
- Estrategia quirúrgica: cirugía precoz en 25 casos.
Resultados: la mortalidad en los casos con Hunt-Hess grados 1 y 2 fue del 2,7%, en 33 pacientes se constató una muy buena evolución y en 8 casos una buena evolución. La mortalidad fue del 50 % en los grados 3 a 5.
Conclusión: se observó evolución favorable en los pacientes intervenidos con Hunt­Hess 1 y 2, en comparación con aquellos en grados 3 a 5. Se evidencia como elemento singular relevante en el pronóstico el nivel de conciencia prequirúrgico con respecto a las demás variables.]]> Objetives: To analyze the relationship between the Hunt and Hess grading system, Fisher tomographic scale, vasospasm incidence, surgical strategy and technic as relevant factors in patient outcome.
Material and Methods: Our 53 patients showed the following distribution :
- Hunt and Hess grade 0: one patient; grade I: 17 patients; grade II: 25 patients; grade III: 8 patients; grade IV: none and grade V: 1 patient.
- Fisher scale. Grade I: 3 cases; grade II: 28 cases; grade III: 11 cases and grade IV: 11 cases. Clinical and/ or angiographic vasospasm: 17 patients.
- Surgical strategy: early surgery in 25 cases.
Results: Patients belonging to Hunt and Hess grades 1 and 2 had a 2.7% mortality rate with a very good outcome in 33 cases and good outcome in 8. Grades 3 to 5 had an overall mortality of 50%.
Conclusion: A good outcome was observed in patients included in Hunt and Hess grades 1 and 2 as compared to patients in grades 3 to 5. Furthermore, the patients presurgical consciousness level resulted in the single most important prognostic factor.]]> Aring CD: A medical perspective. Neurology 34: 1.357-1.361, 1984.
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]]> 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.]]> 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.
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Nerve Sutures in (Extended) Upper Obstetric Brachial Plexus
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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
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AS. Non-Sedated Rapid Volumetric Proton Density MRI Predicts
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Hand Surg Am. 2015;40(6):1246-59.]]> 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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124
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71/2009.6.focus09120.]]> 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
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85(11): 2089–92.
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21(5): 645–50.]]> 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.
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Objetivo: Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del
cerebro humano, y su correlación anatómica con casos quirúrgicos.
Material y Métodos: En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas
en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en
pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014.
Resultados: Extenso conjunto de fibras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo
arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por déficits neurológicos
severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral media, cápsula
interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas.
Conclusión: El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre
neurofisiología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que influencian en los resultados
quirúrgicos.]]> of the brain. It is covered by the frontal, parietal and temporal operculum.
Objectives: To study the anatomy of the insular lobe, one of the most complex parts of the human brain, and to correlate this
anatomy with intraoperative findings.
Materials and Methods: In the first part of this article we show the results of our dissections, documented in 2D and 3D, and
focus on microsurgical anatomy. In the second part we correlate the anatomical structures with intraoperative findings from 44
insular tumor surgeries, mainly gliomas, of patients operated on from 2007 to 2014.
Results: Huge bundles of subcortical fibers, like uncinate, inferior fronto-occipital and arcuate fascicles, connect the insula
to the neighboring structures. Several anatomical structures related to neurological disabilities are closely related to insular
surgery, like the middle cerebral artery, internal capsule, lenticulostriate arteries and cortical and subcortical language circuits.
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plasticity allowing a multistage surgical approach to World Health
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50. Roper SN, Lévesque MF, Sutherling WW, Engel J Jr. Surgical
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51. Sanai N, Polley MY, Berger MS. Insular glioma resection:
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Neurosurg. 2010;112(1):1-9. PMID 19612970.
52. Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J.
Insular gliomas: the case for surgical management. J Neurosurg.
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53. Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella
F, Reulen HJ. Fluorescence-guided surgery with 5-aminolevulinic
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54. Taillandier L, Duffau H. Epilepsy and insular Grade II gliomas:
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55. Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda
A. Microsurgical anatomy of the insula and the sylvian fissure. J
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59. Wen HT, Rhoton AL Jr, de Oliveira E, Cardoso AC, Tedeschi H,
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66. Yasargil MG. Microneurosurgery. Vol 4. New York: Thieme Medical;
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67. Zentner J, Meyer B, Stangl A, Schramm J. Intrinsic tumors of the
insula: a prospective surgical study of 30 patients. J Neurosurg.
1996;85(2):263-71. PMID 8755755.]]> 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.]]> 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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Surgery : Rationale and Results. 2019.]]> 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.

]]> 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.
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2. Attenello FJ, Garces-Ambrossi GL, Zaidi HA, Sciubba DM,
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Patients Receiving Antibiotic-Impregnated Shunt Catheters
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3. Bota DP, Lefranc F, Vilallobos HR, Brimioulle S, Vincent J-L.
Ventriculostomy-related infections in critically ill patients: a 6-year
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4. Camacho EF, Boszczowski Í, Basso M, et al. Infection rate and risk
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13. Klipin M, Mare I, Hazelhurst S, Kramer B. The process of installing
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14. Korinek AM. Risk factors for neurosurgical site infections after
craniotomy: a prospective multicenter study of 2944 patients. The
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15. Lam SK, Srinivasan VM, Luerssen TG, Pan I-W. Cerebrospinal
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doi:10.3171/2014.8.FOCUS14454.
16. Lewin S, Low SW. External ventricular drain infections; successful
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19. Mullan E, Lucas C, Mackie S, Carachi R. Audit of
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21. O'Neill BR, Velez DA, Braxton EE, Whiting D, Oh MY. A survey
of ventriculostomy and intracranial pressure monitor placement
practices. World Neurosurg. 2008;70(3):268-273. doi:10.1016/j.
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22. Paramore CG, Turner DA. Relative risks of ventriculostomy
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at Percutaneous Exit of Ventricular Catheter as a Crucial Risk
Factor for External Ventricular Drainage-Related Infection in
Adult Neurosurgical Patients. World Neurosurg. 2017;109:1-6.
doi:10.1016/j.wneu.2017.09.190.
24. Sandalcioglu IE, Stolke D. Failure of regular external ventricular
drain exchange to reduce CSF infection. J Neurol Neurosurg
Psychiatr. 2003;74(11):1598–9–authorreply1599. doi:10.1136/
jnnp.74.11.1598-a.
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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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jns.1976.44.5.0567.
28. Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases
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Associated Ventriculitis and Meningitis. Clin Infect Dis.
2017;64(6):e34-e65. doi:10.1093/cid/ciw861.
29. Tunthanathip T, Kanjanapradit K, Sae-Heng S, Oearsakul T,
Sakarunchai I. Predictive factors of the outcome and intraventricular
rupture of brain abscess. J Med Assoc Thai. 2015;98(2):170-180.
30. Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk
factors and long-term follow-up. Childs Nerv Syst. 2006;22(7):692-
697. doi:10.1007/s00381-005-0037-8.
31. Wong GKC, Poon WS, Wai S, Yu LM, Lyon D, Lam JMK. Failure
of regular external ventricular drain exchange to reduce cerebrospinal
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Neurosurg Psychiatr. 2002;73(6):759-761.]]> 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.]]> 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.
954954.
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
screening. Lancet Neurology. 2014. 1: 393-404.
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
- analysis of the literature from 1990 to 2011. Journal Neurology
Neurosurgery Psychiatry. 2013. 84: 42-48.
5. Morgan MK, Wiedmann M, Assaad NN, Heller GZ. Complicationeffectiveness
analysis for unruptured intracranial aneurysm surgery:
a prospective cohort study. Neurosurgery. 2016. 78: 648-659.
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.]]> 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
10.1007/978-3-662-47212-5_14.
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.
12. Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to
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
fractures in severely injured patients: A prospective cohort study. J Trauma
Acute Care Surg 590 Volume 74, Number 2.
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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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,
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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.]]> extradural y colecciónsupurada subcutánea (Absceso de
Bezold), asociada a hematoma subdural crónico]]> frecuencia gracias al diagnóstico precoz, acceso a imagenología y uso de antibióticos. La asociación de una OMCS con
empiema extradural y hematoma subdural crónico es extremadamente infrecuente y y reportar un caso clinico es el objetivo de
este reporte.
Caso clínico: Paciente de 28 años, con historia de trauma craneano dos meses antes del ingreso. Consultó por otorrea fétida
derecha de 45 días de evolución. Un mes previo a la consulta instala tumoración fluctuante en planos superficiales de región
temporoparietal derecha que aumenta de tamaño y se hace dolorosa. Examen neurológico normal.
Se realiza tomografía de cráneo que evidencia colección extradural y subdural, asociada a otomastoiditis. Se intervino
en conjunto con ORL para evacuación del proceso supurado intracraneano y mastoidectomía, encontrándose en el
intraoperatorio que la colección subdural no era infecciosa (empiema), sino que era un hematoma subdural crónico. La
evolución fue buena siendo dado de alta asintomático.
Reportamos esta asociación lesional muy poco frecuente, cuyo diagnóstico preoperatorio hubiera hecho variar la táctica
neuroquirúrgica. Se discuten los hechos clínicos e imagenológicos que podrían haber llevado al diagnóstico correcto.]]> thanks to early diagnosis, access to imaging and access to antibiotics. The association of an OMCS with extradural empyema
and chronic subdural hematoma is extremely infrequent. We report a clincal case of OMCS associated with a chronic subdural
haematoma.
Clinical case: A 28-year-old patient with a history of cranial trauma two months before admission, who consulted for a 46-
day history of fetid otorrhea. One month prior to the consultation, he detected a fluctuating tumor in superficial planes of the
right temporoparietal region that increased and became painful. He has a normal neurological examination. We performed a
cranial CT and we detected an extradural and subdural collection, associated with otomastoiditis. A surgical intervention with
a combined team was performed (Othologist and neurosurgeons). The aim of the surgery to evacuate the intracranial process
and mastoidectomy. In the intraoperative period, we discovered that the subdural collection was not infectious but a chronic
subdural hematoma. The evolution was good being discharged asymptomatic.
We report a very rare association (OMCS with chronic subdural haematoma), whose preoperative diagnosis would have
changed the neurosurgical tactic. Clinical and imaging facts that could have led to the correct diagnosis are discussed.]]> infections. In: Schmidek HH, Sweet H.(Eds). Operative neurosurgical
techniques. Fourth edition. WB Saunders. Philadelphia 2000:1685-1693.
2. Bernaldez PC, Morales G, Quantin LG, Hernández C, Litterio M. Otitis
media crónica supurada en niños. Arch Argent Pediatr 2004;102(3):174-179.
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rare intracranial complications secondary to otitis media and mastoiditis. J
Craniofac Surg. 2017;28(3):620-624.
4. Compean Aguilar A, Gutierrez Butando J, Azuano Pliego E, Reyes
Miranda R. Complicaciones de otitis media en el niño. Experiencia del
OTOMASTOIDITIS CRÓNICA SUPURADA COMPLICADA CON ABSCESO EXTRADURAL Y COLECCIÓNSUPURADA SUBCUTÁNEA (ABSCESO DE BEZOLD),
ASOCIADA A HEMATOMA SUBDURAL CRÓNICO
Gabriel Charlone Granucci, Gonzalo Bertullo, Fernando Martínez
REV ARGENT NEUROC. VOL. 33, N° 3: 175-179 | 2019 REPORTE DE CASO
179
Instituto Nacional de Pediatría. Acta Ped Mex 1997;18(1):28-33.
5. Coutinho G, Júlio S, Matos R, Santos M, Spratley J. Otogenic cerebral
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A long-term follow-up. Am J Otolaryngol. 2018;39(3):299-302.
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signs and symptoms of intracranial complications of otitis media in pediatric
and adult patients: A different presentation? Int J Pediatr Otorhinolaryngol.
2017;102:56-60.]]> de la región pineal]]> localizados en esta área. Estos tumores son lesiones con comportamiento biológicamente benigno y potencialmente curables
con la resección quirúrgica radical. A su vez representan un desafío quirúrgico debido a su profunda localización y la cercanía
de estructuras anatómicas vitales. El abordaje supracerebeloso infratentorial, en posición semisentado (cuando las condiciones
generales del paciente lo permiten), provee un corredor natural a la región pineal mediante la retracción cerebelosa gravitatoria.
Objetivo: Presentación de la exéresis microquirúrgica completa de un meningioma de la región pineal.
Descripción del caso: Paciente de 52 años que consulta por inestabilidad de la marcha y diplopía de 2 semanas de evolución.
La resonancia magnética cerebral mostró una lesión expansiva, que realza con contraste, de 43 x 30 mm en la región
pineal, con hidrocefalia obstructiva acompañante. Se realiza la exéresis microquirúrgica mediante abordaje supracerebeloso
infratentorial con el paciente en posición semisentado.
Resultado: Se realizó la exéresis completa de la lesión. La paciente cursó el primer día postoperatorio en Unidad de Terapia
Intensiva y luego pasó a sala de internación general. Fue dada de alta al tercer día, sin déficit neurológico. La anatomía
patológica de la lesión informó meningioma transicional (OMS grado I). El control imagenológico postquirúrgico mostró la
resección de la lesión sin remanente tumoral.
Conclusión: Los meningiomas de la región pineal presentan un desafío quirúrgico debido a la relación con estructuras
anatómicas vitales. El abordaje supracerebeloso infratentorial ofrece un corredor anatómico natural mediante la retracción
cerebelosa por la gravedad.]]> lesions with biologically benign behavior and potentially curable by radical surgical resection. As well, they are a surgical challenge due to
their deep location and the proximity to vital anatomical structures. The supracerebellar infratentorial approach, in a semisitting position
(when the patient’s general conditions allow it), provides a natural corridor to the pineal region through gravitational cerebellar retraction.
Objetive: Presentation of a complete microsurgical resection of a meningioma of the pineal region.
Case description: A 52-year-old patient who consulted due to gait instability and diplopia of 2 weeks of evolution. Brain magnetic
resonance showed an expansive lesion, with contrast enhancement, 43 x 30 mm in the pineal region, with obstructive hydrocephalus.
The microsurgical resection was performed by supracerebellar infratentorial approach with the patient in a semisitting position.
Result: The complete microsurgical resection was achieved. The patient spent the first postoperative day in Intensive Care Unit,
and then went to general room. He was discharged on the third postoperative day, without neurological deficit. The histopathology
assessment of the lesion reported transitional meningioma (WHO grade I). Post-surgical imaging showed the resection of the lesion
without remaining tumor.
Conclusion: Meningiomas of the pineal region present a surgical challenge due to the relationship with vital anatomical structures.
The supracerebellar infratentorial approach offers a natural anatomical corridor through cerebellar retraction by gravity.]]> Kitazawa R, Ohue S. Two cases of pineal-region meningiomas derived from
arachnoid membrane over the vein of Galen without dural attachment.
World J Surg Oncol. 2015 Jul 25;13:226.
2. Konovalov AN, Spallone A, Pitzkhelauri DI. Meningioma of the pineal
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3. Otani N, Mori K, Wada K, Tomiyama A, Toyooka T, Takeuchi S.
Multistaged, multidirectional strategy for safe removal of large meningiomas
in the pineal region. Neurosurg Focus. 2018 Apr;44(4):E13.
4. Goto T, Ohata K, Morino M, Takami T, Tsuyuguchi N, Nishio A, Hara M.
Falcotentorial meningioma: surgical outcome in 14 patients. J Neurosurg.
2006 Jan;104(1):47-53.]]> seguro, no solo para el paciente sino para el educando. La misma fue incorporada en la curricula de nuestras especialidades
quirúrgicas a partir del 2013. Las habilidades neuroquirúrgicas requieren de un experticio que implica un periodo prolongado
de tiempo de práctica. En la actualidad, dicho periodo, se tiende a disminuir con la enseñanza de ensayo y error, repetición de
los procedimientos y automatización de maniobras que la simulación facilita con el agregado de la posibilidad de un feedback
de retroalimentación entre el profesional en formación y el educador en un ambiente seguro.
Objetivo: Describir un modelo de simulador físico sintético de bajo costo como herramienta inicial para mejorar la curva de
aprendizaje de las técnicas de neuroendoscopia intraventricular.
Descripción del simulador: es un modelo físico sintético realizado a través de técnicas de mordería con gel autoportante. El
simulador ofrece la posibilidad de practicar técnicas básicas neuroendoscópicas intraventriculares, ofreciendo la particularidad
de poder repetir las maniobras y gestos quirúrgicas con un coste beneficio muy elevado debido al muy bajo precio de
realización del simulador. A su vez, se trata de un modelo de simulación que se puede fabricar de forma casera en cualquier
centro de simulación.
Discusión: Presentamos un modelo inédito de bajo costo y alta fidelidad para simulación neuroendoscópica. Consta de
un cerebro sintético físico que permite replicar ejercicios de navegación intraventricular con maniobras endoscópicas,
toma de biopsia de lesiones quísticas o sólidas, sección de tabiques, lavado ventricular y desobstrucción de catéteres
intraventriculares. Lo consideramos una herramienta básica y de amplia ayuda para profesionales que decidan iniciar su curva
de aprendizaje en la neuroendoscopia intraventricular. Planeamos su validación en futuros congresos de neurocirugía.]]> learning neurosurgeons. It was incorporated into the curricula of our surgical specialties as of 2013. Neurosurgical skills require an
expertise that involves a prolonged period of practice time. Currently, this period tends to decrease with the teaching of trial and error,
repetition of procedures and automation of maneuvers that the simulation facilitates with the addition of the possibility of feedback
between the professional in training and the educator, all doing in a safe environment.
Objective: To describe a low cost synthetic physical simulator model as an initial tool to improve the learning curve of intraventricular
neuroendoscopy techniques.
Description of the simulator: it is a synthetic physical model realized through self-supporting gel biting techniques. The simulator
offers the possibility of practicing intraventricular neuroendoscopic basic techniques, offering the peculiarity of being able to repeat
maneuvers and surgical gestures with a very high benefit-cost due to a very low price of its creation. At the same time, it is a
simulation model that can be manufactured at home in any simulation center.
Discussion: We present an unprecedented model of low cost and high fidelity for neuroendoscopic simulation. It consists of a
physical synthetic brain that allows the replication of intraventricular navigation exercises with endoscopic maneuvers, a biopsy
of solid or cystic lesions, the section of the ventricular septum, ventricular lavage and unblocking of intraventricular catheters. We
consider this simulator as a basic tool of wide assistance for professionals who decide to start their learning curve in intraventricular
neuroendoscopy. We’re planning its validation in a future neurosurgery congress.]]> Drake. Design and evaluation of a new synthetic brain simulator for
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literature. World Neurosurg 2019; 123:142-55.]]> neurociencias. ¿Por qué nos resulta tan sensible reflexionar sobre la neuroética? Porque se ocupa del cerebro, órgano
responsable de nuestras percepciones, de nuestros pensamientos y de nuestra conciencia, y el conocimiento y/o su
manipulación involucran a lo más genuino e intransferible del ser humano. Desde 2002, la neuroética ha sido considerada
como nueva disciplina que ofrece un campo de reflexión para el conocimiento y las acciones neurocientíficas en lo que atañe a
las personas como individuos y a la sociedad como organización.
Dentro de este marco podemos distinguir dos ramas: la neuroética fundamental y la neuroética aplicada. La neuroética exige
estar alertas y ofrecer ámbitos de encuentros interdisciplinarios donde participe la sociedad, propender a las reflexiones
éticas e inclusive trabajar con anticipación los dilemas que están emergiendo. La ciencia no se detiene ni retrocede y su
desarrollo ha adquirido un ritmo acelerado; por lo que no ha habido suficiente tiempo para debatir estos procesos. Estamos
convencidos que la Neuroética será al siglo XXI, lo que la Genética fue al siglo XX.]]> Why are we so sensitive to ponder on neuroethics? Because it involves the brain, the organ responsible for our perceptions, our
thoughts and our conscience; and its knowledge and/or manipulation entail the most genuine and nontransferable aspects of the
human being.
Since 2002, neuroethics has been recognized as a new discipline that offers an area of consideration for neuroscientific knowledge
and the actions regarding human beings as individuals, and the society as an organization. Whitin its framework, we can distinguish
two branches: fundamental neuroethics and applied neuroethics.
Neuroethics demands that we are on alert, and we offer the possibility of interdisciplinary exchange programs, encouraging society
to participate, promoting the ethical opinions, and even working with anticipation on the dilemmas that are already emerging. Science
does not stop, and its development has acquired such an accelerated pace that there has not been enough time to discuss its
processes.
We are convinced that neuroethics will be for the 21st century, what genetics was for the 20th century.]]> Defining Issues and Perspectives on the Principled Use of Brain Stimulation
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doi:10.4103/2152-7806.171249.]]>