Como resultado de la compresión de las raíces nerviosas distales al cono medular (cola de caballo o cauda equina), aparece un síndrome que consiste en dolor lumbar, radiculalgias uni o bilaterales, debilidad motora en los miembros inferiores, déficits sensitivos, y trastornos en la esfera sexual y esfinteriana. En raras ocasiones se encuentran todas estas manifestaciones, con distintas combinaciones de síntomas y signos.
Algunos autores dividen al SACE en: incompleto (SACEI), cuando no hay retención urinaria ni fecal; y completo (SACEC), cuando aparece la retención.
El diagnóstico se realiza con la clínica compatible y se confirma mediante estudios de imágenes, siendo la Resonancia Magnética el método más sensible y específico.
En la bibliografía no existe consenso en cuanto al mejor momento para realizar la cirugía, ni cuál es el procedimiento quirúrgico de elección.]]>  

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]]> El síndrome de cola de caballo (SCC) es una urgencia quirúrgica poco frecuente con una incidencia estimada de hasta 1,8 casos por millón de habitantes, producida por la compresión de las raíces nerviosas en el extremo inferior del canal espinal. La manipulación espinal puede desempeñar un papel etiogénico, provocando la movilización y extrusión del disco. El diagnóstico temprano y el tratamiento oportuno son cruciales, ya que el pronóstico suele ser desfavorable si el tratamiento quirúrgico se retrasa produciendo un daño neurológico permanente.
El objetivo de este trabajo es identificar los potenciales factores de riesgo para la manipulación espinal y optimizar esta práctica, evitando así posibles complicaciones derivadas del tratamiento quiropráctico. Presentamos 3 casos de SCC, observados y tratados en nuestro centro, en los que se sugiere una estrecha relación entre la manipulación espinal quiropráctica y la aparición de dicho síndrome. Tras realizarles una RM en la que se observó una hernia discal L5-S1 causante del SCC, los 3 pacientes fueron tratados quirúrgicamente de forma urgente.
Los casos presentados demostraron la existencia de una asociación patogénica entre la manipulación espinal y el desarrollo del SCC, al producirse dicho síndrome en las horas siguientes a la manipulación debida a la protusión abrupta de un disco demostrado por RM.]]> ]]>
Ahn UM, Ahn Nu, Buchowski MS, Garrett ES, Sieber AN, KostuikJP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine. 2000. 25:1515-22.


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Bydon M, Lin JA, de la Garza-Ramos R, Macki M, Kosztowski T, Sciubba D, et al. Time to surgery and outcomes in cauda equina syndrome: An analysis of 45 cases. World Neurosurg. 2015, pi: S1878-8750(15)01758-1.


Celik EC, Kabatas S, Karatas M. Atypical presentation of cauda equina syndrome secondary to lumbar disc herniation. J Back Musculoskelet Rehabil 2012. 25:1-3.


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Haldeman S, Rubinstein SM. Cauda equina syndrome in patients undergoing manipulation of the lumbar spine. Spine. 1992. 17:1469–1473.


Hebert J.J., Stomski N.J., French S.D., Rubinstein S.M. Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases. Journal of Manipulative and Physiological Therapeutics, 2015. 38 (9), pp. 677-691.


Kholes SS, Kholes DA, Karp AP, Erlich VM. Time dependent surgical outcomes following cauda equina syndrome diagnosis: coments on a meta-analisis. Spine. 2004. 29:1281-7.


Lisi AJ, Holmes EJ, Ammendolia C. High-velocity low amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature. J ManipPhysiolTher. 2005. 28:429–442.


Malmivaara A, Pohjola R. Cauda equina syndrome caused by chiropraxis on a patient previously free of lumbar spine symptoms. Lancet 1982; 2:986–7.


Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J ManipPhysiolTher. 2004. 27:197–210.


Olivero WC, Wang H, Hanigan WC, Henderson JP, Tracy. PT, Elwood PW, et al. Cauda Equina Syndrome from lumbar disc herniations. J Spinal Disord Tech 2009; 22:202-6.


Oppenheim JS, Spitzer DE, Segal DH. Nonvascular complications following spinal manipulation. Spine J. 2005; 5(6):660–6.


Schmidley JW, Koch T. The noncerebrovascular complications of chiropractic manipulation. Neurology 1984. 34:684–5.


Silver JR. The earliest case of cauda equina syndrome caused by manipulation of the lumbar spine under a general anaesthetic. Spinal Cord. 2001. 39:51–53.


Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropractic & Manual Therapies. 2017; 25:37.


Tamburrelli FC, Genitiempo M, Logroscino CA. Cauda equina syndrome and spine manipulation: case report and review of the literature. Eur Spine J 2011; 20 Suppl 1:S128–S131.


Undabeitia J, et al. Síndrome de cola de caballo tras tratamiento quiropráctico. Neurocirugia. 2016.Volume 27, Issue 3, May–June 2016, Pages 151–153. ]]> Caso clínico: Presentamos el caso de una paciente de 76 años quien concurre en consulta por un cuadro clínico de inestabilidad cráneo espinal secundaria a una lesión osteolítica, con compromiso de C1 y C2. La sintomatología comenzó posteriormente a un proceso infeccioso respiratorio. Se realizó una fijación occípito-cervical posterior y una Odontoidectomía con descompresión anterior por vía endoscópica transnasal. La paciente evolucionó con resolución completa de los síntomas. Los cultivos fueron negativos y el estudio de anatomía patológica concluyó cambios inflamatorios inespecíficos.
Conclusión: Hasta hace algunos pocos años la única opción para abordar esta patología era la vía transoral con técnica microquirúrgica. Hoy en día la endoscopía nos brinda muchas ventajas técnicas por lo que constituye una opción a tener en cuenta en la planificación de los abordajes a la unión cráneo-cervical.
]]> RESUMEN
Introducción: El síndrome de Hakim Adams, o hidrocefalia normotensiva, es un cuadro progresivo que se caracteriza por presentar alteración de la marcha, trastornos esfinterianos y demencia, y que afecta principalmente a pacientes añosos. Si bien existen publicaciones sobre los resultados del tratamiento quirúrgico, estos trabajos suelen evaluar la mejoría sintomática pero no la calidad de vida de los pacientes.
Objetivo: Conocer el impacto del tratamiento en pacientes con síndrome de Hakim Adams tratados con derivación de LCR.
Material y Métodos: Realizamos un estudio retrospectivo de una serie de 8 pacientes. Se realizó una encuesta para la evaluación preoperatoria y postoperatoria; con un tiempo transcurrido no menor a 6 meses luego del procedimiento. Se utilizó la escala de Barthel para la funcionalidad, y una escala numérica simple para la calidad de vida.
Resultados: Previo a la cirugía, 7 casos presentaban alteraciones de la marcha y/o problemas para deambular; 6 casos alteraciones esfinterianas; y 5 casos algún tipo de alteración neurocognitiva. Luego de la cirugía, todos los pacientes refirieron un cambio significativo en la calidad de vida; y también en la funcionalidad, logrando 6 pacientes una independencia absoluta.
Conclusión: Aunque nuestra comunicación tiene las debilidades de una serie pequeña de casos analizados en forma retrospectiva, los resultados son concluyentes en cuanto a mejora en la calidad de vida y funcionalidad en el postoperatorio. Creemos que esta modalidad de evaluación puede ayudar a los pacientes y/o familiares de pacientes en el proceso de toma decisiones del tratamiento quirúrgico.

Palabras Claves: Síndrome de Hakim Adams; Hidrocefalia Normotensiva; Demencia; Trastorno de la Marcha; Derivación de Líquido Cefalorraquídeo; Calidad de Vida

]]>
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    • ]]>         Se trata de 5 mujeres en la edad media de la vida, obesas, multíparas, y 1 hombre de 43 años, todos tenían antecedentes de cefalea de larga data y disminución de la agudeza visual.
    Los estudios neuro-radiológicos demostraron agrandamiento de la silla turca con inexistencia de patología tumoral o vascular de la región selar: en las NCG se apreció la entrada de aire en la silla turca y las mediciones de presión de L.R.C. (PL. Tornillo subdural) evidenciaron cifras por encima de la normalidad.
    Consideramos en base a la clínica y los estudios complementarios de diagnóstico que estos casos correspondían a un Síndrome de Hipertensión Endocraneana Benigna de larga data con herniación de la cisterna a través del diafragma selar, en consecuencia no hay indicación para realizar la corrección quirúrgica del aracnoidocele intraselar que no es la causa sino la consecuencia de la presión endocraneana elevada, al igual que el papiledema.]]>         Descripción. Caso 1: Paciente femenina de 21 años de edad que consulto por oftalmoplejía dolorosa de 72 hs de evolución sin compromiso visual. Se realizó IRM de encéfalo que evidenció el engrosamiento difuso con realce postcontraste del seno cavernoso izquierdo. Se interpretó el cuadro como un STH. Caso 2: Paciente masculino de 45 años de edad que consultó por oftalmoplejía dolorosa de 2 meses de evolución y amaurosis del ojo derecho. Se le solicitó IRM de encéfalo que evidenció el engrosamiento difuso del seno cavernoso derecho. La retinografía evidenció la atrofia de la papila de dicho ojo. El cuadro se interpretó como un STH asociado a una neuritis óptica homolateral.
    Intervención. Caso 1. Inicio tratamiento con corticoides y carbemazepina lográndose a los 3 meses recuperación total sin recaídas posteriores. Caso 2. Se inicio tratamiento con corticoides. Actualmente se encuentra en control por consultorios presentando mejoría significativa de los síntomas sin mejoría de la amaurosis de ingreso.
    Conclusión. El STH es una entidad poco frecuente, con un probable origen autoinmunitario. Existen diversas causas que pueden simular este síndrome. Es mandatorio el análisis exhaustivo de estos pacientes, a fin de descartar otras patologías.]]>         Description. 55, female. Two yrs. history of generalized convultions. Left frontomedial lesion biopsied outwards. PA: low grade astrocytoma. Medically trated until feb. 2007. Sudden headache and right sided hemiparesis with crural predominance. Hoffmann and slight right hyper reflexia. MRI: expansion of primary lesion with intra lesional hemorrhage. Surgical resection. PA: mixed anaplastic glioma. The inmediate posoperative status was of a right CB plejia with severe apathy and abulia with right spatial hemineglect and hypofluent and anomic languaje, with preserved repetition and comprehension. Total recovery of paresis and languaje except when stressed.
    Discussion. The SMA is limited by cingulate cortex inferiorly, PMC posteriorly, and vértex superiorly. The anterior border is not well defined. SMA activates before the PMC, during planification and iniciation of movement. Is connected with the PMC, spinal cord neurons, basal ganglia and contralateral SMA. By intraoperative stimulation it could be established the somatotopic organization of SMA, with the the hindlimb posterior the forelimb intermediate and face anterior. Before the facial representation is the language area in the dominant hemisphere. Epileptogenic crisis originated in this area produce abduction and supination of the contralateral forelimb with deviation of the head to the same side. The syndrome of lesion of SMA includes: Global akinesis, proximal predominance of motor déficit, with secuelar difficulty for the fine movements of hands an a quick recuperation (days to weeks).
    Conclussion. The síndrome of the supplementary motor area is well recognized after medial frontal lobe surgery. Its features include reduction of spontaneous movements in the contralateral limbs and speech deficit. The impairment of volitional movements is the main finding. Recovery is complete in a short period of time.]]>         Presentación de un Caso y Revisión de la Literatura]]> Resultados. Se incluyeron 31 cirugías realizadas en 30 pacientes, 9 con diagnóstico de OW (8 mujeres) con un promedio de edad fue de 24,3 años, y 21 con OTD (18 mujeres) de 37,4 años en promedio. Un 90% de todos los casos de outlet presentaron alteraciones neurofisiológicas preoperatorias, y los estudios imagenológicos fueron anormales en 66,6%. Una vez realizada la exploración, el 100% de los OTV presentó una alteración anatómica claramente relacionada con la sintomatología, hecho observado sólo en el 36,7% de los OTD operados. El 87,5% de los OW mejoraron sus síntomas sensítivos luego de la cirugía, mientras que 77,7% mejoraron desde el punto de vista motor. Por el contrario, 45.4% de los OTD mejoraron permanentemente, 36,3% no tuvieron cambios, 13,6% mejoraron transitoriamente y 4,5% (un caso) empeoró. Las complicaciones postoperatorías fueron más frecuentes aunque transitorias en el grupo de OTV (3 casos sobre 9 operados, 33.3%) que en los OTD (3 casos sobre 22, un 13,6%).
    Conclusión. El OTV es una patología infrecuente cuyo tratamiento quirúrgico suele evolucionar favorablemente. En cambio, el OTD constituye un diagnóstico de exclusion y su tratamiento quirúrgico da un resultado bueno aunque inferior al del OTV. Un análisis reciente de la literatura indica que no existe evidencia estadísticamente concluyente sobre los criterios diagnósticos y terapéuticos de los pacientes que sufren estos síndromes.]]>
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    Results. We achieved total improvement in 8 patients and partial in 4. The most frequent symptom after surgery was hypoesthesia in V2 in patients with trigeminal neuralgia. 3 patients presented temporary facial paresis.
    Conclusion. Microvascular decompression is an effective treatment with low morbidity in patients with compressive syndrome of cranial nerves. The goal of treatment should be complete disappearance of symptoms.]]>         Su diagnóstico resulta dificultoso ante la baja incidencia de formas agudas y subagudas. La sintomatología dolorosa es la forma de presentación más frecuente (cefaleas, cervicalgias, dolores radiculares y cordonales) y también los trastornos de la marcha, sensitivos y tráficos.
    El examen neurológico puede evidenciar un síndrome lesional motor y / o sensitivo y otro sublesional (piramidal ,espinotalámico lateral).
    Los criterios neuropatológicos incluyen la diferenciación con la hidromielia; la relación con el canal ependimario, su comunicación con los espacios ventricular y subaracnoideo y las características de los bordes y del tejido medular que rodea la cavidad.
    La metodología diagnóstica incluye la tomografia axial computada (TAC) complementada con la mielografía y la resonancia magnética nuclear (IRM) que es el único estudio que permite apreciar la exacta extensión rostrocaudal de la cavidad.
    El tratamiento quirúrgico difiere según sea el caso de la siringomielia primaria o asociada a malformaciones y debe estar indicado ante la progresión del déficit neurológico. Existen diferentes técnicas quirúrgicas dependiendo de la patología y de la particular experiencia de los autores.
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    Intervención. Se efectuó una craniectomía suboccipital con laminectomía Cl. El tumor nacíafrancamente del piso del IV ventrículo. Se resecó la lesión enforma completa, efectuando cavitación y disección roma entre la cápsula y el piso del IV ventrículo. El paciente tuvo un postoperatorio tórpido dada la paresia de pares bajos que presentó durante las primeras semanas, por lo que fue intubado, traqueostomizado y alimentado por sonda nasoyeyunal. Al 5t0 mes de postoperatorio el paciente se hallaba independiente para sus actividades de la vida diaria. La resonancia postoperatoria evidenció la exéresis completa de la lesión.
    Conclusión. Los subependimomas que nacen del piso del IV ventrículo tienen una elevada morbimortalidad documentada. Sólo la minuciosa disección con microscopio y cuidados intensivos postoperatorios pueden mejorar este pronóstico.
    Palabras clave: ependimoma, subependimoma, tumor del IV ventrículo.]]>         Descripción. Un paciente masculino de 60 años de edad con una tetraparesia moderada, rápidamente progresiva, piramidalismo y trastornos sensitivos superficiales y profundos, de cuatro meses de evolución. Las radiografías de columna cervical frente y perfil muestraron una subluxación atlanto-axial anterior. La resonancia magnética mostró un tejido patológico periodontoideo con extensión a articulares y mielomalacia compresiva a nivel C1-C2 a expensas de elementos posteriores por la subluxación. Las radiografías del resto de la columna, manos, rodillas y hombros mostraron cambios degenerativos artrósicos. Se realiza una interconsulta con el servicio de reumatología que, luego del analizar los resultados serológicos, clínicos y radiológicos, arribó al diagnóstico de osteoartritis.
    Intervención. Consistió en un abordaje posterior, con apertura del foramen magno, laminectomía de C1 y osteosíntesis occipitocervical con la colocación de injertos óseos autólogos.
    Conclusión. La osteoartritis es una causa infrecuente de subluxación atlantoaxial anterior. Más allá de la patología causal, sabemos que el tratamiento quirúrgico es fundamental en los pacientes sintomáticos.]]>         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.]]>         RESUMEN
    Introducción: Diferentes técnicas quirúrgicas representan una alternativa para el tratamiento de la enfermedad de Parkinson avanzada (EP). El gran desarrollo en las últimas décadas de modernas técnicas de imágenes sumado a los avances del registro neurofisiológico nos permiten localizar y generar lesiones en forma precisa, con bajo número de complicaciones y excelentes resultados funcionales.
    Objetivo: Describir los resultados motores obtenidos a los 12 meses post-operatorios de pacientes con diagnóstico de EP avanzada sometidos a subtalamotomía bilateral diferida guiada por microrregistro.
    Material y Métodos: Se seleccionaron 9 pacientes con diagnóstico de EP avanzada de acuerdo a los criterios de la United Kingdom Parkinson´s Disease Brain Bank, evaluando los efectos de la subtalamotomía bilateral en dos tiempos quirúrgicos.
    Resultados: Una marcada mejoría de los síntomas cardinales como rigidez, bradicinesia y temblor se observó en todos los pacientes, fundamentalmente en la condición de “off”, y en menor medida también en condición “on”. Se destaca un significativo control de las fluctuaciones motoras y discinesias.
    Conclusión: La subtalamotomía bilateral diferida guiada por microregistro es un método útil y efectivo en el tratamiento de los síntomas motores de la Enfermedad de Parkinson.

    Palabras Clave: Enfermedad de Parkinson; Subtalamotomía; Microrregistro

    ABSTRACT
    Introduction: In the treatment of advanced Parkinson´s disease (PD) there are different surgical techniques that represent a valid alternative. The development of modern images techniques and neurofisiological recording allow us to generate accurate lesions, with low complications and excellent functional results.
    Objective: Describe motor results 12 months post-surgical of patients with advanced PD submitted to bilateral and deferred subthalamotomy guided by microrecording.
    Material and Methods: We selected 9 patients with advanced PD diagnosis in concordance with United Kingdom Parkinson`s Disease Brain Bank criteria, evaluating the effects of bilateral subthalamotomy in two different surgical steps.
    Results: A marked improvement of cardinal symptoms such as rigidity, bradykinesia and tremor was observed in all patients, fundamentally in “off” condition, and lesser extent in “on” condition. We highlighted a significant control of motor fluctuations and dyskinesias.
    Conclusion: Bilateral and deferred suthalamotomy guided by microrecording is an effective and useful method in treatment of cardinal motor symptoms of PD.

    Key words: Parkinson`s Disease; Subthalamotomy; Microrecording

    ]]>     BIBLIOGRAFÍA

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    ]]>         Descripción: Se detalla la técnica efectuada sobre 51 subtalamotomías desde el año 2011, en pacientes con diagnóstico de Enfermedad de Parkinson (EP) refractaria al tratamiento. La técnica quirúrgica consta de tres etapas: adquisición de las imágenes estereotácticas, localización anatómo-funcional de blanco quirúrgico y lesión por radiofrecuencia de la región sensitivo-motora del núcleo. Se describe el método utilizado para la exploración de la somatotopía del NST que permite la posterior lesión, confiriendo seguridad y efectividad al procedimiento.
    Conclusión: La subtalamotomía constituye una técnica segura y efectiva realizada en grupos entrenados con los recursos técnicos necesarios, para el tratamiento de la EP refractario, constituyendo una alternativa adaptable a nuestro medio con el objetivo mejorar la calidad de vida.]]>         Material and Method: We retrospectively reviewed the cases of 10 patients with cerebral cavernous malformations presenting with seizures as the main symptom. These 10 patients were treated surgically between 1988 and 2004, at our institution. There were 5 males and 5 females, age range from 1 yr 8 months to 1 5 yrs (mean 8 yrs).The clinical histories, and radiological findings, patholog y and operative reports were reviewed. Imaging studies were done asfollows: CT + Angiogram in 4 patients, CT + MRI + MRA in 3 patients, CT + MRI in 2 patients.
    The cavernomas were located as follows: temporal lobe: 5 cases; parietal lobe: 3 cases (2 in sensory- motor strip); and frontal lobe: 2 cases. All patients had diagnostic EEG, and vine (90 %) were on antiepileptic drugs. Five patients had partial complex seizures and fine generalized tonic- clonic seizures. Seven (70%) patients underwent tailored complete lesionectorny and epileptic focus resection as determined by the use of intraoperative electrocorticography(ECOG). One patient (10%) underwent complete lesionectomy and partialfocus resection. Two patients (20%) with lesions in the sensory motor cortex underwent complete lesionectomy only. Mean follow up time was 5 yrs (range 3 months - 20 yrs).
    Results: All patients tolerated surgery well without morbidity or mortality. All patients are seizurefree. Seven (100%) patients who unclerwent tailored complete lesionectomy and epileptic focus resection are seizure free with no antiepileptic medication. One patient who underwent lesionectomy and partial focus resection is seizure free on rnedication. The two patients who underwent lesionectomy only, are both seizure free, one patient still requiring antiepileptic medication.
    Conclusion: For cerebral cavernous malformations presenting with seizures in this age group, complete microsurgical excision is the treatment of choice. Surgery should be preceded by careful electroclinical, neuroimaging, anatomical and functional evaluation. The good seizure outcome results (100%) after surgical intervention in our patients are probably related to both the lesionectomy and the excision of the epileptogenic focus in non eloquent areas (80%). Nevertheless, the two patients with lesions located in eloquent cortex that underwent complete lesionectomy abone (20%), are also seizurefree. Based on thesefindings it would appear that complete lesionectomy is the main variable in determining seizure outcorne after surgeryfor CCMs presenting with seizures. Larger series will be required to statistically support this assumption.]]>     ]]>
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    • ]]>         Un estudio Multicéntrico de 474 Casos.
    ]]>         La Discectomía Percutánea Endoscópica Lumbar es una técnica mínimamente invasiva para el tratamiento de las hernias discales lumbares con resultados comparables a la microdiscectomía lumbar. La principal complicación, los fragmentos discales remanentes, son en gran parte producidos por la limitación de movimiento del endoscopio una vez realizada la punción.
    Presentamos una nota técnica y aplicación en un caso ejemplo de lo que hemos llamado “libre flotación foraminal”: un acceso al espacio epidural por vía transforaminal que mantiene la libertad de movimiento y permite una exploración endoscópica en busca de fragmentos remanentes.]]>     Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery 2014 Aug;75(2):124-33.
    Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 2006; 58:ONS59-68. 

    Choi KC, Lee JH, Kim JS, Sabal LA, Lee S, Kim H, Lee SH. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery. 2015 Apr;76(4):372-80 Neurosurgery. 2015 Apr;76(4):372-80.
    Choi KC, Park CK. Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc. Pain Physician. 2016 Feb;19(2):E301-8
    Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res 1986; 207:37-43.
    Kim JS, Choi G, Lee SH. Percutaneous endoscopic lumbar discectomy via contralateral approach: A technical case report. Spine (Phila Pa 1976) 2011; 36:E1173-1178. 

    Lee SH, Kang HS, Choi G, Kong BJ, Ahn Y, Kim JS, Lee HY. Foraminoplastic ventral epidural approach for removal of extruded herniated fragment at the L5- S1 level. Neurol Med Chir (Tokyo) 2010; 50:1074-1078. 

    Ruetten S, Komp M, Merk H, Godolias G. Full endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, 
controlled study. Spine (Phila Pa 1976) 2008;33:931-9
    Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: A prospective, randomized, controlled study. J Neurosurg Spine 2009; 10:476-485]]>         Material y método. Se presentan dos pacientes del sexo masculino de 35 y 40 años respectivamente, con lesiones tumorales en áreas elocuentes motoras del hemisferio cerebral derecho a los cuales se le efectuó cirugía, planificación y resección quirúrgica en base a los estudios de RMf (Philips 1,5 T Intera Achieva)
    Resultados. La localización de las áreas elocuentes mediante RMF y los hallazgos basados en las técnicas imagenológicas descriptas permitieron determinar la estrategia y planificación del abordaje quirúrgico obteniéndose una excelente correlación entre los hallazgos imagenológicos e intraoperatorios.
    Conclusión. En tumores cerebrales localizados en áreas elocuentes los estudios de RMI con técnicas especiales pueden contribuir sustancialmente a: 1. El diagnóstico presuntivo del tipo de tumor, grado de malignidad e infiltración del mismo. 2. La planificación de la estrategia quirúrgica para minimizar las secuelas neurológicas post operatorias.]]>         Description. A 23 years old female patient presented with headache, vomiting, dizzines, ataxia, amenorrhea and galactorrhea, progressive during the iast 5 years. MRI showed a fourth ventricle tumoral lesion that involved the medulla oblongata with hydrocephalus.
    Intervention. First a ventriculo-peritoneal shunting was performed. One week later through a midline approach a microsurgical complete removal was done. Postoperative outcome was good. MRI 6 months later was free of tumor. After one year the neurological examination was normal.
    Conclusion. Teratomas of the medulla oblongata are rare lesions. Surgery is the treatment of choice.]]>
    2. Youmans, J. Editor. Neurological Surgery 4a. ed, WB Saunders. 1996; Vol 4, cap. 115.

    3. Tsuzuki N, Kato H, Ishihara S, Miyazawa T, Nawashuro H, Shima K. Malgnant teratoma of the medulla oblongata in an adult male. Acta Neurochir (Wien) 2001; 143: 1303-4]]>         RESUMEN
    Objetivo. Describir las indicaciones, ilustrar la técnica quirúrgica y analizar los resultados de la tercer ventriculostomía endoscópica (TVE) en el manejo de la hidrocefalia de distinta etiología, exclusivamente en población adulta, en nuestra serie de 50 casos consecutivos.
    Material y método. De un total de 79 procedimientos endoscópicos intraventriculares durante el período agosto 2005 - octubre 2011 fueron realizadas 50 TVE solamente en población adulta. Las indicaciones fueron: 23 tumores, 8 hidrocefalias normotensivas del adulto, 7 estenosis acueductales, 3 ventriculomegalias de larga data del adulto, 3 neurocisticercosis, 2 hematomas de fosa posterior, 2 infartos cerebelosos y 2 quistes aracnoideos.
    Resultados. La edad promedio fue de 51 años (rango de 21-78 años). Sexo: 28 hombres y 22 mujeres. Se realizaron 39 cirugías en calidad programada y 11 en calidad de urgencia. El tiempo de estadía hospitalaria promedio fue de 2.5 días. El tiempo de seguimiento fue de 3 a 58 meses (media de 24 meses). El éxito clínico de la TVE se constató en 38 de 50 casos (76%). La mejoría de la hidrocefalia en los controles por imágenes se confirmó en 25 casos (50%). La morbilidad operatoria estuvo presente en cuatro casos (8 %): 1 meningitis, 1 pneumoencéfalo a tensión, 1 paresia de nervio motor ocular externo transitoria, 1 hemorragia ventricular asociada a biopsia tumoral. Siete casos (14%) requirieron una válvula de derivación, siendo la mayoría por progresión tumoral.
    Conclusión. La TVE es una técnica fácilmente reproducible que representa el gold standard actual en el manejo de una gran variedad de hidrocefalias obstructivas, aunque sus indicaciones se han extendido también a algunas hidrocefalias comunicantes. En nuestra experiencia únicamente con pacientes adultos, la TVE resultó ser el procedimiento de elección para el tratamiento definitivo de la hidrocefalia en la mayoría de los casos. Debe considerarse siempre a la evolución clínica favorable como el elemento principal para determinar el éxito del procedimiento y secundariamente a los estudios por imágenes.
    Palabras clave: hidrocefalia, neuroendoscopía, tercer ventriculostomía endoscópica.

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    ]]>         Material and method: 140 ETVs were performed in 132 patients; 120 of them are shunt free (90.90%). Eight patients (5.71%) showed closure of the ventriculostomy: in 4, it was presumed to be related to postoperative radiotherapy; 2 patients had an insufficient opening of the Lilliequist membrane and 2 showed ostoma closure of unknown origin. In all of them a second ETV was performed, and the procedure was successful. Twelve patients (8.57%) required shunt placement; 4, with a history of septated postmeningitis hydrocephalus, now only need a single ventricular catheter. Of the remaining, 3 presented with meningeal seeding from malignant tumors; 1 with racemous neurocysticercosis; 1 with multiple malformations and history meningitis; 2 with a previously unknown aresorptive component; 1 with history of post-shunt meningitis. Most patients with ETV failure developed CSF fistula. In all these cases, patency of the ostoma was confirmed during re-exploration, and consequently, a shunt was indicated.
    Discussion and Conclusions: We consider ETV to be the standard treatment for obstructive hydrocephalus. With low morbidity in our series (4.68%) and no mortality. Re-exploration and eventual re-fenestration are indicated in all cases of ETV failure, given the benefits of shunt independence.]]>         Eilat, Israel, Marzo 19-23, 1995.]]> ]]> Material y Métodos: Se realizó un trabajo prospectivo de macroadenomas hipofisarios con compresión de la vía visual e indicación quirúrgica entre febrero del 2015 y noviembre del 2016. Se evaluaron los estudios de agudeza visual, perimetría computarizada y TCO. Se compararon los resultados tras 6-12 semanas y 6-9 meses de la intervención. Las variables cuantitativas continuas dependientes e independientes se relacionaron mediante una prueba T de Student, regresión lineal y correlación de Pearson considerando como estadísticamente significativo una p<0,05.
    Resultados: La alteración en la agudeza visual y la perimetría computarizada preoperatorios, fue mayor en aquellos pacientes con TCO alterada. Tanto los pacientes con CFNR normal como adelgazada se constató una mejoría significativa del campo visual a las 6-12 semanas. Los valores de TCO se correlacionaron en forma inversa con los valores de campo visual, lo que significa que a mayor grosor menor es el déficit campimétrico. Los pacientes con TCO normal tuvieron una mejor recuperación ya que el defecto campimétrico preoperatorio fue más leve. La correlación entre los valores de TCO y la mejoría del campo visual no fue significativa, lo que sugiere independientemente del grosor del nervio los pacientes mejoran el campo visual tras la cirugía.
    Conclusión: El campo visual computarizado continúa siendo el estudio de elección en la evaluación de pacientes con macroadenomas. La TCO no se considera un predictor de outcome visual.]]>

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