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Peruvian Journal of Neurosurgery

Stereotactic Radiosurgery in Intracranial Meningioma

Andrés Plasencia S.MD, Aldo Berti G.MD, Mayer Saharia B.MD, Luis Pinillos A.MD, Alberto Moscol L. MD et Al
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

The meningioma has the second place in frequency between the intracranial tumors. The best treatment is complete surgical resection with resection of its dural insertion and areas of cranial invasion. In many cases this goal can be reached with minimal and reasonable morbidity, but in others, and despite the recent advances in microsurgical techniques, the eloquence of the region where the tumor sits leads to morbidity rates of 12 to 30% or to resection In order to preserve neurological function. In those cases in which complete resection can be achieved, the recurrence rates expected at 5 and 10 years are 5 and 10%, respectively. Usually, after microsurgery, some modality of radiation therapy is indicated for the management of the residual tumor, be it radiosurgery based on linear accelerator or LINAC, gamma knife, proton beams or conventional fractional external radiotherapy.
At present, due to its high rate of tumor control and low complications, stereotactic radiosurgery has become a reasonable therapeutic alternative, especially for meningiomas of the skull base. In the present article we briefly review the results of microsurgery and radiosurgery in its aspects of indications, radiobiology, dosimetry, and results.

 

Clinical practice guide of Infections and infestations of the Central Nervous System

Federico Valencia L. MD, Jesús Felix MD, Luis Saavedra MD, Luis Antonio T. MD.
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Infectious diseases and infestations are due to the local aggression of the central nervous system and its envelopes, by microbial or parasitic agents, capable of causing damage to our health, causing local and general symptoms.
CRANE AND BRAIN PATHOLOGY GROUPS:
Abscess or epidural empyema
Subdural empyema or abscess
Abscess or intracerebral empyema
Ventriculitis
GROUPS OF COLUMN AND MEDULA PATHOLOGY SPINAL AND SPINAL CORD
Abscess or epidural empemema
Subdural empyema or abscess
Abscess or intramedullary start
NERVOUS SYSTEM CYSTICERCOSIS
Cysticercosis Racemosa
Cysticercosis Cystic
Obstructive Hydrocephalus

 

Anterior communicating artery aneurysms: Management and statistic

Paulo Henrique A. MD.,PhD; Pedro Santana, MD.; Douglas França B. MD.; Fernanda V. Silva, MS.; Alexandros Panagopoulos, MD.; Marcos Vinícius M. MD.,PhD.
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

In this prospective study, the authors report their recent experience with 28 patients, using a combined surgical and endovascular team for the management of ACoA aneurysms from 2000 to 2007. Patients were divided into group A, which included 24 Micro surgical patients (18 of them with subarachnoid hemorrhage, group A1, and 6 with unbroken aneurysms, group A2); And group B, consisting of 4 patients treated with GDC embolization. The proposed treatment was based on the direction of the aneurysm fundus projection, the patient's physiological status, treatment risk, aneurysm neck size and Hunt and Hess classification.
The morphological results were analyzed by performing routine angiography and CT. Excellent outcome (GOS score 5) was observed in 16 (72.2%) among 22 patients with good preoperative grade. Group A1 had permanent morbidity and death rates of 22.2 and 22.2%, respectively. Among the patients in groups A2 and B, there was no death or permanent morbidity. Mortality and death rates related to the procedure were 11.1 and 11.1%, respectively for group A, 0 and 0% for group B, respectively. None of the 6 patients with
Poor preoperative grade had excellent results (GOS with score 5) or good (GOS with score 4).
The study also showed that the direction in which the fundus is projected and the subarachnoid hemorrhage appear significantly as risk factors for the micro-surgically treated groups. Improvement in overall surgical outcome includes early surgical intervention for patients with good grade, while subjects with poor grade should be actively managed and evaluated more closely with early surgery.

 

Endoscopic anatomy of the sella turcica

Alicia Becerra R. MD, Paulo Pires de A. MD, Fernando Campos G. MD
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ABSTRACT

 

Endonasal endoscopic surgery is a team surgery according to Snyderman et al., which requires learning of non-familiar surgical anatomy, use of new technologies and the development of new surgical skills. The major concerns during surgery are the identification of the internal carotid artery, optic nerves and preservation of small cerebral vessels. The potential for a disaster is great if the surgeon is unfamiliar with the anatomy, there is a lack of adequate equipment and clumsiness to maintain adequate visibility with the endoscope. Many publications speak on the subject, both on transsphenoidal endoscopic anatomy, and on anatomy with the approach by extending its limits.

 

Current concepts in peripheral nerve surgery: When to operate an injured nerve?

Mariano Socolovsky MD, Gilda di Masi MD, Gonzalo Bonilla MD, Alvaro Campero MD., Armando Basso MD.
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Peripheral nerve injuries represent a functional deficit of the affected limb that can be reversed if treated properly. The time at which an injury is operated, coupled with the use of the careful microsurgical reconstruction technique, are the most important factors in the final treatment outcome. Open lesions with nerve involvement should be considered surgical in the short term. Closed lesions usually, with the exception of two exceptions described in the text, are scanned from three months to six months after trauma.
It is a frequent occurrence in practice to observe injuries that have lost their ideal repair time, which leads to permanent sequelae. It is important to note that these delays are not seen in the neurosurgical community, but in other specialties that "disbelieve" the usefulness of rapid repairs, or consider that a neurorrhaphy can be performed without adequate instrumentation or magnification. It is to be hoped that in the future every traumatically injured nerve will be rapidly referred to those who are accustomed to the treatment of this type of injury. This will undoubtedly result in better functional outcomes in patients suffering from these lesions.

 

Spinal Cysticercosis: Case Report

Jesús Félix R. MD, Luis A.Toledo. MD, Luis Saavedra R. MD, José Calderón S. MD, Diana Rivas F. MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Cysticercosis is the most common parasitic infection affecting the central nervous system and typically involves the cerebral parenchyma, the subarachnoid space, or the ventricular system. Spinal cysticercosis is rare (0.7-3.2%) even in endemic regions and may require more aggressive management due to the natural confines of the spinal canal. The condition of the lesion, its size, and the inflammatory response generated by cyst degeneration are important factors for the management of spinal CC. We report two cases of spinal cysticercosis in which patients underwent surgical treatment.

 

Clinical radiological results of segmented instrumentation in thoracolumbar vertebral fractures at Guillermo Almenara National Hospital

Luis Chavez C.MD, Alfonso Basurco C.MD, María Chavez MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Retrospective and descriptive study of 34 patients, men 25, women 9; Mean age 33.23 years, with diagnosis of thoracolumbar vertebral medullary trauma, treated surgically with lateral view instrumentation (transpedicular fixation or anterior plaque), in the Department of Neurosurgery of Guillermo Almenara National Hospital, between January 1996 and December 2002, with average follow-up of 23 months (from 8 to 36 months), all had neurological deficit: total (14) and partial (20). We used the Frankel scale and the Magerl classification (A compression, B distraction and C rotation) in order to define the surgical strategy. The posterior approach was performed in 27 patients (group 1): decompressive laminectomy + transpedicular fixation (TPF) + posterolateral arthrodesis with autologous bone graft and anterior pathway in 7 patients (group 2): corporectomy + arthrodesis with iliac crest graft + fixation with Z plate. We show that segmental (short) instrumentation is better than long instrumentation (Harrington, Luque), because of the results: A.- Clinical (Frankel scale, quality of life due to absence of chronic pain, rapid reincorporation to life Daily, labor and lower rate of complications). B.- Radiological (reduction of kyphosis and long-term stability, measured through the sagittal index, facilitates the release of the spinal canal).
 
   Key words: Thoracolumbar vertebro-medullary trauma, Frankel scale, transpedicular fixation, corporectomy.

 

Vertebroplasty in pathological fractures of the spine

Alfredo Fuentes-Dávila M.MD, Wesley Alaba G. MD, Javier Torres M. MD, Federico Valencia L. MD.
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

With the advances in the medicine, we have a high average of life and at the present time leave increment of patient with spine pain for pathological fractures taken place by osteoporosis or in other conditions such as: Spinal metastases, multiple myeloma lesions, and hemangiomas. It is necessary the vertebral stabilization in these patients to improve the pain and at the moment with technical Percutaneous Spinal Vertebroplasty can be reinforced and to give bigger consistency or hardness to the fractured spine.The technique consists to guide placement of the needle and the plastic bone cement that is injected into the vertebrae to stabilize them using Poly methyl methacrylate (PMMA), which is radiopaque due to sterile barium powder, is injected into the bone in the vertebral fractured body, through a stem.Sometimes at level of the spinal compression fractures, we can to introduce and inflates a small balloon into the vertebra to expand its height before injecting the PMMA. This technique is known as Kyphoplasty or Vertebroplasty mediating balloon. The indications of the Vertebroplasty and Kyphoplasty at the moment are the reinforcement of vertebral fractures for spinal metastases too.
In this paper we review the technical basis of the vertebroplasty, according to our experience in this treatment and we present our experience with a small number of cases which had a good outcome for the majority of them.

 

Arteriovenous malformations in children

German Posadas N. MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

In cerebral vascular pathology in children, arteriovenous malformations (AVMs) are the most frequent and they are being detected more and more by the technological neuroradiological advances. This has allowed a large percentage to be diagnosed even at the asymptomatic stage. On the other hand, we know that the surgery of these lesions is the fundamental choice as treatment; However in the last decades the Endovascular techniques and radiosurgery have evolved, and currently for the treatment of AVMs, several options are considered as unique or adjuvant according to guidelines established in various hospitals.
With the bibliographical review and personal contribution we want to provide updated information related to epidemiology, clinical picture, diagnosis, treatment and prognosis; And that I hope will help to improve our attention in the neurosurgical patients suffering from this vascular pathology with a often devastating and crippling evolution.

 

Radiosurgery in the treatment of brain metastases

Andrés Plasencia S.MD, Aldo Berti G.MD, Mayer Saharia B.MD, Luis Pinillos A.MD, Alberto Moscol L. MD et Al
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Radiosurgery may be chosen for brain metastases smaller than 3.5 cm. Of large diameter and with the primary tumor controlled in the following scenarios: 1) Solitary metastases and in good neurological conditions could be treated with radiosurgery only 2) Relatively radioresistant metastases such as melanoma and renal cell carcinoma, 3) Multiple metastases, complementing with total brain radiotherapy, 4) Recurrent metastases. The relative indications for radiosurgery alone, radiosurgery, more radiotherapy, radiotherapy alone and surgical resection remain controversial. Because of its proven efficacy and low morbidity, radiosurgery could be indicated for most cases of brain metastases excluding lesions larger than 3.5 cm, numerous metastases (depending on cumulative volume and whole dose to the brain) and / or with symptomatic mass effect, or causing hydrocephalus. In the latter case the surgery would be the first therapeutic consideration and when a biopsy is necessary to confirm a neoplasia.

 

Transcranial doppler to detect regional cerebral vasospasm in patients with SAH of aneurysmal cause.

Oscar Saldarriaga R. MD, Azucena Dávila M. MD, Fernando Palacios S. MD, Renso Trelles MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

Transcranial Doppler (TCD) is a useful tool in the diagnosis of both regional and diffuse vasospasm, as it is demonstrated in this case (corroborated by angiography). This makes it possible not to reduce triple therapy H when the patient still requires it, TCD is a important arsenal we have, it is not enough clinical diagnosis, since the TCD is noninvasive, fast, online, is performed in bed Patient, and the Doppler vasospasm occurs before clinical vaospasm which makes it a very useful tool. I believe that we are advancing in this area of neuromonitoring in Peru, having as final result patient with favorable evolution, if not for the measurements made.

 

Pituitary carcinoma: Case report

Marco Chipana S. MD, Vittorio Nieri L. MD, Luis Huamán T. MD, Luis Contreras M. MD, Marco Gonzáles-Portillo S. MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

The pituitary carcinomas are rare and aggressive adenohypophyseal tumors, that usually present themselves like invasive macroadenomas, producing ACTH or prolactin. For clinical definition, they have metastases of a pituitary neoplasm, craniospinal or systemic. It is possible the existence of a time of latency between the diagnosis of pituitary tumor and the diagnosis of pituitary carcinoma that may vary from 5 to 12 years. The histological study is necessary for the diagnosis, and reveals functionally tumors, microscopically atypical, with high mitotic activity. The survival after documentation of metastases is low, being of only 34 % at the end of the first year. The treatmentincludes radical surgery and the use of radiotherapy and chemotherapy, nevertheless the results are still discouraging.
 
   Key Words: Pituitary adenomas, Pituitary macroadenomas, Pituitary carcinomas.
 

Anaplastic ependymoma in pediatric population

Mauro Toledo MD., Ricardo Zopfi MD., Luis Gutiérrez MD., Luis Chenet MD.
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

The objective of this paper is to show the clinical presentation, neuroradiological evaluation, surgical therapy and postoperative evolution of an anaplastic ependymal brain tumor in a pediatric patient. Clinical presentation, Female patient, 8 months old, natural and from cusco, with antecedent: Craniotomy due to spontaneous intracerebral hemorrhage 4 months before admission. It enters with history of irritability, vomits, and increase of cranial volume in operative zone. Intervention and follow-up, Craniotomy was performed right temporal temporalis + Total resection of intracerebral tumor parietal temporal fronto + resection and plastid of dura mater. Neuroradiological and clinical postoperative control showed favorable evolution. Conclusion, ependymomas in the pediatric population should be considered high risk if the patient is younger than 3 years of age at the time of diagnosis, if he has preoperative metastases, features of anaplasia, or residual tumor, surgery as a therapeutic modality is the one that Provides greater disease-free survival, adjuvant therapy does not determine predictive value.
 
   Key words: Ependymoma anaplasico, pediatric craniotomy.

 

History of the Discovery of Normal Pressure Hydrocephalus

Otto Campano V. MD,Nicolás Campano C. MD
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

When we read or hear Normal Pressure Hydrocephalus or chronic hydrocephalus of the adult as it is called at the moment, the Hakim Adams Syndrome comes to our mind immediately. We find it very important to expose the history of the discovery of hydrocephalus at normal pressure,
Pathology that to date has many questions and is a subject of constant research.

 

Radiosurgery in acoustic neurinoma: Preliminary results at the Pacific Radiosurgery Institute

Andrés Plasencia S.MD, Aldo Berti G.MD, Mayer Saharia B.MD, Luis Pinillos A.MD, Alberto Moscol L.MD et Al
Abstract (Spanish) || Full Text || PDF (Spanish)

ABSTRACT

 

The series of acoustic neurinoma cases treated with LINAC are limited compared to GK. Friedman et al. treated 390 patients. Actuarial control rates at 1 and 2 years were both 98% and 5% at 90%. Only 4 patients (1%) required surgery for tumor growth. Seventeen patients (4.4%) experienced facial paresis and 14 patients (3.6%) reported facial hypoesthesia. The risk of these complications is directly related to tumor volume and / or the prescribed dose at the periphery of the tumor. Since the doses were reduced to 1250 cGy in 1994, only 2 patients (0.7%) had facial paresis and another 2 (0.7%) facial numbness. The safety and efficacy of ER as an alternative to microsurgery in acoustic neurinoma is emphasized.

 

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