ABSTRACT
La neuromodulación es una práctica médica implementada desde hace más de cuatro décadas. En lo que respecta a la Neurocirugía, cumple un papel en el tratamiento de diversas patologías (Parkinson, distonías, epilepsia, etc.) y con un gran potencial para aplicarlas en otras (trastorno obsesivo compulsivo [TOC], dolor pélvico). Es por ello que, en los últimos años, se cuadruplicaron las inversiones de empresas biotecnológicas en este campo por la demanda y aplicación de la terapia. La neuromodulación abarca también otras especialidades, como por ejemplo Otorrinolaringología (ORL) en implantes cocleares, Cardiología con diversos modelos de marcapasos cardíacos, Endocrinología con bombas de infusión de medicamentos, Uroginecología en incontinencia, etcétera. Nuestra institución aplica en su práctica clínica todas estas técnicas, y cumple una función jerárquica como centro de referencia en educación y políticas sanitarias. Por estos aspectos, sumados a su infraestructura, personal profesional y enfoque sanitario, puede ser considerada como un Centro de Neuromodulación referente en la región. (AU)
Neuromodulation is a medical practice established for more than forty years. In the neurosurgical field it plays a role in the treatment of different diseases (Parkinson, Dystonia, Epilepsy, etc) and has a great potential to apply in other pathologies (Obsessive Compulsive Disorder, Pelvic pain). In the last years the biotechnological industry has quadrupled the investment in this field because of the demand and therapy application. Neuromodulation encompasses other specialities, for example otorhinolaryngology in cochlear implants, in cardiology with different models of pacemakers, endocrinology with implanted infusion pumps, urological gynecology in incontinence treatments, etc. Our institution applies all these techniques in its clinical practice, having a hierarchical role as a reference center in education and health policies. Due to these aspects, added to its infrastructure, professional staff and health approach, it can be considered as a reference Neuromodulation Center in the region. (AU)
Subject(s)
Humans , Parkinson Disease/therapy , Neurotransmitter Agents/therapeutic use , Deep Brain Stimulation , Chronic Pain/therapy , Drug Resistant Epilepsy/therapy , Pain Management/methods , Functional StatusABSTRACT
El síndrome de Eagle está caracterizado por una elongación o una curvatura medial excesiva de la apófisis estiloides o por una calcificación del ligamento estilohioideo que puede provocar dolor cervicofacial o síntomas neurológicos por la compresión de los vasos o nervios del cuello. El tratamiento más eficaz es el quirúrgico y consiste en la resección de la apófisis estiloides; puede ser realizado por vía externa o mediante un abordaje transoral. Se describe el caso clínico de un paciente con síndrome de Eagle que fue tratado con éxito mediante un abordaje transoral, sin amigdalectomía y con asistencia de endoscopios. (AU)
Eagle syndrome is characterized by an elongation or excessive medial curvature of the styloid process or calcification of the stylohyoid ligament that can cause cervicofacial pain or neurological symptoms due to compression of the vessels or nerves of the neck. The most effective treatment is surgical and consists of resection of the styloid process, it can be performed by externally or through a transoral approach.The clinical case of a patient with Eagle syndrome who was successfully treated by a transoral approach, without tonsillectomy and with the assistance of endoscopes, is described. (AU)
Subject(s)
Humans , Male , Middle Aged , Temporal Bone/abnormalities , Temporal Bone/surgery , Ossification, Heterotopic/surgery , Ossification, Heterotopic/diagnostic imaging , Mandible/surgeryABSTRACT
El manejo de pacientes debido a la aparición del nuevo coronavirus 2019 (COVID-19) representa un desafío para los equipos médicos y quirúrgicos, ya que modificó el funcionamiento de los sistemas de salud en casi todo el mundo. Para contribuir a la re organización del sistema de salud, el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires trabajó en adoptar distintas medidas en concordancia con las tomadas a nivel institucional y nacional; por lo que se analizó la bibliografia publicada, asi como las normas dictadas por el comité de crisis de nuestra institucion. A su vez realizamos una breve encuesta dirigida a neurocirujanos de america latina para conocer como se manejaban actualmente en relación a niveles de protección y realización de cirugias. La actual pandemia de COVID-19 es el mayor desafío que enfrentan los sistemas nacionales de salud en los últimos tiempos. Los neurocirujanos podemos contribuir a la reducción del riesgo de infección nosocomial de los trabajadores de la salud al adaptar distintos protocolos en pacientes con COVID-19.
Patient's management due to the appearance of new coronavirus 2019 (COVID-19) represents a challenge for medical and surgical departments, since it modified the running of health systems in almost all the world. In order to help in this new situation, the Neurosurgical Department of our institution has adopted different measures in accordance with those taken at institutional and national level. In order to do this, we made a literature review and we added to this, the norms dictated by the crisis committee of our hospital. We also carried out a brief survey among neurosurgeons from Latin America to find out how they managed protection levels in relation to surgery. COVID-19 pandemic is certainly one of the greatest challenge national health systems face in a century. Adapting different protocols in neurosurgical patients with COVID-19 can contribute in reducing the risk of nosocomial infection of health workers.
Subject(s)
Humans , Coronavirus Infections , Health Personnel , Coronavirus , Pandemics , Neurosurgeons , NeurosurgeryABSTRACT
Objective. Stereotactic CT-guided biopsy is a safe procedure for the diagnosis of brain lesions unsuitable for surgical treatment because of their location, number, histology or poor medical status. The objective of this study is to analyze the indications,demography, topography, anatomopathologic diagnosis and complications in a series of stereotactic CT-guided brain biopsies. Method. 192 CT assisted stereotactic brain biopsies in 186 patients were retrospectively reviewed from june 1998 to june of 2008. Results. 186 patients, 101males (54.3%) and 85 females (45.7%), were analyzed. Mean age was 54.5 years. 144 (75%) of the biopsies were performed in hemispheric lesions, 43 (22.4%) in deep seated localization. The most frequent anatomopathologic diagnosis were glioblastoma (36,5%) and anaplasic astrocytoma (17%). 90,62% of the biopsies were positive, 7,3% were negative and 2,08% nondiagnostic. Morbility rate was 3,64% and mortality 2,08%. Conclusion.Stereotactic brain biopsy is a safe and effective procedure providing tissue for definitive anatomopathological diagnosis; it offers low morbidity and mortality rate. Our findings are similar to the literature.
Subject(s)
Biopsy , Brain Neoplasms , Tomography , Brain Injuries, TraumaticABSTRACT
Introduction. Surgical treatment of trigeminal neuralgia remains a matter of debate since there are no studies comparing long term effectiveness of the different surgical techniques. We present our 10 year experience. Description. Series: 40 patients. Period: 1998 - 2008. Surgical techniques: microvascular decompression, radiofrequency thermorhizotomy and balloon compression. Analyzed parameters: age, sex, nerve root involved, pain relief, recurrence, complications, need to restart medication and reintervention. Discussion. Microvascular decompression offers better long term results, radiofrequency is adequate for special cases (higher recurrence rate), and balloon compression is better for V1 neuralgia. Our sample is too small for statistics, yet our findings are coincident with the literature. Conclusion. Better patient selection criteria for each technique are needed. Microvascular decompression should be the treatment of choice when possible. How to treat recurrence remains unanswered.