Esclerosis temporal mesial: paradigma de la epilepsia de resolución quirúrgica: 2da. parte / Temporary mesial sclerosis: Surgical resolution epilepsy paradigm 2nd. Part*

Objective. To describe the Mesial Temporal Lobe Sclerosis (MTS), in relation to its anatomical, clinical, iconographic, neurophysiologic, neuro psychologic, and surgical aspects, in reference to the epilepsy cases that needed a surgical resolution. Additionally, it’s realized a statistical analysis of our series and its results.Material and methods. From the series of 469 patients (115 adults and 354 children) operated on between 1989 and 2007, at National Pediatrics . Dr. Juan Garrahan, FLENI, Dr. Cosme Argerich, and Prof. Dr. R. Rossi Hospitals; who harbored RefractoryEpilepsy ; were analyzed 91 cases (19,4%) with the diagnosis of MTS; 38 patients belong to the pediatric group and 53 were adults. Results. The results were evaluated by the Engel score. Applying this classification, our population of patients showed thenext pattern of distribution: 69 (75,8%) are in Engel’s class IA, from this group, 36 (52,2%) are children, and 33 (47,8%), adults; 4 adults patients;( 4,4%) are in Engel’s class IB, 3 patients (3,3%) in Engel’s class IC; 1 (in Engel’s class ID(1,1%); 4 adults in Engel’s class IIA (4,4%); 5 in Engel’s class IIB (5;5%) and 3 (3,3%) in Engel’s class IVA; from then, one patient was a child, and underwent the implantation of VNS, the rest were adults. One adult patient committed suicide, one year after surgery (was in Engel’s class IA). One patient is on his first post operative year,and then couldn’t been included in statistical analysis, because follow up wasn’t enough. Conclusion. The MTS is the paradigm of Refractory Epilepsy inthe adult population, and in the pediatric subgroup involved a significant percentage: the presurgical evaluation must be exhaustive for adequate selection of cases. The extent of resection should be done with high degree of selectivity. The early diagnosis and treatment can obtain a high index of good results without ictal phenomena and the absence of necessity of antiepileptic drugs.

Esclerosis temporomesial en adultos: revisión del síndrome y evalución de resultados / Mesial temporal sclerosis in adults: Revision of the syndrome and assessment of results

Objective: To describe the presentation and the management of the Mesial Temporal Sclerosis (ETM) in adult patients and to evaluate the results of the presented series. Description: the authors selectioned 3 cases among 53 adults who underwent surgical treatment with ETM diagnosis. Case 1: female patient, 32 years old. Antecedents of complex partial crisis since 6 years old, some of the crisis related to febrile episodes. Aura related like unpleasent gastroesophageal sensation, break of contact, right hand dystonia, cephalic turn to right and oroalimentary and manual automatism. RMI and EEG-video: injury compatible with left ETM. Case 2: male patient, 24 years old. Antecedents of complex partial crisis since 13 years old. Breack of contact, verbal automatisms (repeats unintelligible sounds) and sensation of postictal sikness. RMI: increase of signal (FLAIR) in both hippocampus, impressing right atrophy. EEG-video with profund electrodes implanted: start of the crisis on a right mesial temporal level. Case 3: female patient, 21 years old. Antecedents of complex partial crisis since 12 years old. Complex partial crisis with bimanual and oroalimentary automatisms with an episode of generalization. RMI and EEG-video: injury compatible with right ETM. Intervention: case 1 and 2 were resolved by the realization of an anteromesial resection of Spencer. In case 3 a selective amygdalo hippocampectomy was practiced. Conclusion: ETM is the paradigm of the refractory epilepsy in an adult population. Precocious diagnosys and treatment allow to obtain a high index of cure with small amount of significant sequels.

Subluxacion cervical espondiloartrosica / Degenerative cervical subluxation

Objective: To analyze the biomechanical and anatomical factors and the surgical treatment and outcome in cervical degenerative spondylolisthesis. 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 had only spondylotic myelopathy (63 vs 13 years). The former 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 with affection of two levels and 1 with three levels. 33 patients had unstable subluxations. The most commonly affected levels were C3-C4 and C4-C5. In all the cases, an anterior approach with autogenous bone graft and locking plate was performed. REsults: After surgical teatment, 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-C5 segments. In all 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 plate, allowed spinal cor decompression and cervical fusion

Artritis reumatoidea del raquis cervical. Algoritmo de tratamiento / Cervical rheumatoid arthritis. Treatment algoritm

Objective: To describe an algorithm for surgical management of cervical spine RA. Methods: RA cases treated by the senior authors from 1978 to 2003 have been analyzed. An algorithm for surgical management of the different forms of this pathology is proposed. Results: Cervical spine involvement by RA includes atlantoaxial subluxation, settling of the odonteid process, and suaxial subluxation. Surgical treatment should be established immediately after is radiological diagnosis. The optimal approach is a posterior one in every case, followed by an anterior approach when periodontal pannus, superior migration of the odontoid process, or subaxial subluxation are associated with an anterior compression. Conclusion: This algorithm is a useful guide to the treatment of spine RA