Early IGF-1 Gene Therapy Prevented Oxidative Stress and Cognitive Deficits Induced by Traumatic Brain Injury.

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality in adults under 40 years old. Once primary injury occurs after TBI, neuroinflammation and oxidative stress (OS) are triggered, contributing to the development of many TBI-induced neurological deficits, and reducing the probability of critical trauma patients´ survival. Regardless the research investment on the development of anti-inflammatory and neuroprotective treatments, most pre-clinical studies have failed to report significant effects, probably because of the limited blood brain barrier permeability of no-steroidal or steroidal anti-inflammatory drugs. Lately, neurotrophic factors, such as the insulin-like growth factor 1 (IGF-1), are considered attractive therapeutic alternatives for diverse neurological pathologies, as they are neuromodulators linked to neuroprotection and anti-inflammatory effects. Considering this background, the aim of the present investigation is to test early IGF-1 gene therapy in both OS markers and cognitive deficits induced by TBI. Male Wistar rats were injected via Cisterna Magna with recombinant adenoviral vectors containing the IGF-1 gene cDNA 15 min post-TBI. Animals were sacrificed after 60 min, 24 h or 7 days to study the advanced oxidation protein products (AOPP) and malondialdehyde (MDA) levels, to recognize the protein oxidation damage and lipid peroxidation respectively, in the TBI neighboring brain areas. Cognitive deficits were assessed by evaluating working memory 7 days after TBI. The results reported significant increases of AOPP and MDA levels at 60 min, 24 h, and 7 days after TBI in the prefrontal cortex, motor cortex and hippocampus. In addition, at day 7, TBI also reduced working memory performance. Interestingly, AOPP, and MDA levels in the studied brain areas were significantly reduced after IGF-1 gene therapy that in turn prevented cognitive deficits, restoring TBI-animals working memory performance to similar values regarding control. In conclusion, early IGF-1 gene therapy could be considered a novel therapeutic approach to targeting neuroinflammation as well as to preventing some behavioral deficits related to TBI.

Termocoagulación por radiofrecuencia de ganglio de Gasser para el tratamiento de neuralgia trigeminal, resultados de 11 años / Gasser's ganglion radiofrequency thermocoagulation for the treatment of trigeminal neuralgia, 11-year results

Objetivos: Describir resultados de los últimos 11 años en el tratamiento de neuralgia del trigémino con termocoagulación por radiofrecuencia, analizar variables relacionadas a complicaciones y resultados. Material y Métodos: Estudio retrospectivo, descriptivo, longitudinal, comparativo y analítico. Se analizaron los resultados de los últimos 11 años de nuestro servicio evaluando las temperaturas de las lesiones armando dos grupos, de 65°C-70°C y 71°C-75°C para analizar su relación con resultados y complicaciones. Resultados: Se trataron 59 pacientes en los cuales se realizaron 74 procedimientos, la edad media fue 59.22 años (±13,45). Se observó recidiva en 23 procedimientos con una tasa global de 31%. El tiempo medio de recidiva fue de 28,19 meses (±26,21). El tiempo medio de seguimiento fue de 33,10 meses (±33,49). El tiempo medio de evolución del dolor, previo al primer procedimiento, fue de 5,35 años (±4,37). Analizando los grupos se observó que no existía relación significativamente estadística (p = 0,74) entre el grupo de pacientes de 65ºC-70ºC y el grupo de 71ºC-75ºC y recidiva. No se observó relación estadísticamente significativa entre el grupo de 65ºC-70ºC y el grupo de 71ºC-75ºC y tiempo de recidiva (p=0,12). Se observó más pacientes con hipoestesia inmediata en el grupo de pacientes de 65ºC-70ºC, sin significación estadística (p=0,47). Conclusión: La termocoagulación por radiofrecuencia de ganglio de Gasser es un procedimiento accesible, mínimamente invasivo que demostró buenos resultados y buen manejo del dolor con bajo índice de complicaciones.

Objectives: Describe results of the last 11 years in the treatment of trigeminal neuralgia with radiofrequency thermocoagulation, analyze variables related to complications and results. Methods: Retrospective, descriptive, longitudinal, comparative and analytical study. The results of the last 11 years of our service were analyzed by assessing the temperatures of the lesions by assembling two groups, 65° C-70° C and 71 ° C-75° C to analyze their relationship with results and complications. Results: 59 patients were treated in which 74 procedures were performed; the mean age was 59.22 years (± 13.45). Recurrence was observed in 23 procedures with an overall rate of 31%. The average recurrence time was 28.19 months (± 26.21). The average follow-up time was 33.10 months (± 33.49). The average time of pain evolution, prior to the first procedure, was 5.35 years (± 4.37). Analyzing the groups, it was observed that there was no significant statistical relationship (p = 0.74) between the group of patients from 65ºC-70ºC and the group from 71ºC-75ºC and recurrence. No statistically significant relationship was observed between the 65ºC-70ºC group and the 71ºC-75ºC group and recurrence time (p = 0.12). More patients with immediate hypoaesthesia were observed in the group of patients from 65ºC-70ºC, without statistical significance (p = 0.47). Conclusion: Gasser's ganglion radiofrequency thermocoagulation is an accessible, minimally invasive procedure that demonstrated good results and good pain management with a low complication rate

Extradural minipterional approach: Evolving indications of the minipterional craniotomy.

BACKGROUND: In this paper, we report a clinical series of skull base lesions operated on trough the MiniPT, extending its application to skull base lesions, either using the classical minipterional or a variant, we call extradural minipterional approach (MiniPTEx). METHODS: We describe our surgical technique of operating on complex skull base lesions using a minipterional extradural approach. Anterior clinoidectomy, middle fossa peeling, transcavernous, and Kawase approaches were performed as needed. In total, we carried out 24 surgeries: three skull base tumors, 1 Moyamoya case, and 20 giant/complex intracranial aneurysms. All the patients present good neurological result (mRs < 3). Only two patients had paralysis of any cranial nerve and only one patient had a mild hemiparesis. RESULTS: This surgery series there are 24 cases, 10 patients were treated with exclusive MiniPT. MiniPT extradural approach was made in 14 patients. Twelve were treated using pure MiniPTEx approach, 1 patient using transcavernous approach, and in 1 patient, the anterior clinoid was resected with the combination of a MiniPT, a medium fossa peeling, and the Kawase anterior petrosectomy for skull base surgery. CONCLUSION: We further advance the indications of the MiniPT by extending it to operate on the cranial base tumors or complex vascular lesions without additional morbidity. MiniPT approach may be safely associated with skull base techniques, including anterior and posterior clinoidectomies, peeling of the middle fossa, transcavernous approach, and anterior petrosectomy. The versatility of the MiniPT craniotomy and the feasibility of performing skull base surgery through the MiniPT technique have been demonstrated in this paper.

The "Brain Stress Timing" phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage.

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Long-term follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

Spontaneous Regression of a True Intracanalicular Fusiform Ophthalmic Artery Aneurysm After Endovascular Treatment of an Associated Dural Arteriovenous Fistula.

BACKGROUND: Ophthalmic trunk aneurysms associated with other vascular malformations are extremely rare, and little is known regarding its natural history and options of treatment. CASE DESCRIPTION: We present the interesting case of a 51-year-old man who was admitted with progressive visual loss secondary to a concurrent fusiform ophthalmic trunk aneurysm associated with a dural arteriovenous fistula. He was treated with transarterial embolization of the fistulous point. CONCLUSIONS: A follow-up angiogram at 6 months showed complete obliteration of the dural arteriovenous fistula and regression of the ophthalmic trunk aneurysm. The literature is reviewed, and potential pathophysiologic mechanisms leading to this association and regression in this subgroup of aneurysms are discussed.

Acute Deafness: A Rare Complication of Shunting.

BACKGROUND: Mild hearing loss following shunting has been described; however, severe auditory impairment associated with ventriculoperitoneal (VP) shunt is an uncommon, rarely reported phenomenon. Treatment options and pathophysiologic considerations are discussed in this case report. CASE DESCRIPTION: A 27-year-old man who was treated for an eighth cranial nerve schwannoma with complete resection and a VP shunt 10 years previously presented to the emergency department with acute severe hearing loss and headache. Imaging showed diminished size of the ventricles and dural contrast enhancement. The previous shunt was replaced with a programmable antisiphoning VP shunt. The patient's hearing and headache improved 48 hours later, as demonstrated in serial audiograms. CONCLUSIONS: Hearing loss is an underestimated complication of shunting that in some cases may progress to severe impairment and deafness. Patients with a VP shunt who experience hearing loss should undergo further evaluation and possibly adjustment of shunt settings.