Microsurgical and illustrative anatomy of the cavernous sinus, middle fossa, and paraclival triangles: a straightforward, comprehensive review.

The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.

Compassionate use of Quantum Magnetic Resonance Therapy for treatment of children with Diffuse Brainstem Glioma in Mexico City: a single institutional experience.

PURPOSE: Diffuse Brainstem Glioma (DBG) is a catastrophic brain tumor with a survival rate of less than 10% two years after diagnosis despite the existence of different treatment protocols. Among the devices that use magnetic fields generated by Magnetic Resonance Imaging is Quantum Magnetic Resonance Therapy (QMRT). METHODS: Five children diagnosed with DBG in our institution in Mexico City underwent treatment of compassionate use with QMRT between December 2018 and July 2019. A survival analysis was performed with previously reported historical data (n = 15). RESULTS: Two patients (40%) survived after three years of follow-up; the log-rank test showed a statistically significant difference in overall survival between both groups (p = 0.032). All patients tolerated the treatment adequately without reporting any severe clinical or neuroradiological adverse effects. Of the patients included, all showed a decrease in the tumor one month after the end of the treatment, although there was great variability in the response and the difference was not statistically significant (p = 0.06). CONCLUSIONS: Although future investigations are needed to confirm the findings reported in the present study, the improvement in survival is promising for a group of patients whose prognosis has been catastrophic over the years. Trial registration NCT03577600.

The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis.

There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.

On the construction of a skill-based wheelchair navigation profile.

Assisted wheelchair navigation is of key importance for persons with severe disabilities. The problem has been solved in different ways, usually based on the shared control paradigm. This paradigm consists of giving the user more or less control on a need basis. Naturally, these approaches require personalization: each wheelchair user has different skills and needs and it is hard to know a priori from diagnosis how much assistance must be provided. Furthermore, since there is no such thing as an average user, sometimes it is difficult to quantify the benefits of these systems. This paper proposes a new method to extract a prototype user profile using real traces based on more than 70 volunteers presenting different physical and cognitive skills. These traces are clustered to determine the average behavior that can be expected from a wheelchair user in order to cope with significant situations. Processed traces provide a prototype user model for comparison purposes, plus a simple method to obtain without supervision a skill-based navigation profile for any user while he/she is driving. This profile is useful for benchmarking but also to determine the situations in which a given user might require more assistance after evaluating how well he/she compares to the benchmark. Profile-based shared control has been successfully tested by 18 volunteers affected by left or right brain stroke at Fondazione Santa Lucia, in Rome, Italy.

Effectiveness of the use of an omega 3 and omega 6 combination(EquazenTM) in paediatric patients with refractory epilepsy / Eficácia do uso de uma combinação de ômega 3 com ômega 6 (EquazenTM) em pacientes pediátricos com epilepsia refratária

INTRODUCTION: Epilepsy is considered a health problem. 85% of patients are satisfactorily controlled with antiepileptic drugs (AEDs) and 15% have refractory seizures. The combination of omega 3 and omega 6 fatty acids (EquazenTM) can contribute to changes in ionic currents and to stabilization of neurotransmitter's function resulting in cell membrane equilibrium. These changes lead to potential seizure control. OBJECTIVE: To compare efficacy and safety in the treatment of refractory epilepsy with a supplement combining EPA, DHA (omega 3 fatty acids) and GLA (omega 6 fatty acids). METHODS: We reviewed patients from the Neurology Department of the Children's Hospital of Mexico who have refractory epilepsy, evaluating clinical characteristics of seizures, number of seizures and AEDs. 792 mg of EPA, DHA and GLA per day (6 capsules of EquazenTM) were administrated for four weeks in order to assess the frequency of seizures as well as tolerability and probable side effects. RESULTS: The study was conducted with a total of 13 patients with follow-up four weeks after the start of supplementation. We obtained a satisfactory clinical response with ≥ 80% decrease in the daily number of seizures in more than 60% of patient. The mean of number of seizures over all patients was reduced significantly from 26.61±37.2 to 5.92 daily. In addition a significant improvement in the neurocognitive capacity was observedin all patients. CONCLUSION: The co-adjuvant supplementation with EquazenTM may result in a reduction of the number of seizures in refractory epilepsy having in addition significant impact on neurocognitive aspects. To enhance the quality of life of epileptic patient supplementation with a specific combination of EPA, DHA and GLA should be reconsidered.

INTRODUÇÃO: epilepsia é considerada um problema de saúde em que 85% dos pacientes são satisfatoriamente controlados com drogas antiepilépticas (DAE) e 15% tem crises refratárias. A combinação de ácidos graxos ômega 3 e ômega 6 (EquazenTM) pode contribui em mudanças em correntes iônicas e estabilização de neurotransmissores, resultando em equilíbrio da membrana celular. Estas mudanças levam a potencial controle de crises. OBJETIVO: comparar a eficácia e segurança suplementos combinando EPA, DHA (ácidos graxos ômega 3) e GLA (ácidos graxos ômega 6) no tratamento da epilepsia refrataria. MÉTODOS: crianças com epilepsia refratária do Departamento de Neurologia do Hospital Infantil do México tiveram avaliadas as características de suas crises, frequência e numero de DAEs. EPA, DHA e GLA (6 capsulas de Equazem - 729mg) foram administrados em um período de 4 semanas, sendo acessados tolerabilidade, efeitos colaterais e frequência de crises. RESULTADOS: 13 pacientes foram avaliados por 4 semanas após o início da suplementação. Um controle clínico satisfatório (redução de 80% ou mais das crises) foi obtido em 60% dos pacientes (26.61±37.2 crises para 5.92 crises ao dia), além de significativa melhora em sua capacidade neurocognitiva. CONCLUSÃO: a suplementação de Equazen pode determinar redução no número de crises em epilepsia refratária e determinar melhora em parâmetros neurocognitivos. O uso da combinação EPA, DHA, GLA deveria ser reconsiderado neste cenário.