Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: experience at an epilepsy centre.

OBJECTIVE: Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS: In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS: The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION: SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.

Stereoelectroencephalography in the preoperative assessment of patients with refractory focal epilepsy: Experience at an epilepsy centre. / Estereoelectroencefalografía en la evaluación prequirúrgica de epilepsias focales refractarias: experiencia de un centro de epilepsia.

OBJECTIVE: Stereoelectroencephalography (SEEG) is a technique for preoperative evaluation of patients with difficult-to-localise refractory focal epilepsy (DLRFE), enabling the study of deep cortical structures. The procedure, which is increasingly used in international epilepsy centres, has not been fully developed in Spain. We describe our experience with SEEG in the preoperative evaluation of DLRFE. MATERIAL AND METHODS: In the last 8 years, 71 patients with DLRFE were evaluated with SEEG in our epilepsy centre. We prospectively analysed our results in terms of localisation of the epileptogenic zone (EZ), surgical outcomes, and complications associated with the procedure. RESULTS: The median age of the sample was 30 years (range, 4-59 years); 27 patients (38%) were women. Forty-five patients (63.4%) showed no abnormalities on brain MR images. A total of 627 electrodes were implanted (median, 9 electrodes per patient; range, 1-17), and 50% of implantations were multilobar. The EZ was identified in 64 patients (90.1%), and was extratemporal or temporal plus in 66% of the cases. Follow-up was over one year in 55 of the 61 patients undergoing surgery: in the last year of follow-up, 58.2% were seizure-free (Engel Epilepsy Surgery Outcome Scale class I) and 76.4% had good outcomes (Engel I-II). Three patients (4.2%) presented brain haemorrhages. CONCLUSION: SEEG enables localisation of the EZ in patients in whom this was previously impossible, offering better surgical outcomes than other invasive techniques while having a relatively low rate of complications.

[Forestier-Rotes-Querol's disease. Ossification of the anterior cervical longitudinal ligament as a cause of dysphagia]. / Enfermedad de Forestier-Rotes-Querol. Osificación del ligamento longitudinal cervical anterior como causa de disfagia.

Forestier's disease or diffuse idiophatic skeletal hyperostosis is a systemic reumathological abnormality of unknown etiology. It produces calcificationossification of the anterior longitudinal ligament. The low dorsal region is the most affected in the raquis. These patients are tipically asymptomatic or with few symptoms (minimal joint pain, spinal pain, stiffness). Dysphagia is the most common symptom when the disease affects the cervical spine; less frequent is dyspnea, both secondary to extrinsic compression of the esophagus and trachea. Neurological complaints are quite rare. In the 1970s Resnick described specific radiological criteria for the diagnosis of Forestier's disease that are still used today. It affects men more frequently than women (2:1); the peak occurrence is in patients in their 60s. We present two cases diagnosed by severe difficulty with deglution, a 84 years-old woman and a 54 years-old man; we operated on them for surgical decompression of the esophagus with resection of osteophytes C3-C4 and C5-C6 respectively through a conventional anterolateral neck approach. Relief of difficulty in swallowing was immediately ensued.

Delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion. Case report and literature review.

We present another case of delayed intracerebral hemorrhage after a ventriculoperitoneal (VP) shunting procedure. In this case, a right occipital intraparenchymal hematoma and associated intraventricular hemorrhage occurred six days after the operation for hydrocephalus secondary to subarachnoid hemorrhage in a 64 year old woman. It is a rare complication of VP shunting, with few cases reported previously in the literature. The presumed mechanism is the erosion of a cerebral blood vessel secondary to a close contact with the ventricular catheter; bleeding disorder, vascular malformation, head trauma or brain tumor were excluded in this patient.

[Leiomyosarcoma of the paranasal sinuses with intracranial involvement: report of a clinical case and review of the literature]. / Leiomiosarcoma de senos paranasales con extensión intracraneal: presentación de un caso clínico y revisión de la literatura.

We describe a 53 year old man with a two months history of frontal headache and right visual loss, with complete right blindness at the moment of diagnosis. Neither nasal obstruction nor endocrine symptoms were found. Computerized Tomography showed a neoplasm involving both paranasal sinuses and sellar region, with bilateral orbital extension. The patient underwent a bifrontal craniotomy with apparent complete excision. Histopathologic examination proved smooth muscle cells sarcoma (leiomyosarcoma). Clinical evolution was unfavorable, with rapid local recurrence. The patient died of cerebellar metastasis 4 months after the initial diagnosis and treatment. Leiomyosarcoma of the sinonasal tract is an unusual tumor, and we have found only 63 cases previously reported. The most frequent clinical presentation is nasal obstruction. Surgery is the treatment of choice, as far as radiotherapy or chemotherapy do not appear to slow disease progression. No relationship has been found between the aggressiveness of leiomyosarcoma of the sinonasal tract and morphologic parameters; instead, prognosis is dependent on the distribution of disease at clinical onset. Leiomyosarcoma of the sinonasal tract may be regarded as a locally aggressive neoplasm with only limited metastatic potential.

Psychological and behavioural factors associated with relapse among heroin abusers treated in therapeutic communities.

The authors carried out a comparative study on two groups of heroin abusers treated in several therapeutic communities: One group consumed heroin on at least three occasions between the fifth and sixth months of treatment (n = 130), and the other continued without consuming heroin after 7 months of treatment (n = 130). The instruments used for data collection were a structured interview and urine analysis. The relapsed group includes older patients with more medical problems, lower educational and occupational level, and major chronicity in heroin consumption. The collection of retrospective data referring to the treatment period shows that relapsed patients more frequently consumed alcohol, hashish, cocaine, and amphetamines; suffered more heroin cravings; used fewer coping strategies to overcome the craving; and justified the craving or the heroin consumption in more situations than those who abstained. The last heroin craving during the treatment period arose in different temporal, social, and physical contexts in the two groups, and it was accompanied more frequently by inadequate responses in the relapsed group: psychophysiological alterations, depressed feelings, negative thoughts, and coping behaviours. The two groups are different in their attitudes toward heroin abstinence. The authors discuss the findings from a cognitive-behavioural perspective and come to the conclusion that various models need to be integrated.

Clinicopathological experience with intraventricular neurocytomas.

Intraventricular neurocytoma is a rare clinicopathological entity that has been recently described. We are reporting our experience with four diagnosed cases and the previously reported cases from the available literature are reviewed. These neoplasms occur mainly in young adults, and their histological diagnosis is difficult on light microscope, because they are almost indistinguishable from oligodendrogliomas. Nevertheless, the presence of tumoral cells arranged around nucleus-free fibrillary zones, resembling the large rosettes of pineocytomas and the immunohistochemical demonstration of synaptophysin are useful data for the pathological diagnosis. This diagnosis is easy on electron microscope, because it demonstrates the neuronal nature of tumoral cells. Regarding prognosis, we have found increasing evidence that these tumors are associated with a favourable course after surgery, and at present there is no clear evidence of the usefulness of radiotherapy.

Method for the determination of optical constants of thin films: dependence on experimental uncertainties.

The analytical dependence of sigma(n) and sigma(k) on related experimental uncertainties when conventional reflectance-transmittance methods for the determination of optical constants of thin films are used has been found. Two kinds of singularity appear. These are responsible for the loss of solution in these methods. From the properties of the derivatives of n and k with respect to the measured thickness, a new method has been developed without loss of solution. Different derivative behaviors for physical and nonphysical solutions were found. The film thickness is also determined by this method with an accuracy better than 0.2%. The method has been applied to thin films of amorphous germanium.

[Suicide attempt with diltiazem]. / Intento de autólisis con diltiacem.

We report a case of a patient, with no conduction abnormalities, who had took 1,800 mg of diltiazem in an attempted suicide. We haven't come across a similar case, which is not associated with other drugs, in bibliography we have consulted. She had conduction abnormalities at different levels, such as atrioventricular block and sinoatrial block, but after a few hours sinus rhythm returned without more complicated treatment. Serial electrocardiograms showed the different types of block. Although we didn't make an electrophysiologic study, we made vagal tests which were normal.

Intrasellar granuloma. Case report.

A case of giant-cell granuloma of the pituitary in a 28-year-old woman is reported. Clinical complaints included headache and amenorrhea. Endocrinological studies showed hypopituitarism. X-ray films showed enlargement of the sella turcica.

Functional treatment of acromegaly by transsphenoidal microsurgery.

The authors have analyzed the results from 41 acromegalic patients who underwent transsphenoidal surgery. In 31 patients, postoperative growth hormone (GH) levels fell and remained below 10 ng/ml. This represents an endocrinological "cure" of 78%. In the remaining 10 cases, postoperative GH values have not stabilized below 10 ng/ml, although seven show some clinical improvement. The results were particularly good in those cases of localized adenomas, which allowed a selective removal while maintaining pituitary function within normal limits in 65.5% of cases. The postoperative GH level in this group fell and remained below 10 ng/ml in more than 90% of cases. Four patients required reoperation to normalize the GH levels which had not been sufficiently modified after the first operation; only one of them remained with plasma GH levels above normal limits. There were no deaths in this series. Rhinorrhea occurred as a postsurgical complication in four cases. In three this disappeared with bed rest and lumbar drainage; in the other, surgical repair was necessary. The occurrence of surgical complications has decreased as our experience has increased, and the need for reoperation has been unusual after the first year of our study.

Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal.

Within the germinal neoplasms of the central nervous system, the embryonal carcinoma is a very rare tumor. The authors report such a lesion arising on the corpus callosum in a child 8 months after a differentiated teratoma was totaly removed from the pineal region. The classification of the germ cell tumors of the central nervous system and their relation with similar tumors of the gonads are discussed. The treatment of the pineal tumors is also discussed.