Worldwide Research Trends on Transvenous Embolization of Brain Arteriovenous Malformations: A Bibliometric and Visualized Study.

BACKGROUND: Transvenous embolization (TVE) of brain arteriovenous malformations (bAVMs) is an emerging endovascular technique that has shown high cure rates in selected cases. The rationale of our study was to determine authorship and worldwide institutional trends and contributions to the knowledge in this topic. METHODS: Web of Science database was used. A total of 63 articles were included based on predefined inclusion criteria, which were manually reviewed. The bibliometric analysis involved the use of quantitative bibliometric indicators and network analysis with co-authorship and co-occurrence of terms, which were performed using the bibliometrix package in R and VOSviewer, respectively. RESULTS: The first article was published in 2010, with the largest number of articles published in 2022 (10 articles). The average number of citations per document was 11.38, and the annual growth rate was 14.35%. The top 10 authors with the most scientific production on TVE of bAVMs were from France, and the most cited study was published by Iosif C in 2015, followed by Consoli A in 2013, and Chen CJ in 2018. Journal of Neurointerventional Surgery was the journal with the most articles published. The most commonly used keywords were dural arteriovenous fistula, Onyx, vascular disorders, and neurological surgery around 2016, and intervention around 2021. CONCLUSIONS: TVE of bAVMs is an emerging technique. Our search identified some scientific articles, without randomized clinical trials, but many case series from single institutions. French and German institutions are the pioneers in the field, and further research is required in specialized endovascular centers.

Características clínicas e histopatológicas de niños peruanos con craneofaringioma

Introducción: Los craneofaringiomas son tumores benignos, de los cuales hasta el 50% ocurren en niños. Sin embargo, no hay estudios en niños peruanos. Objetivo: describir las características clínicas e histopatológicas de niños con craneofaringioma hospitalizados en el Hospital Nacional Edgardo Rebagliati Martins entre agosto de 2019 y mayo de 2021. El estudio: El diseño es transversal y la fuente de los datos fueron las historias clínicas. Se recolectó información sobre el sexo, edad, cirugías y características relacionadas a la primera cirugía de resección tumoral. Hallazgos: Incluimos 12 pacientes. El 83.3% fueron varones, al momento del diagnóstico la mediana de edad fue de 6 años y predominaron los síntomas visuales, todos tuvieron deficiencias hormonales luego de la primera cirugía de resección. Conclusión: tres recibieron radioterapia, uno desarrolló transformación maligna y otro falleció. Es necesario realizar a futuro estudios prospectivos.

Introduction: Craniopharyngiomas are benign tumors, of which up to 50% occur in children. However, there are no studies in Peruvian children. Objective : to describe the clinical and histopathological characteristics of children with craniopharyngioma hospitalized at the Edgardo Rebagliati Martins National Hospital between August 2019 and May 2021. The study: The design is cross-sectional and the data source were medical records. Information on sex, age, surgeries and characteristics related to the first tumor resection surgery were collected. Findings: We included 12 patients. 83.3% were male, at the time of diagnosis the median age was 6 years and visual symptoms predominated, all had hormonal deficiencies after the first resection surgery. Conclusions: three received radiotherapy, one developed malignant transformation and one died. Future prospective studies are necessary.

Spontaneous intracranial hypotension: from cerebral venous thrombosis to neurosurgical treatment: a case series experience from a Brazilian tertiary health care center / Hipotensão intracraniana espontânea: de trombose venosa cerebral ao tratamento cirúrgico: uma série de casos de um centro terciário de saúde brasileiro

Abstract Background Spontaneous intracranial hypotension (SIH) is a secondary cause of headache and an underdiagnosed disease. The clinical presentation can be highly variable. It typically presents with isolated classic orthostatic headache complaints, but patients can develop significant complications such as cerebral venous thrombosis (CVT). Objective To report 3 cases of SIH diagnosis admitted and treated in a tertiary-level neurology ward. Methods Review of the medical files of three patients and description of clinical and surgical outcomes. Results Three female patients with SIH with a mean age of 25.6 ± 10.0 years old. The patients had orthostatic headache, and one of them presented with somnolence and diplopia because of a CVT. Brain magnetic resonance imaging (MRI) ranges from normal findings to classic findings of SIH as pachymeningeal enhancement and downward displacement of the cerebellar tonsils. Spine MRI showed abnormal epidural fluid collections in all cases, and computed tomography (CT) myelography could determine an identifiable cerebrospinal fluid (CSF) leak in only one patient. One patient received a conservative approach, and the other two were submitted to open surgery with lamino-plasty. Both of them had uneventful recovery and remission in surgery follow-up. Conclusion The diagnosis and management of SIH are still a challenge in neurology practice. We highlight in the present study severe cases of incapacitating SIH, complication with CVT, and good outcomes with neurosurgical treatment.

Resumo Antecedentes Hipotensão intracraniana espontânea (HIE) é uma causa secundária de cefaleia e uma doença subdiagnosticada. A apresentação clínica pode ser muito variável. Tipicamente, se apresenta com queixas isoladas de cefaleia ortostática clássica, porém pode evoluir com complicações significativas como trombose venosa cerebral (TVC). Objetivo Relatar 3 casos de diagnóstico de hipotensão intracraniana espontânea manejados em uma enfermaria de neurologia de nível terciário. Métodos Revisão dos prontuários de três pacientes e descrição dos resultados clínicos e cirúrgicos. Resultados Três pacientes do sexo feminino com média de idade de 25.6 ± 10.0 anos. As pacientes apresentavam cefaleia ortostática e uma delas apresentou sonolência e diplopia devido a TVC. A ressonância magnética (RM) do encéfalo varia de achados normais até achados clássicos de HIE como realce paquimeníngeo e deslocamento inferior das tonsilas cerebelares. A RM da coluna mostrou coleções anormais de líquido epidural em todos os casos e a mielografia por tomografia computadorizada (TC) foi capaz de determinar fístula liquórica identificável em apenas uma paciente. Uma paciente recebeu abordagem conservadora e as outras duas foram submetidas a cirurgia aberta com laminoplastia. Ambas tiveram recuperação e remissão sem intercorrências no seguimento cirúrgico. Conclusão O diagnóstico e manejo da hipotensão intracraniana ainda são desafios na prática neurológica. Destacamos no presente estudo casos graves, complicação com TVC e bons resultados com tratamento neurocirúrgico.

Técnica de clonación 3D aplicada en planificación quirúrgica para craneosinostosis sagital en Latinoamérica-Perú: reporte de caso

La craneosinostosis sagital es el cierre prematuro de la sutura sagital, ocasionando alteraciones funcionales y estructurales. El tratamiento es quirúrgico, y actualmente se cuenta con diversas técnicas, las cuales requieren de una planificación y entrenamiento para lograr óptimos resultados. Se presenta el caso de un varón de 1 año presenta crecimiento anteroposterior anormal del cráneo, indicándose tomografía cerebral sin contraste evidenciando una sinostosis sagital. Se realiza la planificación quirúrgica de la técnica a desarrollar mediante modelo 3D personalizado a escala real. Paciente cursa con buena evolución y es dado de alta. Finalmente, la tecnología de clonación 3D esencial para la educación y desarrollo neuroquirúrgico permitiendo acceder a modelos táctiles de alta precisión y bajo costo que mejoran la calidad del manejo de craneosinostosis.

Sagittal craniosynostosis is the premature closure of the sagittal suture, causing functional and structural alterations. The treatment is surgical, and there are currently various techniques, which require planning and training to achieve optimal results. We present the case of a 1-year-old male with abnormal anteroposterior growth of the skull, indicating brain tomography without contrast, showing sagittal synostosis. Surgical planning of the technique to be developed is carried out using a real-scale personalized 3D model. The patient progresses well and is discharged. Finally, essential 3D cloning technology for neurosurgical education and development allows access to high-precision, low-cost tactile models that improve the quality of craniosynostosis management.

Neurosurgery Research Productivity in Latin American and Caribbean Countries: A Bibliometric and Visualized Study.

OBJECTIVES: Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean. METHODS: A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures, and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. RESULTS: We identified 882 articles published in 271 journals. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9, and the average number of citations per document was 11.2. The author with the highest number of publications was Teixeira MJ (41 articles), and the University of Sao Paulo had the highest number of articles on this topic. WORLD NEUROSURGERY was the journal with the most publications (120 articles), and the study by Carney et al (2017) was the most cited (1175 citations). The country of corresponding authors with the most publications and the greatest number of total citations was Brazil. Surgery, and Management were the most used keywords plus; however, in the most recent articles Simulation and Guidelines were used. CONCLUSIONS: In the past decade, there has been an increase in articles on neurosurgery in Latin America and the Caribbean. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine.

Safety and Feasibility of Nucleus Accumbens Surgery for Drug Addiction: A Systematic Review.

BACKGROUND: Substance addiction encompasses the incapacity to discontinue urgent drug use; many severely disabled patients might be considered appropriate candidates for surgery due to the high rates of relapse despite conservative treatment. A crucial finding in the brain of these patients is increased extracellular concentrations of dopamine in the nucleus accumbens (NAcc). OBJECTIVES: To determine the efficacy and safety of NAcc surgery for the treatment of substance dependence. MATERIALS AND METHODS: Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies in which NAcc surgery was performed to treat relapsing drug addiction with a minimum follow-up of six months. From database inception to April 10, 2020, we searched PubMed, Scopus, and LILACS. Two reviewers independently selected studies and extracted data. The main outcome was the relapse rate. The GRADE methods were applied to evaluate the quality of evidence. This study was registered with PROSPERO CRD42020177054. RESULTS: Fifteen studies involving 359 participants met inclusion criteria; eight (56%) included NAcc deep brain stimulation (DBS) in 13 patients with addiction for alcohol (N = 6, 46.1%), opioid (N = 4, 30.7%), and nicotine (N = 3, 15.3%); seven studies (N = 346, 44%) performed NAcc radiofrequency (RF) ablation for opioid (N = 334) and alcohol (N = 12) dependence. Relapse rates were 38.4% for DBS and 39% for RF ablation. CONCLUSIONS: Despite available studies reporting a benefit in the treatment of drug addictions with NAcc surgery, this systematic review stresses the need for carefully planned prospective studies in order to further address the efficacy and indications.

Molecular basis and clinical perspectives of deep brain stimulation for major depressive disorder.

It is possible to consider the stimulation of the cingulate gyrus in its portion below the corpus callosum (SCC, or subcallosal cingulate cortex) as an effective, promising, and safe alternative intervention for treatment-resistant depression. In studies with deep brain stimulation - DBS, when follow-on with functional magnetic resonance imaging and/or PET-CT (Positron emission tomography-computed tomography) is performed, it is observed an increase in the blood supply and glucose metabolism in this region, which is the anterior part of the limbic system. This same location has good experimental results also for the treatment of anorexia nervosa. The hypotheses suggest a greater activation of the reward system, a greater sense of well-being, and a consequent reduction in depressive symptoms, the objective of the treatment. Over the last 20 years, multicenter studies have shown symptomatic improvement in 50-60% of patients, and about a third even reach criteria for remission of the depressive disorder.

Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-Analysis.

Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: "SILK", "Flow Diverter", "Mortality", and "Prognosis". The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00-6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00-5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65-9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.

Reflejo de Bezold-Jarish: una puesta al día en neurocirugía / Bezold-Jarisch reflex: an update in neurosurgery

El reflejo de Bezold Jarisch es un reflejo cardioinhibitorio que juega un papel en la homeostasis cardiovascular. Consiste en la triada dada por hipotensión, bradicardia y vasodilatación periférica que puede ser desencadenada tanto por estímulos mecánicos, como químicos. Se considera que el mecanismo eferente contrarresta e inhibe los efectos del influjo simpático y, por el contrario, activa los efectos producidos por el sistema parasimpático. Durante la cirugía neurológica, la disminución de la presión intracraneal posterior a la extracción de colgajo óseo en la craneotomía, el uso de medicamentos osmóticos para disminuir el edema cerebral e incluso la posición del paciente durante el procedimiento suponen situaciones más propensas a la aparición del reflejo.

The Bezold Jarisch reflex is a cardioinhibitory reflex that plays a role in cardiovascular homeostasis. It consists of a triad given by hypotension, bradycardia, and peripheral vasodilation that can be triggered by both mechanical and chemical stimuli. The efferent counteracting mechanism is considered to inhibit the effects of sympathetic influx and, conversely, activates the effects produced by the parasympathetic system. During neurological surgery, the decrease in intracranial pressure after bone flap extraction in the craniotomy, the use of osmotic medications to decrease cerebral edema and even the position of the patient during the procedure supposes situations more prone to reflex appearance

Isolated neuroparacoccidioidomycosis as a pseudotumoral lesion in the absence of systemic disease.

BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery. CASE DESCRIPTION: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease. CONCLUSION: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.

Surgery for spontaneous intracerebral hemorrhage.

Spontaneous intracerebral hemorrhage is a devastating disease, accounting for 10 to 15% of all types of stroke; however, it is associated with disproportionally higher rates of mortality and disability. Despite significant progress in the acute management of these patients, the ideal surgical management is still to be determined. Surgical hematoma drainage has many theoretical benefits, such as the prevention of mass effect and cerebral herniation, reduction in intracranial pressure, and the decrease of excitotoxicity and neurotoxicity of blood products.Several surgical techniques have been considered, such as open craniotomy, decompressive craniectomy, neuroendoscopy, and minimally invasive catheter evacuation followed by thrombolysis. Open craniotomy is the most studied approach in this clinical scenario, the first randomized controlled trial dating from the early 1960s. Since then, a large number of studies have been published, which included two large, well-designed, well-powered, multicenter, multinational, randomized clinical trials. These studies, The International Surgical Trial in Intracerebral Hemorrhage (STICH), and the STICH II have shown no clinical benefit for early surgical evacuation of intraparenchymal hematoma in patients with spontaneous supratentorial hemorrhage when compared with best medical management plus delayed surgery if necessary. However, the results of STICH trials may not be generalizable, because of the high rates of patients' crossover from medical management to the surgical group. Without these high crossover percentages, the rates of unfavorable outcome and death with conservative management would have been higher. Additionally, comatose patients and patients at risk of cerebral herniation were not included. In these cases, surgery may be lifesaving, which prevented those patients of being enrolled in such trials. This article reviews the clinical evidence of surgical hematoma evacuation, and its role to decrease mortality and improve long-term functional outcome after spontaneous intracerebral hemorrhage.

Microsurgery for Unruptured Cerebral Arteriovenous Malformations in the National Inpatient Sample is More Common Post-ARUBA.

BACKGROUND: The ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) was the first randomized control trial to investigate unruptured cerebral arteriovenous malformation (cAVM) treatments and concluded that medical management was superior to interventional therapy for the treatment of unruptured cAVMs. This conclusion generated considerable controversy and was followed by rebuttals and meta-analyses of the ARUBA methodology and results. We sought to determine whether the ARUBA results altered treatment trends of cAVMs within the United States. METHODS: Using the National Inpatient Sample, the largest all-payer inpatient care database within the United States, we isolated patients who were admitted on an elective basis for cAVM treatment and determined the treatment modality undergone by these patients. The cohort was dichotomized separately at 2 ARUBA time points: the European Stroke Conference presentation in May 2013, and The Lancet publication in February 2014. RESULTS: We found that the overall treatment rate of unruptured cAVMs decreased after both time points. However, the rate of surgical excision alone, relative to other modalities, was significantly increased, and endovascular intervention demonstrated a nonsignificant decrease. CONCLUSIONS: Our findings suggest that the ARUBA trial has influenced unruptured cAVM treatment patterns within the United States. Although the overall treatment rate has decreased, unruptured cAVMs, when treated post-ARUBA, are most commonly approached with surgical excision alone.

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte / Prevention and treatment of surgical site infections in neurosurgery: state of the art

RESUMEN El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes. La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.

SUMMARY The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.

[Post-neurosurgical infections. Update and intersociety recommendations]. / Infecciones postneuroquirúrgicas. Puesta al día y recomendaciones intersociedades.

Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.

Las infecciones asociadas a procedimientos neuroquirúrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como también a la prolongación de la estancia en la UTI y/o en el hospital. El diagnóstico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duración dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibióticos efectivos en el sitio de la infección. La implementación de medidas de prevención con evidencia demostrada minimiza el riesgo de infección. Esta puesta al día intersociedades SADI-SATI presenta datos epidemiológicos (internacionales y locales), métodos diagnósticos, tratamiento, y pautas de prevención, considerando las publicaciones más relevantes de los últimos años sobre el tema.

Infecciones postneuroquiróºrgicas: Puesta al día y recomendaciones intersociedades / Post-neurosurgical infections. Update and intersociety recommendations

Las infecciones asociadas a procedimientos neuroquiró;ºrgicos son complicaciones graves que contribuyen a la morbimortalidad de los pacientes neurocríticos, así como tambín a la prolongació;n de la estancia en la UTI y/o en el hospital. El diagnó;stico es complejo ya que no se dispone de gold standard y se apoya en la sospecha clínica, las alteraciones físico-químicas del líquido cefalorraquídeo y el aislamiento microbiano. El tratamiento debe ser precoz y guiado por la epidemiología local. La duració;n dependerá del microorganismo causal, su sensibilidad y la disponibilidad de tratamientos antibió;ticos efectivos en el sitio de la infecció;n. La implementació;n de medidas de prevenció;n con evidencia demostrada minimiza el riesgo de infecció;n. Esta puesta al día intersociedades SADI-SATI presenta datos epidemioló;gicos (internacionales y locales), mó;©todos diagnó;sticos, tratamiento, y pautas de prevenció;n, considerando las publicaciones más relevantes de los ó;ºltimos aó;±os sobre el tema.

Infections associated with neurosurgical procedures are serious complications that contribute to the morbidity and mortality of neurocritical patients, as well as to the prolongation of the stay in the ICU and the hospital. The diagnosis is complex since there is no gold standard, so it is based on clinical suspicion, CSF physical-chemical examination, and microbial isolation. Treatment should be initiated early, guided by local epidemiology. The duration will depend on the causative microorganism, its sensitivity and the availability of antibiotic treatments that are effective at the site of infection. The implementation of preventive measures with proven efficacy minimizes the risk of infection. This SADI-SATI intersociety update reviews relevant data recently published on this area at the national at international level regarding epidemiology, diagnostic methodologies, therapeutic approaches, and prevention guidelines.

Indications of the Neurotomy of Genicular Nerves by Radiofrequency for the Treatment of Knee Osteoarthritis: A Literature Review.

Osteoarthritis (OA) is one of the most frequent and incapacitating pathologies today, especially of the knee. Among the possible approaches for knee OA, the neurotomy of the genicular nerves by radiofrequency (RF) has been gaining prominence. However, as this is a relatively new procedure, indications for its implementation are still unclear. The objective of the present review is to identify the main indications of the use of RF for the treatment of knee OA in the medical literature. A review of the literature was performed in January 2018 through a search in the PubMed, ClinicalKey and Google Scholar databases. After reviewing the main articles on the subject, it was concluded that the main indications of the use of RF for the treatment of knee OA were: OA Kellgren-Lawrence grades 3 and 4, with moderate to severe pain and failure of conservative treatment, mainly in elderly people; persistence of pain even after total knee arthroplasty (TKA); patients with an indication for TKA who refuse to undergo surgical treatment.

Indications of the Neurotomy of Genicular Nerves by Radiofrequency for the Treatment of Knee Osteoarthritis: A Literature Review / Indicações da neurotomia dos nervos geniculares por radiofrequência para o tratamento da osteoartrite do joelho: uma revisão de literatura

Abstract Osteoarthritis (OA) is one of the most frequent and incapacitating pathologies today, especially of the knee. Among the possible approaches for knee OA, the neurotomy of the genicular nerves by radiofrequency (RF) has been gaining prominence. However, as this is a relatively new procedure, indications for its implementation are still unclear. The objective of the present reviewis to identify the main indications of the use of RF for the treatment of knee OA in themedical literature. A review of the literature was performed in January 2018 through a search in the PubMed, ClinicalKey and Google Scholar databases. After reviewing themain articles on the subject, it was concluded that the main indications of the use of RF for the treatment of kneeOAwere:OA Kellgren-Lawrence grades 3 and 4, withmoderate to severe pain and failure of conservative treatment, mainly in elderly people; persistence of pain even after total knee arthroplasty (TKA); patients with an indication for TKAwho refuse to undergo surgical treatment.

Resumo A osteoartrite é uma das patologias mais frequentes e incapacitantes na atualidade, principalmente do joelho. Dentre as abordagens possíveis para osteoartrite, a neurotomia dos nervos geniculares por radiofrequência vem se destacando. Todavia, por se tratar de um procedimento relativamente novo, as indicações para realização ainda não estão bem definidas. O principal objetivo desta revisão foi identificar as principais indicações do uso da radiofrequência para o tratamento da osteoartrite do joelho na literatura médica. Foi realizada revisão da literatura em janeiro de 2018, através de pesquisa nas bases de dados PubMed, Clinicalkey e Google Scholar. Após revisão dos principais artigos no assunto, foi concluído que as principais indicações do uso da radiofrequência para o tratamento da osteoartrite do joelho foram: pacientes com osteoartrite grau 3 e 4 da classificação de Kellgren-Lawrence, com dor de moderada a severa e falha do tratamento conservador, principalmente idosos; persistência da dor, mesmo após realizado artroplastia total de joelho; pacientes com indicação de artroplastia total de joelho e que se recusam a submeter-se ao tratamento cirúrgico.

Caracterización clínico-quirúrgico, neuroimagenológico y por neuromonitorización del trauma craneoencefálico en la provincia matanzas. 2016-2018 / Clinical-surgical, neuroimaging and neuromonitored characterization of the encephalococranial trauma in the province of Matanzas. 2016-2018

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4% (AU).

ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4% (AU).

Caracterización clínico-quirúrgico, neuroimagenológico y por neuromonitorización del trauma craneoencefálico en la provincia matanzas. 2016-2018 / Clinical-surgical, neuroimaging and neuromonitored characterization of the encephalococranial trauma in the province of Matanzas. 2016-2018

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.

ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.

Microneurorrhaphy of the mentonian nerve during the removal of a giant odontoma / Microneurorrafia do nervo mentoniano durante a remoção de um odontoma gigante

ABSTRACT The aim of this article is to describe a surgical technique of option in the treatment of large tumors in jaw whose risk of accidental rupture of the mental nerve presents increased by the report of a patient with mandibular giant case of odontoma. The option for intraoral access, intentional sectioning of the mentonian nerve, followed by resection of the tumor and the installation of fixation material, which in turn was followed by microneurorraphy. A surgical microscope was used to perform microneurorrhaphy of the mentonian nerve with Nylon 8-0 wire. The evolution of the patient was satisfactory, with no complaints or complications. A mechanical assessment for torque and pressure was conducted using wire with a diameter of 1.0mm and 2.5mm, respectively. The sensitivity of the patient's lower lip returned to normal within 120 days of the surgery. Significant enucleations or resections in the mandible involves a great risk of accidental nervous rupture, with permanent sequelae. In these cases, the intentional section of the mentonian nerve, followed by microneurorrhaphy, is a viable option, particularly in young patients. The results of this procedure tend to be more predictable than accidental nervous ruptures.

RESUMO O objetivo deste artigo é descrever uma técnica cirúrgica de opção no tratamento de grandes tumores na mandíbula cujo risco de ruptura acidental do nervo mental apresenta aumento pelo relato de uma paciente com extenso odontoma complexo em corpo mandibular. A opção foi pelo o acesso intraoral, corte intencional do nervo mentoniano, seguida da ressecção do tumor e da instalação de material de fixação, que por sua vez foi seguida pela microneurorrafia do nervo mentoniano. Um microscópio cirúrgico foi utilizado para realizar microneurorrafia do nervo mentoniano com fio Nylon 8-0. A evolução do paciente foi satisfatória, sem queixas ou complicações. Uma avaliação mecânica para torque e pressão foi realizada usando fio com um diâmetro de 1,0 mm e 2,5 mm, respectivamente. A sensibilidade do lábio inferior do paciente voltou ao normal dentro dos 120 dias da cirurgia. Enucleações significativas ou ressecções na mandíbula envolvem um grande risco de ruptura nervosa acidental, com seqüelas permanentes. Nestes casos, a seção intencional do nervo mentoniano, seguida de microneurrafia, é uma opção viável, particularmente em pacientes jovens. Os resultados deste procedimento tendem a ser mais previsíveis do que as rupturas nervosas acidentais.