Solución salina hipertónica versus otros agentes reductores de la presión intracraneal en personas con lesión cerebral traumática aguda / Hypertonic saline versus other intracranial pressure–lowering agents for people with acute traumatic brain injury

Se revisaron las pruebas de la efectividad y la seguridad de las infusiones (en las que se administra una sustancia a través de una vena) de solución salina hipertónica (SSH) [solución salina concentrada (cloruro de sodio)] en comparación con otros tipos de infusión para disminuir la presión intracraneal (PIC, la presencia de presión alta dentro y alrededor del cerebro) en el tratamiento de la lesión cerebral traumática aguda. Fundamento. Las LCT agudas (lesiones repentinas y graves en el cerebro, a menudo debidas a accidentes) son una de las principales causas de muerte y discapacidad en el mundo, especialmente en niños y jóvenes. La hipertensión intracraneal es común después de un daño cerebral. Esto se debe a que el cráneo es un compartimento rígido que contiene 3 partes: tejido cerebral blando, sangre y líquido cefalorraquídeo. Si aumenta el volumen de uno de los componentes, por ejemplo los hematomas (acumulaciones de sangre) dentro del tejido blando del cerebro, el volumen de uno o más del resto de componentes debe disminuir. Si no, la PIC aumentará. Si esta aumenta más allá de ciertos límites, se produce un desequilibrio y el flujo sanguíneo al cerebro disminuye peligrosamente. Esta PIC elevada puede causar efectos graves que incluyen daños cerebrales y muerte. La terapia hiperosmolar es un tratamiento importante para la PIC elevada. Un tipo de terapia hiperosmolar consiste en una infusión de solución salina concentrada (hipertónica) (sal de mesa/cloruro sódico) en la sangre; también pueden utilizarse otros tratamientos, como el manitol (una forma de azúcar). Estos tratamientos pueden reducir la PIC al disminuir el volumen de agua dentro y entre las células cerebrales. (AU)

Causa rara de papiledema / Papilledema's rare etiology in Pediatrics

El papiledema es la inflamación del nervio óptico causada por un aumento de la presión intracraneal. Existen otras patologías que pueden dar imágenes fundoscópicas con elevación de la cabeza del nervio óptico, semejantes al papiledema, que deben diferenciarse debido a la importancia de dicho signo clínico. Presentamos un caso de una paciente en que la imagen fundoscópica, con la presencia bilateral de drusas del nervio óptico, precisó realizar un diagnóstico diferencial con papiledema (AU)

Papilledema is inflammation of the optic nerve caused by increased intracranial pressure. There are other conditions that can give rise fundus images of the optic nerve head, similar to papilledema, which must be distinguished because of the importance of this clinical sign. We present a case of a patient in the fundus image, the presence of bilateral optic nerve drusen needs a differential diagnosis with papilledema (AU)

Aturdimiento miocárdico neurogénico en Pediatría. A propósito de un caso / Neurogenic stunned myocardium in Pediatrics. A case report

El aturdimiento miocárdico neurogénico es una entidad poco frecuente que semeja un síndrome coronario agudo, con alteraciones electrocardiográficas, disfunción cardiaca y aumento de enzimas cardiacas, pero sin evidencia de lesión coronaria. Puede ocurrir en el posoperatorio de neurocirugía. Se presenta el caso de un paciente pediátrico que a las 24 h de ser intervenido de un meduloblastoma de fosa posterior desarrolló un aturdimiento miocárdico neurogénico que evolucionó a taquicardia nodal con repercusión hemodinámica. La evolución fue satisfactoria, aunque precisó tratamiento antiarrítmico, con resolución bioquímica, ecográfica y clínica en menos de una semana (AU)

Neurogenic stunned myocardium is an unusual clinical entity. It mimics an acute coronary syndrome with electrocardiographic abnormalities, cardiac dysfunction and elevated cardiac enzymes with absence of obstructive coronary disease. It may occur after a neurosurgical procedure. A case is presented of neurogenic stunned myocardium occurring in a child after removal of a posterior fossa medulloblastoma. The patient developed nodal tachycardia with hemodynamic impairment. The clinical course was satisfactory due to antiarrhythmic therapy, with biochemical, echocardiographic, and clinical improvement within a week (AU)

Safety and efficacy of radiofrequency ablation of brain: a potentially minimally invasive treatment for brain tumours.

INTRODUCTION: Cerebral metastases are associated with a very poor prognosis. The best survival results are seen after surgical resection. However this involves a relatively invasive procedure and many patients are not suitable for surgical resection. We have evaluated the safety and efficacy of radiofrequency ablation of the brain in a sheep model. METHODS: We produced ablations of 1 - 3 cm diameter in the brain of sheep using the RITA starburst XL probe and RITA 1500 generator. We varied the time of RF application between 1 minute and 5 minutes and observed the animals for between 24 hours and 3 weeks for short-term and long-term effects and measured the intracranial pressure (ICP) in 2 animals following RFA. RESULTS: A total of 8 ablations were produced in 8 sheep. There was no change in the ICP measurements and there were no neurological complications in the 5 sheep with superficial ablation of up to 2 cm. Three sheep failed to regain consciousness due to large ablations near the brain stem and cerebellum. The sizes of the ablations were confirmed on necropsy and there was no other evidence of damage to the surrounding brain. Satisfactory ablation of brain was achieved at 70 degrees C and an ablation time as short as 3 minutes produced a 1.5 - 2.0 cm diameter of ablation. CONCLUSION: Cerebral RFA is a relatively safe and effective technique capable of producing a predictable ablation with no damage to surrounding brain. The potential of this technique requires further evaluation but likely advantages include the ability to treat multiple tumours and perform repeated treatment with a minimally invasive approach.

In vivo effect of visible light on feline cortical microcirculation.

The present study was designed to test the hypothesis that prolonged illumination of the cerebral cortex, for instance during neurosurgical interventions, may affect the pial microcirculation. Experiments were performed with the closed window technique in cats. The cortical surface below the window was exposed to visible, cold light of 61,000 lumens/m2 (lux) over a period of 1 to 5 hours. Pial arterioles reacted with a slight initial dilatation to 106.8 +/- 2.6% of their resting diameter after switching to the high intensity light. Measurements of the cortical surface temperature showed an average temperature increase of 1.5 +/- 0.34 degrees C within the first 10 minutes of illumination. For assessment of pial vascular function, the responses to topical application of acetylcholine (ACh) were tested before and during the illumination period. The effect of sustained illumination on the cortical microcirculation consisted of abolition of the endothelium dependent relaxation due to ACh, and of intravascular thrombus formation, the latter, however, only in the presence of topically applied ACh. The suspected mechanism responsible for these functional alterations is light-induced generation of free oxygen radicals which are known to inactivate or destroy the endothelium-derived relaxing factor (EDRF). Further studies are recommended to elucidate the practical and clinical relevance of these findings to neurosurgical procedures.

[Radiotherapy in tumors of ventricles I-III]. / Zur Strahlentherapie bei Prozessen der Ventrikel I-III.

The indications for a radiation therapy as the exclusive or adjuvant form of therapy in the treatment of supratentorial ventricular tumors is discussed. In particular the change with respect to the indications in the last ten years is dealt with. 254 patients with tumours of the ventricles I to III were treated at the Neurosurgical University Hospital of Leipzig in the period 1953-1983. 25 of them were irradiated.

Experimental carbon dioxide laser brain lesions and intracranial dynamics: Part 2. Effect on brain water content and its response to acute therapy.

Experimental brain lesions were created over the left parietooccipital cortex of the albino rabbit through the intact dura mater with high radiating carbon dioxide laser energy (40-W impact, 0.5-second duration, for a total time of 4 seconds on a 12.5-mm surface). The brain water content was studied 2, 6, and 24 hours after the insult. Another two groups of animals received acute therapy with either dexamethasone (1 mg/kg) or furosemide (1 mg/kg). In all groups, Evans blue extravasation uniformly extended from the impact crater into the surrounding white matter. The brain water content in the gray matter was elevated from the control value by 2 hours after impact (P less than 0.005) and remained elevated at 6 and 24 hours. The white matter brain water content did not increase until 6 hours after impact and remained elevated in the 24-hour group (P less than 0.005). After dexamethasone treatment, there was a significant decrease of water in the gray matter (P less than 0.01), but not in the white matter. With furosemide therapy, there was no reduction of gray or white matter brain water.

[Clinical aspects, EEG and biophysical and biochemical parameters of the intracranial system in large fractionated-dose irradiation]. / Klinika, EEG i nekotorye biofizicheskie i biokhimicheskie parametry intrakranial'noi sistemy pri krupnofraktsionnom obluchenii.

Seven patients operated on for intracerebral tumors received a course of large fractionating irradiation during which the patients' clinical status, changes of the ventricular CSF pressure, intracerebral pressure of the interstitial liquid, biochemical parameters of the blood and CSF and the EEG summary rate were assessed over time. The patients' reaction was characterized by a moderately expressed change of the above parameters in response to irradiation which returned to normal within 12 hrs. following large fractionating irradiation.