Anatomic study of the central core of the cerebrum correlating 7-T magnetic resonance imaging and fiber dissection with the aid of a neuronavigation system.

BACKGROUND: Different strategies have been used to study the fiber tract anatomy of the human brain in vivo and ex vivo. Nevertheless, the ideal method to study white matter anatomy has yet to be determined because it should integrate information obtained from multiple sources. OBJECTIVE: We developed an anatomic method in cadaveric specimens to study the central core of the cerebrum combining traditional white matter dissection with high-resolution 7-T magnetic resonance imaging (MRI) of the same specimen coregistered using a neuronavigation system. METHODS: Ten cerebral hemispheres were prepared using the traditional Klingler technique. Before dissection, a structural ultrahigh magnetic field 7-T MRI study was performed on each hemisphere specifically prepared with surface fiducials for neuronavigation. The dissection was then performed from the medial hemispheric surface using the classic white fiber dissection technique. During each step of the dissection, the correlation between the anatomic findings and the 7-T MRI was evaluated with the neuronavigation system. RESULTS: The anatomic study was divided in 2 stages: diencephalic and limbic. The diencephalic stage included epithalamic, thalamic, hypothalamic, and subthalamic components. The limbic stage consisted of extending the dissection to complete the Papez circuit. The detailed information given by the combination of both methods allowed us to identify and validate the position of fibers that may be difficult to appreciate and dissect (ie, the medial forebrain bundle). CONCLUSION: The correlation of high-definition 7-T MRI and the white matter dissection technique with neuronavigation significantly improves the understanding of the structural connections in complex areas of the human cerebrum.

Avoidance conditioning in bamboo sharks (Chiloscyllium griseum and C. punctatum): behavioral and neuroanatomical aspects.

Animals face different threats; to survive, they have to anticipate how to react or how to avoid these. It has already been shown in teleosts that selected regions in the telencephalon, i.e., the medial pallium, are involved in avoidance learning strategies. No such study exists for any chondrichthyan. In nature, an avoidance reaction may vary, ranging from a 'freeze' reaction to a startling response and quick escape. This study investigated whether elasmobranchs (Chiloscylliumgriseum and C. punctatum) can be conditioned in an aversive classical conditioning paradigm. Upon successful conditioning, the dorsal, medial and lateral pallium were removed (group 1) and performance tested again. In a second group, the same operation was performed prior to training. While conditioning was successful in individuals of both groups, no escape responses were observed. Post-operative performance was assessed and compared between individual and groups to reveal if the neural substrates governing avoidance behavior or tasks learned in a classical conditioning paradigm are located within the telencephalon, as has been shown for teleosts such as goldfish.

Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.

BACKGROUND AND IMPORTANCE: State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD. CLINICAL PRESENTATION: A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up. CONCLUSION: This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.

Embryological development of the human insula and its implications for the spread and resection of insular gliomas.

The human insular cortex, or the lobus insularis, is considered the developmentally most primitive lobe of the telencephalon. Covered by an overlying cortical lid, the insula has functions that are distinct from yet related to those of the adjacent temporal lobe and deep limbic structures. In the first part of this paper the authors outline the development of the human insula, including the cellular heterogeneity comprising the various parts of the insular lobe. Using the understanding gained from the development of the insula they then address implications of insular development for cortical development and connection as well as for tumorigenesis and tumor spread from the insula to other cortical structures, most notably the temporal lobe. An understanding of cortico-insular development and interconnection allows for both a better understanding of insular pathology and also facilitates planning of resection of cortico-insular gliomas to avoid damage to eloquent structures.

Chlorpheniramine impairs functional recovery in Carassius auratus after telencephalic ablation

We determined the effect of an H1 receptor antagonist on the functional recovery of Carassius auratus submitted to telencephalic ablation. Five days after surgery the fish underwent a spatial-choice learning paradigm test. The fish, weighing 6-12 g, were divided into four groups: telencephalic ablation (A) or sham lesion (S) and saline (SAL) or chlorpheniramine (CPA, ip, 16 mg/kg). For eight consecutive days each animal was trained individually in sessions separated by 24 h (alternate days). Training trials (T1-T8) consisted of finding the food in one of the feeders, which were randomly blocked for each subject. Animals received an intraperitoneal injection of SAL or CPA 10 min after the training trials. The time spent by the animals in each group to find the food (latency) was analyzed separately at T1 and T8 by the Kruskal-Wallis test, followed by the Student Newman-Keuls test. At T1 the latencies (mean ± SEM) of the A-SAL (586.3 ± 13.6) and A-CPA (600 ± 0) groups were significantly longer than those of the S-SAL (226.14 ± 61.15) and S-CPA (356.33 ± 68.8) groups. At T8, the latencies of the A-CPA group (510.11 ± 62.2) remained higher than those of the other groups, all of which showed significantly shorter latencies (A-SAL = 301.91 ± 78.32; S-CPA = 191.58 ± 73.03; S-SAL = 90.28 ± 41) compared with T1. These results support evidence that training can lead to functional recovery of spatial-choice learning in telencephalonless fish and also that the antagonist of the H1 receptor impairs it.

Chlorpheniramine impairs functional recovery in Carassius auratus after telencephalic ablation.

We determined the effect of an H1 receptor antagonist on the functional recovery of Carassius auratus submitted to telencephalic ablation. Five days after surgery the fish underwent a spatial-choice learning paradigm test. The fish, weighing 6-12 g, were divided into four groups: telencephalic ablation (A) or sham lesion (S) and saline (SAL) or chlorpheniramine (CPA, ip, 16 mg/kg). For eight consecutive days each animal was trained individually in sessions separated by 24 h (alternate days). Training trials (T1-T8) consisted of finding the food in one of the feeders, which were randomly blocked for each subject. Animals received an intraperitoneal injection of SAL or CPA 10 min after the training trials. The time spent by the animals in each group to find the food (latency) was analyzed separately at T1 and T8 by the Kruskal-Wallis test, followed by the Student Newman-Keuls test. At T1 the latencies (mean +/- SEM) of the A-SAL (586.3 +/- 13.6) and A-CPA (600 +/- 0) groups were significantly longer than those of the S-SAL (226.14 +/- 61.15) and S-CPA (356.33 +/- 68.8) groups. At T8, the latencies of the A-CPA group (510.11 +/- 62.2) remained higher than those of the other groups, all of which showed significantly shorter latencies (A-SAL = 301.91 +/- 78.32; S-CPA = 191.58 +/- 73.03; S-SAL = 90.28 +/- 41) compared with T1. These results support evidence that training can lead to functional recovery of spatial-choice learning in telencephalonless fish and also that the antagonist of the H1 receptor impairs it.

Chlorpheniramine facilitates inhibitory avoidance in teleosts submitted to telencephalic ablation.

The present study investigated the involvement of H(1) histaminegic receptor on the acquisition of inhibitory avoidance in Carassius auratus submitted to telencephalic ablation. The fish were submitted to telencephalic ablation 5 days before the experiment. The inhibitory avoidance procedure included 1 day for habituation, 3 days for training composed of 3 trials each (1st day: T1, T2, T3; 2nd day: 2T1, 2T2, 2T3; 3rd day: 3T1, 3T2, 3T3) and 1 day for test. On training days, the fish were placed in a white compartment, after 30 s the door was opened. When the fish crossed to a black compartment, a weight was dropped (aversive stimuli). Immediately after the third trial, on training days, the fish received, intraperitoneally, one of the pharmacological treatments (saline (N = 20), 8 (N = 12) or 16 (N = 13) microg/g chlorpheniramine, CPA). On the test day, the time to cross to the black compartment was determined. The latency of the saline group increased significantly only on the 3rd trial of the 2nd training day (mean +/- SEM, T1 (50.40 +/- 11.69), 2T3 (226.05 +/- 25.01); ANOVA: P = 0.0249, Dunn test: P < 0.05). The group that received 8 microg/g CPA showed increased latencies from the 2nd training day until the test day (T1 (53.08 +/- 17.17), 2T2 (197.75 +/- 35.02), test (220.08 +/- 30.98); ANOVA: P = 0.0022, Dunn test: P < 0.05)). These results indicate that CPA had a facilitating effect on memory. We suggest that the fish submitted to telencephalic ablation were able to learn due to the local circuits of the mesencephalon and/or diencephalon and that CPA interferes in these circuits, probably due an anxiolytic-like effect.

Context-dependent prey avoidance in chicks persists following complete telencephalectomy.

Young naive domestic chicks readily attack green insects and avoid insects painted red but show no discrimination of the same colours when applied to fruit-like objects, a discrimination that has been depicted as context-dependent preference. To study the neural representation of such preference we performed bilateral telencephalectomy on 1-day-old domestic chicks and tested them on an unlearned prey discrimination paradigm. Here we show that following complete decerebration, young domestic chicks preferentially peck at red fruit versus red insects and tend to choose green insects over green fruit indistinguishably from unoperated chicks. The present study provides the first direct evidence that sophisticated context-dependent, unlearned colour preference is processed by subtelencephalic areas of an amniote species.

Chlorpheniramine facilitates inhibitory avoidance in teleosts submitted to telencephalic ablation

The present study investigated the involvement of H(1) histaminegic receptor on the acquisition of inhibitory avoidance in Carassius auratus submitted to telencephalic ablation. The fish were submitted to telencephalic ablation 5 days before the experiment. The inhibitory avoidance procedure included 1 day for habituation, 3 days for training composed of 3 trials each (1st day: T1, T2, T3; 2nd day: 2T1, 2T2, 2T3; 3rd day: 3T1, 3T2, 3T3) and 1 day for test. On training days, the fish were placed in a white compartment, after 30 s the door was opened. When the fish crossed to a black compartment, a weight was dropped (aversive stimuli). Immediately after the third trial, on training days, the fish received, intraperitoneally, one of the pharmacological treatments (saline (N = 20), 8 (N = 12) or 16 (N = 13) µg/g chlorpheniramine, CPA). On the test day, the time to cross to the black compartment was determined. The latency of the saline group increased significantly only on the 3rd trial of the 2nd training day (mean ± SEM, T1 (50.40 ± 11.69), 2T3 (226.05 ± 25.01); ANOVA: P = 0.0249, Dunn test: P < 0.05). The group that received 8 µg/g CPA showed increased latencies from the 2nd training day until the test day (T1 (53.08 ± 17.17), 2T2 (197.75 ± 35.02), test (220.08 ± 30.98); ANOVA: P = 0.0022, Dunn test: P < 0.05)). These results indicate that CPA had a facilitating effect on memory. We suggest that the fish submitted to telencephalic ablation were able to learn due to the local circuits of the mesencephalon and/or diencephalon and that CPA interferes in these circuits, probably due an anxiolytic-like effect.

Chlorpheniramine impairs spatial choice learning in telencephalon-ablated fish.

This work investigated the effect of the H1 receptor blockade in the forebrain of ablated Carassius auratus in a simple stimulus-response learning task using a T-maze test with positive reinforcement. The goldfish were submitted to surgery for removal of both telencephalic lobes five days before beginning the experiment. A T-shaped glass aquarium was employed, with two feeders located at the extremities of the long arm. One of the two feeders was blocked. The experimental trials were performed in nine consecutive days. Each fish was individually placed in the short arm and confined there for thirty seconds, then it was allowed to swim through the aquarium to search for food for ten minutes (maximum period). Time to find food was analysed in seconds. Animals were injected intraperitoneally with chlorpheniramine (CPA) at 16 mg/kg of body weight or saline after every trial, ten minutes after being placed back in the home aquarium. The results show that all the training latencies of the A-SAL group were higher than the latencies of the S-SAL group. The S-SAL group had decreased latencies from the second trial on, while the S-CPA group showed decreased latencies after the fourth trial. The A-SAL group showed reduced latencies after the fifth trial, but the A-CPA group maintained the latencies throughout the experiment. This suggests that CPA impairs the consolidation of learning both on telencephalon ablated animals and in sham-operated ones through its action on mesencephalic structures of the brain and/or on the cerebellum in teleost fish.

Chlorpheniramine impairs spatial choice learning in telencephalon-ablated fish

This work investigated the effect of the Hj receptor blockade in the forebrain of ablated Carassius auratus in a simple stimulus-response learning task using a T-maze test with positive reinforcement. The goldfish were submitted to surgery for removal of both telencephalic lobes five days before beginning the experiment. A T-shaped glass aquarium was employed, with two feeders located at the extremities of the long arm. One of the two feeders was blocked. The experimental triáis were performed in nine consecutive days. Each fish was individually placed in the short arm and confined there for thirty seconds, then it was allowed to swim through the aquarium to search for food for ten minutes (máximum period). Time to find food was analysed in seconds. Animáis were injected intraperitoneally with chlorpheniramine (CPA) at 16 mg/kg of body weight or saline after every trial, ten minutes after being placed back in the home aquarium. The results show that all the training latencies of the A-SAL group were higher than the latencies of the S-SAL group. The S-SAL group had decreased latencies from the second trial on, while the S-CPA group showed decreased latencies after the fourth trial. The A-SAL group showed reduced latencies after the fifth trial, but the A-CPA group mainteined the latencies throughout the experiment. This suggests that CPA impairs the consolidation of learning both on telencephalon ablated animáis and in sham-operated ones through its action on mesencephalic structures of the brain and/or on the cerebellum in teleost fish.

Atypical growth pattern of a meningioma in an adult.

A 49-year-old woman presented with a rare atypical growth pattern of meningioma without evidence of dural attachment manifesting as chronic headache associated with transient paresthesia and left motor disorders. On admission, neurological examination showed no abnormalities. Magnetic resonance (MR) imaging revealed a right temporo-parieto-occipital lesion, which appeared to involve the subdural space and filling the cortical sulci. The lesion caused peritumoral white matter edema. The tumor appeared hypointense on T(1)-weighted and hyperintense on T(2)-weighted MR images, with homogeneous enhancement after contrast administration. A biopsy of the lesion was performed. Histological examination indicated that the lesion was a meningioma. Intraparenchymal meningiomas should be considered in the differential diagnosis of intraaxial lesions in patients of any age.

Revisão anatômica do seio venoso sagital dorsal no crânio de cães braquicéfalos / Anatomic features of the dorsal venous sinus in skull of brachycephalous dogs

Os seios venosos do crânio realizam a drenagem do cérebro e da medula espinhal, a fim de manter a homeostasia e o perfeito funcionamento do sistema nervoso central. Lesões na rede venosa cerebral podem causar déficits severos tais como hemiplegia, hemorragia, coma e morte. Os seios venosos são importantes pontos de referência para a realização de técnicas cirúrgicas de acesso ao cérebro. Este estudo visou analisar o trajeto do seio venoso sagital dorsal no crânio de cães braquicéfalos. Os animais braquicéfalos possuem crânios curtos e com características biométricas específicas. Foram utilizados 8 crânios de cães da raça Boxer, que foram submetidos à injeção de látex com pigmento corado e sulfato de bário. Após a perfusão, foram feitas radiografias contrastadas e imagens de tomografia computadorizada para relacionar o seio venoso com a estrutura óssea e dimensões relativas da calota craniana. Os crânios apresentaram índice cefálico (IC) médio de 91,24±8,34mm e índice crânio-facial (ICF) médio de 2,89±0,23mm. As mensurações do seio venoso sagital dorsal, relativas à calota craniana, apresentaram os seguintes valores médios: Area = 10,18±4,69mm²; D1 = 11,84±2,35mm; D2 = 19,57±2,61mm; D3 = 17,88±2,31mm; D4 = 25,32±5,68mm; e D5= 24,84±4,40mm.

The dorsal venous sinuses of the Dura mater perform the cerebral and spinal cord drainage to keep homeostasis of the Central Nervous System. Injuries in the cerebral venous network may cause severe deficits, including hemiplegia, hemorrhage, coma and death. The main landmark for neurologic surgery is the Dura mater venous sinus. The aim of this study is to analyse the pathway of the Sinus sagittalis dorsalis in the brachycephalous skull, as the brachycephalous dogs have specific characteristics. The skulls were taken from 8 Boxer dogs and venous perfusion with latex and barium sulfate solution was performed. After the perfusion, radiographies and tomographies were obtained to relate the dorsal sagittal sinus and the skull averages. The cephalic index showed mean values of 91.24±8.34cm, and the cranio-facial index was 2.89±0.23cm. The venous sinus mensuration interface to the skull was: Area = 10.18±4.69mm²; D1 = 11.84±2.35mm; D2 = 19.57±2.61mm; D3 = 17.88±2.31mm; D4 = 25.32±5.68mm e D5 = 24.84±4.40mm.

Adaptación y validación de un test de denominación en hispanohablantes: fiabilidad y discriminación de pacientes con demencia y con lesiones cerebrales unilaterales / Adaptation and validation of a naming test in Spanish speaker: reliability and discrimination of patients with dementia and unilateral brain lessions

Introducción. No existen antecedentes de estudios psicométricos realizados en hispanohablantes para este test de denominación por confrontación visual. Objetivos. Estudios de fiabilidad (consistencia interna [N = 304], test-retest [N = 33] y objetividad [N = 37]) en sujetos sanos. Estudios preliminares de validez concurrente en 46 pacientes con lesiones lateralizadas (18 izquierdas, 28 derechas) incluyendo sujetos sanos (N=101) y en 28 pacientes derivados por sospecha de demencia. Métodos. Material: test basado inicialmente en los sustantivos empleados por Oldfield y Wingfield en inglés. Se trabajó con pacientes sucesivos y con voluntarios sanos. Las lesiones laterales fueron confirmadas por neuroimágenes y cirugía. Los tres grupos del estudio de validez con lesiones fueron equiparados por sexo, edad, educación y preferencia manual. Ambos grupos del estudio de validez con demencia fueron equiparados por sexo, edad, educación y presencia de lesión vascular. Definición operacional para los pacientes con demencia: los que obtuvieron9 puntos en la escala conductual de Blessed (N=15). Análisis estadístico. Para fiabilidad: coeficientes: alfa de Cronbach, correlación de Pearson e intraclase. Para la diferencia entre los dos jueces y las dos sesiones: t de Student para muestras dependientes. Para los estudios de validez con lesiones lateralizadas: ANOVA. Para los estudios de validez con demencia: t de Student para muestras independientes. Resultados. Fiabilidad: coeficientes superiores a 0,82, sin diferencias en la prueba t para los jueces y para los tests. Validez: diferencias significativas entre todos los grupos. Discusión. El test evidenció una adecuada fiabilidad y validez

Introduction. Psychometric studies with this confrontation- naming test have not been reported in Spanish speakers. Objectives. To study the internal consistency (N = 304), test-retest (N = 33) and inter-scorer (N = 37) reliability on healthy subjects. To study the concurrent validity (preliminary data) in 46 patients with unilateral brain lesions (left: 18, right: 28) including healthy subjects (N = 101), and in 28 patients referred for suspected dementia. Methods. Material: the test was based initially on the nouns used by Oldfield and Wingfield in English. Data were obtained from consecutive patients and healthy volunteers. Lateral lesions were confirmed by neuroimages and surgery. The three groups of the validity study with lateral lesions were matched by gender, age, education and manual preference. Both groups of the dementia validity study were matched by gender, age, education and presence of vascular lesion. Patients who scored 9 points in the Blessed behavioral rating scale were operationally defined as patients with dementia (N=15). Statistical analysis. For reliability studies: Cronbach's alpha, Pearson and intraclass correlation coefficients were used. Differences between scorers and between tests were analyzed by dependent sample Student's t tests. For the validity study with lateral lesions, ANOVA was employed. For the dementia validity study: independent sample Student's t test was used. Results. All reliability coefficients were > 0.82 without differences in the t tests between scorers and tests. Validity was verified by the significant differences obtained between all the pairs of groups analyzed

Consenso para el tratamiento de las metástasis cerebrales / Consensus about cerebral metastases treatment

El avance en la terapia oncológica ha hecho del tratamiento de las metástasis cerebrales un factor primordial en el tiempo de sobrevida y la calidad de vida de los pacientes con cáncer. A pesar de que existen numerosas publicaciones sobre el tema, no existe todavía un consenso sobre la mejor estrategia terapéutica, problablemente por la heterogeneidad de la población en términos de estado funcional, tipo de neoplasia, control sistémico de la enfermedad y número y localización de las lesiones en el sisteman nervioso central. Nuestro objetivo es presentar recomendaciones generales basadas en un análisis racional para guiar el manejo práctico de las metástasis cerebrales. Con este propósito, un equipo multidisciplinario integrado por neurocirujanos, neurooncólogos, neuropatólogos, radioterapeutas y neurólogos fue convocado para conducir una búsqueda minuciosa en las publicaciones en inglés y español a través de PubMed (1980-2006) coincidiendo con el comienzo del empleo de la resonancia magnética en la práctica médica. Se seleccionaron revisiones y artículos originales con un n=o>a 20. También se incluyeron capítulos de libros escritos por expertos conocidos. La evaluación de la literatura así como la experiencia de los autores permitió el desarrollo del "Consenso para el Tratamiento de las Metástasis Cerebrales". Finalmente los autores esperan que elpresente trabajo contribuya a un abordaje multidisciplinario para el manejo de las metástasis cerebrales con recomendaciones simples y prácticas y probablemente estimule nuevos desarrollos en este campo. Palabras clave: cirugía, metástasis cerebrales, quimioterapia, radioterapia

The advances in oncological therapies has made brain metastases treatment a major factor influencing the survival time and the quality of life patients with cancer. Although there are numerous publications on the issue, there is no consensus about the best treatment strategy. This is probably due to population heterogeneity in terms of functional status, type of neoplasia, control of the systemic disease, and the number and localization of the lesions in the cetral nervous system. Our objective is to present general recommendations based on a rational analysis in order to guide the practical management of brain metastases. With this purpose, a multidisciplinary team composed by neurosurgeons, neurooncologists, neuropathologist, radiotherapist and neurologists were brought together to conduct athrough search in english and spanish publications through PubMed (1980-2006). The starting period was set at the beginning of the use of magnetic resonance in medical practice. Reviews and original articles with n=or>20 were selected. Also, book chapters of renowned authors in the different consulted areas were included. The assessment of the literature, in addition to the experience of the authors allowed the development of "Consensus for the treatment of Brain Metastases". Finally, the authors expect that the present work will contribute to the multidisciplinary approach in the management of brain metastases with simple and practical recommendations, and probably stimulating future developments in this field. Key words: cerebral metastasis, chemotherapy, radiotherapy, surgery.

Consenso para el tratamiento de las metástasis cerebrales / Consensus about cerebral metastases treatment

El avance en la terapia oncológica ha hecho del tratamiento de las metástasis cerebrales un factor primordial en el tiempo de sobrevida y la calidad de vida de los pacientes con cáncer. A pesar de que existen numerosas publicaciones sobre el tema, no existe todavía un consenso sobre la mejor estrategia terapéutica, problablemente por la heterogeneidad de la población en términos de estado funcional, tipo de neoplasia, control sistémico de la enfermedad y número y localización de las lesiones en el sisteman nervioso central. Nuestro objetivo es presentar recomendaciones generales basadas en un análisis racional para guiar el manejo práctico de las metástasis cerebrales. Con este propósito, un equipo multidisciplinario integrado por neurocirujanos, neurooncólogos, neuropatólogos, radioterapeutas y neurólogos fue convocado para conducir una búsqueda minuciosa en las publicaciones en inglés y español a través de PubMed (1980-2006) coincidiendo con el comienzo del empleo de la resonancia magnética en la práctica médica. Se seleccionaron revisiones y artículos originales con un n=o>a 20. También se incluyeron capítulos de libros escritos por expertos conocidos. La evaluación de la literatura así como la experiencia de los autores permitió el desarrollo del "Consenso para el Tratamiento de las Metástasis Cerebrales". Finalmente los autores esperan que elpresente trabajo contribuya a un abordaje multidisciplinario para el manejo de las metástasis cerebrales con recomendaciones simples y prácticas y probablemente estimule nuevos desarrollos en este campo. Palabras clave: cirugía, metástasis cerebrales, quimioterapia, radioterapia (AU)

The advances in oncological therapies has made brain metastases treatment a major factor influencing the survival time and the quality of life patients with cancer. Although there are numerous publications on the issue, there is no consensus about the best treatment strategy. This is probably due to population heterogeneity in terms of functional status, type of neoplasia, control of the systemic disease, and the number and localization of the lesions in the cetral nervous system. Our objective is to present general recommendations based on a rational analysis in order to guide the practical management of brain metastases. With this purpose, a multidisciplinary team composed by neurosurgeons, neurooncologists, neuropathologist, radiotherapist and neurologists were brought together to conduct athrough search in english and spanish publications through PubMed (1980-2006). The starting period was set at the beginning of the use of magnetic resonance in medical practice. Reviews and original articles with n=or>20 were selected. Also, book chapters of renowned authors in the different consulted areas were included. The assessment of the literature, in addition to the experience of the authors allowed the development of "Consensus for the treatment of Brain Metastases". Finally, the authors expect that the present work will contribute to the multidisciplinary approach in the management of brain metastases with simple and practical recommendations, and probably stimulating future developments in this field. Key words: cerebral metastasis, chemotherapy, radiotherapy, surgery.(AU)

Consenso para el tratamiento de las metástasis cerebrales / Consensus about cerebral metastases treatment

El avance en la terapia oncológica ha hecho del tratamiento de las metástasis cerebrales un factor primordial en el tiempo de sobrevida y la calidad de vida de los pacientes con cáncer. A pesar de que existen numerosas publicaciones sobre el tema, no existe todavía un consenso sobre la mejor estrategia terapéutica, problablemente por la heterogeneidad de la población en términos de estado funcional, tipo de neoplasia, control sistémico de la enfermedad y número y localización de las lesiones en el sisteman nervioso central. Nuestro objetivo es presentar recomendaciones generales basadas en un análisis racional para guiar el manejo práctico de las metástasis cerebrales. Con este propósito, un equipo multidisciplinario integrado por neurocirujanos, neurooncólogos, neuropatólogos, radioterapeutas y neurólogos fue convocado para conducir una búsqueda minuciosa en las publicaciones en inglés y español a través de PubMed (1980-2006) coincidiendo con el comienzo del empleo de la resonancia magnética en la práctica médica. Se seleccionaron revisiones y artículos originales con un n=o>a 20. También se incluyeron capítulos de libros escritos por expertos conocidos. La evaluación de la literatura así como la experiencia de los autores permitió el desarrollo del "Consenso para el Tratamiento de las Metástasis Cerebrales". Finalmente los autores esperan que elpresente trabajo contribuya a un abordaje multidisciplinario para el manejo de las metástasis cerebrales con recomendaciones simples y prácticas y probablemente estimule nuevos desarrollos en este campo. Palabras clave: cirugía, metástasis cerebrales, quimioterapia, radioterapia (AU)

The advances in oncological therapies has made brain metastases treatment a major factor influencing the survival time and the quality of life patients with cancer. Although there are numerous publications on the issue, there is no consensus about the best treatment strategy. This is probably due to population heterogeneity in terms of functional status, type of neoplasia, control of the systemic disease, and the number and localization of the lesions in the cetral nervous system. Our objective is to present general recommendations based on a rational analysis in order to guide the practical management of brain metastases. With this purpose, a multidisciplinary team composed by neurosurgeons, neurooncologists, neuropathologist, radiotherapist and neurologists were brought together to conduct athrough search in english and spanish publications through PubMed (1980-2006). The starting period was set at the beginning of the use of magnetic resonance in medical practice. Reviews and original articles with n=or>20 were selected. Also, book chapters of renowned authors in the different consulted areas were included. The assessment of the literature, in addition to the experience of the authors allowed the development of "Consensus for the treatment of Brain Metastases". Finally, the authors expect that the present work will contribute to the multidisciplinary approach in the management of brain metastases with simple and practical recommendations, and probably stimulating future developments in this field. Key words: cerebral metastasis, chemotherapy, radiotherapy, surgery.(AU)

Robotic virtual endoscopy: development of a multidirectional rigid endoscope.

INTRODUCTION: The use of neuroendoscopy has increased in the past 20 years. Despite an increase in the number of indications for use, novel adjuncts and modifications to existing endoscopes remain all but nonexistent. We introduce a robotic virtual endoscope with applications for neurosurgery that could serve as a novel step in the evolution of future endoscopic technologies. METHODS: Over the past 8 years, we have worked on the construction of a prototype endoscope with three degrees of freedom that was designed to allow for enhanced safety while maximizing the benefits of virtual field rendition and robotic control. We have developed a prototype to examine a cerebral ventricular model in vitro that functions via either a direct video- or computer-based interface. RESULTS: Assessment of viewing angulation with robotic feedback has verified the accuracy of the prototype. Models support the ability of the endoscope to localize regions identified via a software interface. CONCLUSION: The endoscope is a rigid virtual robotic endoscope that provides complete visual coverage of a three-dimensional space by controlling an adjustable viewing direction with three degrees of freedom.

Ultrasonido intraoperatorio en neurocirugía: aspectos técnicos / Intraoperative ultrasound in neurosurgery: technical aspects

Introducción. La ultrasonografía intraoperatoria en neurocirugía es una técnica útil, especialmente en la cirugía oncológica. Nuestro propósito es presentar los aspectos prácticos de su aplicación y a la vez describir nuestra experiencia inicial con su uso. Material y Métodos. Se empleó el ultrasonido TITAN™ de la empresa Sonosite Inc. Bothell, WA. USA con diferentes modelos de transductores. El estudio se realizó durante cuatro etapas de la cirugía: al realizar la craneotomía/laminotomía sobre la duramadre, al abrir duramadre sobre tejido neural, al resecar la lesión y posteriormente al cerrar la duramadre. Resultado. La identificación óptima de la lesión y de las estructuras anatómicas adyacentes se logró utilizando el transductor L38/5-10 Mhz. La adecuada visualización de las lesiones fue posible en todos los casos que se utilizó este transductor. No se logró una visualización adecuada en 2 casos en los cuales se utilizo el transductor C15/2-4 Mhz. Conclusión. La ultrasonografía intraoperatoria es útil en localizar lesiones e identificar estructuras anatómicas adyacentes. El transductor óptimo es uno que posea una cabeza de transductor pequeña plana (2.5cm x 1.5cm o menos) que emita frecuencias que oscilen entre 4-10 Mhz.

Delirio postoperatorio en pacientes neuroquirúrgicos: evaluación mediante el Test Mental Abreviado / Postoperative delirium in patient neurosurgical: evaluation by means of the Abbreviated Mental Test

Objetivo. Evaluar la incidencia y características de la alteración postoperatoria de las funciones cerebrales superiores en los pacientes sometidos a cirugía intracraneal electiva bajo anestesia general. Pacientes y método. Estudio prospectivo de 60pacientes ASA I-III, de edades comprendidas entre los 18 y 81 años, intervenidos quirúrgicamente por el Servicio de Neurocirugía de nuestro Hospital, distribuidos en dos grupos de 30 pacientes cada uno: grupo cirugía intracraneal, pacientes sometidos a cirugía por procesos intracraneales, y grupo cirugía extracraneal o grupo control, pacientes intervenidos de columna cervical o lumbar. Se registraron los datos demográficos de edad, sexo, peso, talla, así como hábitos, enfermedades coexistentes y medicación habitual. A todos los pacientes se les realizó el test mental abreviado (AMT) el día previo a la intervención quirúrgica y a las 2 y 24horas del periodo postoperatorio. Todos los pacientes fueron sometidos a la misma técnica anestésica. Fueron excluidos los pacientes que presentaron un AMT preoperatorio ≤ 8.Resultados. No hubo diferencias en los datos demográficos, duración de la cirugía, estado físico ASA y consumo de alcohol y tabaco. No se hallaron diferencias significativas entre grupos en la puntuación media obtenida en el AMT realizado el día antes de la cirugía, que fue de 9,87 ± 0,35 para los pacientes sometidos a cirugía intracraneal y de 9,80 ± 0.41 para los pacientes intervenidos de columna. Así mismo, no se observaron diferencias significativas entre los dos grupos en el AMT realizado a la 2 y 24 horas del postoperatorio: 4 de los pacientes sometidos a cirugía intracraneal presentaron una puntuación en el AMT ≤ 8 a las 2 horas de finalizada la cirugía, y 3 pacientes del mismo grupo, a las 24horas del postoperatorio; tan solo 2 pacientes intervenidos de columna presentaron una puntuación en el AMT≤ 8 a las 2 horas de finalizada la cirugía y ninguno a las 24 horas del postoperatorio. Conclusiones. Según los resultados obtenidos en este estudio podemos concluir que los pacientes sometidos a cirugía intracraneal no sufren alteraciones de la función cognitiva ni de la atención durante las primeras 24horas del postoperatorio, evaluados mediante el AMT

Objectives. To assess the incidence and characteristics of postoperative changes in the higher cerebral functions after elective intracranial surgery under general anesthesia. Patients and methods. This is a prospective study of60 patients, aged 18-81 years, submitted to neurosurgical operations, allocated into two groups of 30 patient seach: intracranial surgery group, patients submitted to craniotomy, and extracranial surgery group or control group, patients submitted to spinal procedures. All patients were given the Abbreviated Mental Test (AMT)on the day before to the operation, and then 2 and 24hours after the end of the procedure. All individuals were managed with the same anesthetic technique. Results. No differences in regard to demographics, duration of the operation, ASA physical state, and habits were found between the two groups. No differences in the pre-surgical and post-surgical AMT mean score were encountered between patients submitted to intracranial 9.87 ± 0.35 or to spinal surgeries 9.80 ±0.41. Similarly, there were no significant differences between the two groups in the results of the AMT performed at 2 and 24 hours after the end of the surgeries. Only two subjects undergoing spinal procedures had as core of ≤ 8 in the AMT performed 2-hours after the operation, while none showed a decrease in the 24-hourtest score. Conclusions. Patients submitted to intracranial surgery did not show any changes in cognitive or attention functions during the first postoperative 24 hours as assessed by the AMT