Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada / Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease

OBJETIVO: El objetivo es evaluar los efectos de la estimulación cerebral profunda del núcleo subtalámico bilateral (STN-DBS) sobre el estado cognitivo de los pacientes con enfermedad de Parkinson 5 años después de la cirugía. Materiales y métodos: En este estudio prospectivo se incluyeron 50 pacientes con enfermedad de Parkinson (62,5% hombres, edad media 62,2 ± 8,2 años y duración de la enfermedad 14,1 ± 6,3 años) sometidos a STN-DBS. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía, y 40 pacientes fueron seguidos hasta 5 años. En cada visita se realizaron las siguientes evaluaciones neuropsicológicas: Mini-Mental State Examination, Mattis Dementia Rating Scale (MDRS), test de secuencias números-letras de WAIS III-LN, Prueba de dibujo de reloj, Prueba de aprendizaje verbal auditivo Rey, la Prueba de retención visual de Benton, la Prueba de juicio de orientación de línea de Benton, la fluidez verbal fonética y semántica, la Prueba Stroop y la Escala de clasificación de depresión de Montgomery-Asberg. RESULTADOS: Anualmente se observaron reducciones en la puntación de Mini-Mental State Examination (-0,89%), Prueba del dibujo de reloj (-2,61%) y MDRS (-1,72%), fueron más marcados tanto para la fluidez verbal fonética (-13,28%) como semántica (-12,40%). Para la Prueba de aprendizaje verbal auditivo Rey observamos un deterioro en la capacidad de recuerdo diferido (-10,12%) un año después de la cirugía. A los 5 años la mayor parte del deterioro se produjo en la fluidez verbal, con reducciones adicionales de 16,10% y 16,60% para la fluidez verbal semántica y fonética, respectivamente. Se observó un empeoramiento más moderado del recuerdo inmediato (-16,87%), WAIS III-LN (-16,67%) y de la prueba de orientación lineal de Benton (-11,56%). Discusión: La STN-DBS no condujo a deterioro cognitivo global a los 5 años de la cirugía. Hubo un deterioro significativo en la función verbal desde el primer año de la cirugía. El deterioro de la capacidad de aprendizaje y de las funciones visuoespaciales podría atribuirse al propio proceso degenerativo de la enfermedad

OBJECTIVE: The aim of this study was to evaluate the effects of deep brain stimulation of the subthalamic nucleus (DBS-SN) on cognitive function in patients with Parkinson's disease (PD) 5 years after surgery. MATERIAL AND METHODS: We conducted a prospective study including 50 patients with PD who underwent DBS-SN (62.5% were men; mean age of 62.2 ± 8.2 years; mean progression time of 14.1 ± 6.3 years). All patients were assessed before the procedure and at one year after surgery; 40 patients were further followed up until the 5-year mark. Follow-up assessments included the following neuropsychological tests: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), letter-number sequencing of the WAIS-III (WAIS-III-LN), clock-drawing test, Rey auditory verbal learning test (RAVLT), Benton Visual Retention Test (BVRT), Judgment of Line Orientation (JLO) test, FAS Phonemic Verbal Fluency Test, Stroop test, and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Patients were found to score lower on the MMSE (-0.89%), clock-drawing test (-2.61%), MDRS (-1.72%), and especially phonemic (-13.28%) and sematic verbal fluency tests (-12.40%) at one year after surgery. Delayed recall on the RAVLT worsened one year after the procedure (-10.12%). At 5 years, impairment affected mainly verbal fluency; scores decreased an additional 16.10% and 16.60% in semantic and phonemic verbal fluency, respectively. Moderate decreases were observed in immediate recall (-16.87%), WAIS-III-LN (-16.67%), and JLO test (-11.56%). Discussion: In our sample, DBS-SN did not result in global cognitive impairment 5 years after surgery. Verbal function was found to be significantly impaired one year after the procedure. Impaired learning and visuospatial function may be attributed to degeneration associated with PD

Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease. / Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada.

OBJECTIVE: The aim of this study was to evaluate the effects of deep brain stimulation of the subthalamic nucleus (DBS-SN) on cognitive function in patients with Parkinson's disease (PD) 5 years after surgery. MATERIAL AND METHODS: We conducted a prospective study including 50 patients with PD who underwent DBS-SN (62.5% were men; mean age of 62.2±8.2 years; mean progression time of 14.1±6.3 years). All patients were assessed before the procedure and at one year after surgery; 40 patients were further followed up until the 5-year mark. Follow-up assessments included the following neuropsychological tests: Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), letter-number sequencing of the WAIS-III (WAIS-III-LN), clock-drawing test, Rey auditory verbal learning test (RAVLT), Benton Visual Retention Test (BVRT), Judgment of Line Orientation (JLO) test, FAS Phonemic Verbal Fluency Test, Stroop test, and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Patients were found to score lower on the MMSE (-0.89%), clock-drawing test (-2.61%), MDRS (-1.72%), and especially phonemic (-13.28%) and sematic verbal fluency tests (-12.40%) at one year after surgery. Delayed recall on the RAVLT worsened one year after the procedure (-10.12%). At 5 years, impairment affected mainly verbal fluency; scores decreased an additional 16.10% and 16.60% in semantic and phonemic verbal fluency, respectively. Moderate decreases were observed in immediate recall (-16.87%), WAIS-III-LN (-16.67%), and JLO test (-11.56%). DISCUSSION: In our sample, DBS-SN did not result in global cognitive impairment 5 years after surgery. Verbal function was found to be significantly impaired one year after the procedure. Impaired learning and visuospatial function may be attributed to degeneration associated with PD.

Molecular and antigenic characterization of bovine Coronavirus circulating in Argentinean cattle during 1994-2010.

Bovine coronavirus (BCoV) is an important viral pathogen associated with neonatal calf diarrhea. Our aim was to investigate the incidence of BCoV in diarrhea outbreaks in beef and dairy herds from Argentina during 1994-2010. A total of 5.365 fecal samples from diarrheic calves were screened for BCoV diagnosis by ELISA. The virus was detected in 1.71% (92/5365) of the samples corresponding to 5.95% (63/1058) of the diarrhea cases in 239 beef and 324 dairy farms. The detection rate of BCoV was significantly higher in dairy than in beef herds: 12.13% (29/239) vs. 4.32% (14/324) respectively. Phylogenetic analysis of the hypervariable S1 region of seven representative samples (from different husbandry systems, farm locations and years of sampling) indicated that BCoV strains circulating in Argentinean beef and dairy herds formed a cluster distinct from other geographical regions. Interestingly, Argentinean strains are distantly related (at both the nucleotide and amino acid levels) with the Mebus historic reference BCoV strain included in the vaccines currently available in Argentina. However, Mebus-induced antibodies were capable of neutralizing the BCoV Arg95, a field strain adapted to grow in vitro, and vice versa, indicating that both strains belong to the same CoV serotype reported in cattle. This work represents the first large survey describing BCoV circulation in Argentinean cattle.

Phylogenetic analyses of typical bovine rotavirus genotypes G6, G10, P[5] and P[11] circulating in Argentinean beef and dairy herds.

Group A rotavirus (RVA) is one of the main causes of neonatal calf diarrhea worldwide. RVA strains affecting Argentinean cattle mainly possess combinations of the G6, G10, P[5] and P[11] genotypes. To determine RVA diversity among Argentinean cattle, representative bovine RVA strains detected in diarrheic calves were selected from a survey conducted during 1997-2009. The survey covered the main livestock regions of the country from dairy and beef herds. Different phylogenetic approaches were used to investigate the genetic evolution of RVA strains belonging to the prevalent genotypes. The nucleotide phylogenetic tree showed that all genotypes studied could be divided into several lineages. Argentinean bovine RVA strains were distributed across multiple lineages and most of them were distinct from the lineage containing the vaccine strains. Only the aminoacid phylogenetic tree of G6 RVA strains maintained the same lineages as observed at the nucleotide level, whereas a different clustering pattern was observed for the aminoacid phylogenetic trees of G10, P[5] and P[11] suggesting that the strains are more closely related at the aminoacid level than G6 strains. Association between P[5] and G6(IV), prevalent in beef herd, and between P[11] and G6(III) or G10 (VI and V), prevalent in dairy herds, were found. In addition, Argentinean G6(III), G10, P[5] and P[11] bovine RVA strains grouped together with human strains, highlighting their potential for zoonotic transmission. Phylogenetic studies of RVA circulating in animals raised for consumption and in close contact with humans, such as cattle, contribute to a better understanding of the epidemiology of the RVA infection and evolution.

Bovine rotavirus strains circulating in beef and dairy herds in Argentina from 2004 to 2010.

Bovine Group A Rotavirus (RVA) is one of the main causes of neonatal calf diarrhea worldwide. The present study reports the genotyping of bovine RVA strains circulating in Argentinean cattle from 2004 to 2010. Additionally, a new set of typing primers was designed and tested to differentiate between G8 and G6 (lineage III and IV) RVA strains. Bovine RVA was detected in 30% (435/1462) of the tested samples, corresponding to 49% (207/423) of the studied outbreaks with a similar detection rates in beef (53%; 67/127) and dairy herds (52%; 65/126). The RVA strains circulating in Argentinean cattle belonged to the common bovine genotypes G6 (lineages III and IV), G8, G10, P[5] and P[11]. A different RVA G/P-genotype distribution was found between the exploitation types, with the combination G6(IV)P[5] being by fare the most prevalent RVA strain in beef herds (58%), whereas a more even distribution of G6(III)P[11] (15%), G10P[11] (17%), G6(IV)P[5] (14%), and G6(IV)P[11] (6%) RVA strains was detected in dairy herds. G8 RVA strains were found in two dairy farms in calves co-infected with G8+G6(III)P[11]. A high percentage of co-infections and co-circulation of RVA strains with different genotypes during the same outbreak were registered in both exploitation types (20% of the outbreaks from beef herds and 23% from dairy herds), indicating a potential environment for reassortment. This finding is significant because G10P[11] and G6(III)P[11] strains may possess zoonotic potential. Continuous surveillance of the RVA strains circulating in livestock provides valuable information for a better understanding of rotavirus ecology and epidemiology.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital.

OBJECTIVES: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. MATERIALS AND METHODS: We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. RESULTS: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097 €, sig<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality. CONCLUSIONS: We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications.

Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital

Objectives. To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service.Materials and methods. We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed.Results. We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097€, sig.<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality.Conclusions. We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications can improve quality of care and reduce costs (AU)

Objetivos. Analizar la relación entre la presencia de infección nosocomial y el resultado clínico final, la duración de la estancia y el coste del episodio en los pacientes diagnosticados de tumoración cerebral en nuestro servicio.Material y método. Realizamos un estudio retrospectivo incluyendo los pacientes ingresados en el Servicio de Neurocirugía del Hospital Universitario de Cruces con diagnostico de tumoración cerebral en el periodo comprendido entre el 1-1-2007 y el 31-12 del 2007. Recogimos variables demográficas, los microorganismos responsables y la localización de las distintas infecciones, el tiempo de ingreso y los costes de los distintos procedimientos médicos y quirúrgicos realizados.Resultados. Recogimos 139 pacientes, que acumularon un total de 210 episodios. Encontramos la presencia de infecciones nosocomiales en 34 episodios (16,25%). La localización mas frecuente fue la respiratoria, seguida del tracto urinario y la infección de herida quirúrgica. Encontramos unas diferencias significativas en la situación funcional al alta (sig <0.01), el coste medio de los episodios (17097€, sig.<0.01) y en la estancia media (15.45 días, sig.<0.01). No encontramos diferencias significativas con respecto a la mortalidad.Conclusiones. Encontramos asociaciones significativas entre la presencia de infección nosocomial, un peor resultado clínico, un mayor coste y una mayor estancia. Los gérmenes responsables y localizaciones fueron similares a las series previamente publicadas. A pesar de que la variabilidad en el diseño de los estudios recogidos en la literatura dificulta la interpretación y comparación de los resultados, las medidas destinadas a la prevención de esta complicación permiten simultáneamente mejorar la asistencia prestada, asi como reducir los costes generados por la enfermedad (AU)

[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de laliteratura / Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature

Introducción. Las fístulas espontáneas de LCR noson una entidad frecuente y pueden ser infradiagnosticadasen el adulto. Para algunos autores, debesospecharse esta patología en cualquier paciente mayorde 50 años con episodios de otitis serosas recurrentesy ausencia de antecedentes otológicos. La meningitis essu complicación más grave, por lo que es prioritario undiagnóstico precoz y certero.Objetivo. Presentar dos casos clínicos atendidos ennuestro servicio y revisar la literatura científica existenteal respecto.Conclusión El tratamiento de estas fístulas atraumáticases eminentemente quirúrgico, pudiendo emplear lacraneotomía de fosa media o la vía transmastoidea. Enel sellado debe emplearse una técnica multicapa, combinandomateriales autólogos y artificiales para conseguirmejores resultados (AU)

Introduction. Spontaneous cerebrospinal fluid otorrheais a relatively rare entity and can be easily missedin adults. Every adult older than 50 years with a negativehistory of otologic disease who has recurrent serousotitis media should be evaluated for this pathology.Meningitis is the most serious complication, so there isno doubt that the condition needs immediate attentionand correction.Objective. We present two patients who were diagnosedwith spontaneous CSF otorrhea and make areview of what is reported about this topic (..) (AU)

A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral haematomas treated in a Neurosurgical Department.

BACKGROUND: Spontaneous supratentorial intracerebral haemorrhages (SSIH) carry high morbidity and mortality rates. At present, the proper role of surgery is not clear and data from the International STICH trial have not clarified this challenging question. On the other hand, few prospective studies have measured long term survival regardless of the treatment and clinical condition of the patient. PATIENTS AND METHODS: We prospectively collected data from all SSIH patients (n = 356) admitted at a tertiary reference hospital over a 40-month time period regardless of their clinical condition and treatment received. Among data investigated were preclinical neurological state, GCS on admission, history of systemic hypertension and treatment (surgical or conservative). Clinical factors influencing mortality at 1-year follow-up were analysed statistically by univariable and multivariable methods. FINDINGS: We found that patients in the eighth decade were the most frequent. Hypertension was present in 47% of patients. Based on the prehospitalisation modified Rankin Scale, 305 (86%) patients were independent for activities of daily living (ADL). At 12-months follow-up, 91 (46% of alive patients) remained independent for ADL. The surgical rate was 22%. Although it was not a randomised study, we did not find a significantly different mortality rate according to whether the patient was treated surgically or conservatively. Overall, the mortality rate was 44% (157 patients) with a 79% of deaths taking place in the first 30 days after admission. CONCLUSIONS: This study underscores the high mortality rate of SSIH, especially so in the first month after admission. Among the subgroup of patients clinically independent before the haemorrhagic stroke, only 29.8% remained independent one year after the event. We did not find any statistically significant difference in mortality according to treatment modality received (surgical vs conservative) although treatment assignment was not randomised. Among other clinical factors, pre-ictal functional status, age, level of consciousness on admission and volume of haemorrhage strongly influence mortality as determined at the 1-year follow-up.

17beta-estradiol differentially activates mitogen-activated protein-kinases and improves survival following reperfusion injury of reduced-size liver in mice.

Ischemia-reperfusion injury (I/R-I), which is unavoidable in liver transplantation, impairs liver regeneration and predisposes to liver failure. The three major mitogen-activated protein-kinases (MAPKs): ERK, p38, and JNK, are critical in the transmission of signals triggered by proinflammatory cytokines, by stress, and by growth factors. JNK and p38alpha activation have been associated with apoptosis; p38beta with cell survival; and ERK with proliferation. Previous studies have demonstrated gender dimorphism in hepatocellular dysfunction after experimental trauma and hemorrhage. Female mice are protected to a much greater extent from I/R-I than male mice. We assessed the effects of 17beta-estradiol (17beta-E) on liver function, host survival, and cellular activation of MAPK in a murine model of I/R-I in reduced-size livers. C57BL/6 mice were subjected to 45 minutes of warm ischemia (70% of the liver mass). After reperfusion, the nonischemic lobes were excised. Vehicle, 17beta-E or the estrogen receptor antagonist ICI-182780, was delivered 1 hour before the injury. We evaluated AST and apoptosis as well as activation of JNK, p38, and ERK. Female mice showed a lower level of hepatocellular injury (AST = 445 +/- 82 IU/L) after I/R-I compared with male mice (AST = 1400 +/- 210). 17beta-E decreased the liver injury in male mice (AST = 522 +/- 77), an effect that was partially reversed by ICI-182,780 (910 +/- 92). A higher rate of apoptosis was observed in male animals given saline (enrichment factor = 7.22 +/- 0.8) versus those treated with 17beta-E (5.85 +/- 0.3, P < .05). A significant increase in liver regeneration, as assessed by the percentage of liver weight/body weight was demonstrated in females (184% +/- 24%) and male mice given 17beta-E (168% +/- 22%) compared with male mice given vehicle (9% +/- 4%). 17beta-E significantly down-regulated JNK and p38alpha activities, whereas I/R-I promoted p38beta and ERK activation. These results suggest that the cytoprotective effects of 17beta-E on I/R-I to reduced-size livers are associated with selective modulation of MAPK kinases.

Improvement in quality of life in patients with advanced Parkinson's disease following bilateral deep-brain stimulation in subthalamic nucleus.

In this article we investigate the changes observed in the scales that quantify the quality of life (PDQ-39) in patients that have already completed 1 and 2 years of bilateral subthalamic stimulation (DBS-STN). Fourteen patients were evaluated 1 year after DBS-STN; the evaluation was repeated on 11 of them, 2 years after surgery. All of them suffered from Parkinson's disease with a 14.3 (+/-5.7) years history of motor complications. Patients were selected according to CAPSIT criteria. All of them were implanted bilateral electrodes in the subthalamic nucleus. The parameters applied were UPDRS II, UPDRS III, PDQ-39, and the scale of quality of life for caregivers (SQLC). Scorings in motor scales (UPDRS III) improved 45% in relation to the first year, and 48% in relation to the second year (P < 0.001). Patient's quality of life (PDQ-39 summary index) improvement was 62% 2 years after surgery (P < 0.001), and caregivers' quality of life improvement was 68% (P = 0.002) by the same time. DBS-STN is a therapy that efficiently improves the quality of life of selected patients with Parkinson's disease. This improvement is still present 2 years after surgery and has a positive impact on caregivers quality of life.

[Intraabdominal complications in the lumbar disc surgery]. / Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar.

INTRODUCTION: : Removal of a lumbar disc herniation is, at present, the most frequent surgical procedure, related to the spine in Neurosurgical Departments. It carries a very low rates of complications and a short postoperative hospital stay. However, in spite of their rarity, serious adverse intraoperative complications may occur, so we must be aware of its existence in order to make an early diagnosis and treatment to prevent a fatal outcome. It is important to ensure that the patient understand the possible complications and obtaining written consent to avoid later medico-legal problems. CLINICAL CASES: We report two cases with typical lumbociatic pain secondary to lumbar disc herniation operated at our Department, that resulted in intraoperative complications, due to perforation of intraabdominal structures. Initially, the patients underwent planned flavectomy, followed by simple disc removal. However, symptoms of abdominal pain and systemic hypotension in each case, began some hours later. Early diagnosis was achieved using abdominal-pelvic CT scan, showing an intestinal perforation in one patient and a tear of both iliac artery and vein in the other. In both, an urgent laparotomy was performed by colleagues from the Department of General and Vascular Surgery, with surgical repair. The final outcome was good and both are asymptomatic. CONCLUSION: Surgical removal of the lumbar disc herniation is a very effective procedure, but is not free from certain severe though rare complications. Intestinal perforation and vascular tears are two possible complications to suspect if abdominal pain or systemic arterial to suspect if abdominal pain or systemic arterial urgent surgical repair of such complications. It is of vital importance that the patient knows the existence of such complications and so obtain a written consent.

[Tentorial meningiomas. Report of our series]. / Meningiomas de la tienda del cerebelo. Revisíon de nuestra casuística.

PURPOSE: The main objectives of this report are to describe the clinical and radiological features, surgical management, complications, and final outcome of patients with a tentorial meningioma. METHODS: This is a retrospective study of 25 patients operated on for tentorial meningiomas at our department since december 1975 to may 2002. All the patients, except the first, were diagnosed by computed tomography; in 13 of them a magnetic resonance imaging was performed too; in 14 patients, diagnosis was completed with cerebral arteriography. The preoperative clinical condition, the interval between the first symptoms and the date of the operation, the postoperative morbidity and the recurrence are analysed. RESULTS: There were 20 women and 5 men of ages ranging from 35 to 79 years (average of 54.6). Surgical removal was considered radical (Simpson I-II) in 22 patients. Of them one had a recurrence 25 years after the operation, another had three recurrences, in two years, that were reoperated, and a third one had recurrence at five years who did not require surgery. The postoperative mortality was 8%. The mean follow-up period was of 5.3 years. The final outcome was good recovery in 19 patients, moderate disability in 1 and death in 4. CONCLUSIONS: Despite the advances in Neuroradiology and Microsurgery, these tumors represent a challenge for the neurosurgeon, due in some cases to a large tumor size and extension to critical areas. A removal as complete as possible allows minimizing the recurrence risk.

[Bilateral subthalamic nucleus deep-brain stimulation (STN-DBS) in Parkinson's disease: initial experience in Cruces Hospital]. / Estimulación bilateral del núcelo subtalámico en la enfermedad de Parkinson. Experiencia inicial en el Hospital de Cruces.

INTRODUCTION: Clinical outcomes of Parkinson's disease patients treated for 12 months with STN-DBS were analyzed. PATIENTS ADN METHODS: Twelve patients were selected using the CAPSIT protocol criteria and placement of electrodes in the appropriate target was performed according to results of fusion image techniques and intraoperative microrecording. RESULTS: A reduction in motor UPDRS (44 %) and activities of daily living (58 %) scores during <> phases were observed. <> time with dyskinesias was reduced (86 %), while severe dyskinesias disappeared. Levodopa dosage was also lowered (44 %). Patients and caregivers showed a clear-cut benefit on quality of life (58 % and 61 % respectively). No cognitive deterioration was observed and morbidity was in the same range as that published by other teams. CONCLUSION: Bilateral STN-DBS is an effective symptomatic therapy for complicated Parkinsons disease patients. It improves the quality of life of patients and their caregivers and allows a reduction of levodopa dosage.

Estimulación bilateral del núcleo subtalámico en la enfermedad de Parkinson. Experiencia inicial en el Hospital de Cruces / Bilateral subthalamic nucleus deep-brain stimulation (STN-DBS) in Parkinson's disease: initial experience in Cruces Hospital

Introducción: Se presentan los resultados clínicos tras 1 año de evolución en 12 pacientes con enfermedad de Parkinson tratados con estimulación bilateral de núcleo subtalámico. Pacientes y métodos: Los pacientes han sido seleccionados y estudiados de acuerdo con el protocolo CAPSIT y la colocación de los electrodos se ha realizado con el apoyo de técnicas de fusión de imagen y microrregistro intraoperatorio. Resultados: Se ha observado una mejoría clínica significativa en la intensidad del off, tanto en actividades de la vida diaria (58 por ciento) como en el aspecto motor (44 por ciento), ha disminuido el tiempo de discinesias (86 por ciento), con desaparición total de las discinesias graves, y se ha reducido en un 44 por ciento la dosis equivalente de levodopa del tratamiento médico. Se ha observado también una mejoría del 58 por ciento en la calidad de vida de los pacientes, así como un beneficio de un 61 por ciento en la calidad de vida de los cuidadores. No se ha observado deterioro cognitivo y la morbilidad ha sido similar a la de otros equipos quirúrgicos. Conclusión: La estimulación bilateral del núcleo subtalámico en la enfermedad de Parkinson evolucionada es una terapia eficaz que mejora la calidad de vida de los pacientes y de sus cuidadores y permite la reducción de dosis de levodopa (AU)

[Neuropsychological changes and bilateral subthalamic deep brain stimulation in Parkinson's disease]. / Efectos cognitivos de la estimulación cerebral profunda sobre el núcleo subtalámico en la enfermedad de Parkinson.

INTRODUCTION: To investigate neuropsychiatric changes in Parkinson's disease (PD) patients after 12 months of bilateral subthalamic deep brain stimulation (DBS-STN). SUBJECTS: Nine out of 23 patients with PD subjected to DBS-STN were included. The mean follow-up of this cohort was 12 months, mean disease duration 14.2 5.5 years and mean UPDRS motor score in <> 43.2 13.7. METHODS: Patients were selected on the basis of CAPSIT criteria. They underwent bilateral implant of stimulators in STN under stereotactic conditions. Quality of life scale (PDQ 39), depression scale (Brev-Cet), frontal function test (Stroop, Wisconsin, verbal fluency) and memory evaluation (Barcelona test) were monitored at baseline in <> medication and after 12 months in <> medication/<> stimulation. RESULTS: The patients' motor scores improved on an average of 40.2 % (p = 0.0002) in <> medication situation and 58 % in quality of life scores. We observed a benefit in depression scores (52 %, p = 0.003). Immediate verbal memory improved as well, 25 % (p = 0.04) in recall memory and 14 % (p = 0.02) in recognition memory. No changes were observed in visual memory, verbal fluency and/or global cognitive tests. CONCLUSION: DBS-STN in PD patients seems to be an effective tool for improving their quality of life, due to its benefits on motor function, verbal memory and mood. Bilateral DBS-STN did not affect either verbal fluency or executive functions in our patients. Neuropsychological assessment is a good tool for selection and study of the operated patients.

Efectos cognitivos de la estimulación cerebral profunda sobre el núcleo subtalámico en la enfermedad de Parkinson / Neuropsychological changes and bilateral subthalamic deep brain stimulation in Parkinson's disease

Introducción: Se investigan cambios en la esfera cognitiva en pacientes con enfermedad de Parkinson (EP) tras 12 meses de estimulación cerebral profunda en el núcleo subtalámico (ECP NS). Pacientes: La serie recoge nueve de 23 pacientes con EP sometidos a ECP NS, con 12 meses de seguimiento. La duración media de la enfermedad era 14,2 ñ 5,5 años y la puntuación de UPDRS III en situación off de 43,2 ñ 13,7. Métodos: Se utilizaron los criterios CAPSIT para la inclusión de pacientes. Se les implantaron electrodos (bilateralmente) mediante cirugía estereotáctica. Se monitorizaron en situación basal (on medicación) y al año (on medicación, on estimulación) los siguientes parámetros: calidad de vida (PDQ 39), depresión (Brev-Cet), funciones frontales subcorticales (Stroop, Wisconsin, fluencia verbal) y valoración de la memoria (test de Barcelona). Resultados: Las puntuaciones en escalas motoras mejoraron un 40,2 por ciento (p = 0,0002) en off/on y un 58 por ciento en calidad de vida. Se observó una mejoría del 52 por ciento en escalas de depresión (p = 0,003). La memoria verbal inmediata también mejoró, un 25 por ciento en evocación (p = 0,04) y un 14 por ciento en reconocimiento (p = 0,02). No se observaron modificaciones en memoria visual, fluencia verbal y parámetros cognitivos globales. Conclusiones: La ECP NS es un tratamiento eficaz para mejorar la calidad de vida de enfermos parkinsonianos avanzados, debido a la mejoría que se produce en síntomas motores, depresivos y memoria verbal. En nuestra serie no hemos detectado cambios en las funciones ejecutivas ni en la fluencia verbal. El estudio neuropsicológico ayuda a una mejor selección y estudio de los pacientes intervenidos (AU)

Prognostic factors in a series of 185 consecutive spontaneous supratentorial intracerebral haematomas.

We report a retrospective observational study of 185 cases with spontaneous supratentorial intracerebral haemorrhage, in which, by univariate and multivariate analysis, the main clinical and CT findings influencing patient outcome were studied. Forty (22%) patients died and 77 (41%) remained in a very disabled state. Using logistic regression analysis we found that the volume of the haematoma, its deep location, surgical treatment and the preictal status in relation to activities of daily living (ADL) were independent factors for patient outcome measured with the Modified Rankin Scale. Similarly, GCS at presentation, preictal status in relation to ADL and age were directly correlated with mortality at 6 months follow-up. We also observed that age, GCS at admission and the volume of the haematoma, were the main factors influencing the neurosurgeon's decision regarding surgical treatment.

[Lumbar root compression secondary to juxtafacet cysts: review of 10 cases]. / Compresión radicular lumbar secundaria a quistes yuxtafacetarios: revisión de 10 casos.

OBJECT: We report a series of 10 patients with 11 juxtafacet cysts of the lumbar spine treated in our center from 1994 to 2000. METHODS: The clinical histories, radiographic images, surgical protocols and pathological records of the 10 patients diagnosed of lumbar juxtafacet cyst have been analyzed. RESULTS: Six patients were women and four were men. The average age of presentation was 54 years. The most frequent clinical presentation was radicular pain, and motor or sensitive deficits were not very common. Computed tomography and magnetic resonance are essential in establishing the diagnosis. The cysts were located at L4-L5 in eight patients, at L2-L3 in one patient, and at L3-L4 in other patient. Eight patients were treated by means of decompressive laminectomy and excision of the cyst, and the remaining two underwent conservative treatment. Degenerative phenomena adjacent to the juxtafacet cysts are easy to evidence. All the patients were improved of their radicular pain. CONCLUSIONS: Analysing our series, we conclude that the juxtafacet cysts appear more frequently at L4-L5 level in people of advanced age, and produce commonly low back pain and radiculopathy. Although they can be treated initially in a conservative way, in the presence of a progressive sciatic syndrome, surgical management is preferable.