Gliomas difusos en áreas elocuentes: avances diagnósticos y terapéuticos / Diffuse gliomas within eloquent areas: diagnostic and therapeutic advances

Objetivo: presentar los avances diagnósticos, moleculares y radiológicos, así como en las estrategias terapéuticas para gliomas difusos en los últimos 5 años (2018-2023) en la Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia. Materiales y métodos: se describen las técnicas diagnósticas y terapéuticas utilizadas para gliomas difusos con casos ilustrativos. Resultados: se muestran los avances de las herramientas diagnósticas y terapéuticas para el manejo de gliomas difusos. Discusión: en los últimos 5 años se ha avanzado en la clasificación, diagnóstico y tratamiento de los gliomas difusos, gracias a los avances tecnológicos como los marcadores moleculares, la tractografía y la fusión de imágenes para la neuronavegación y las técnicas de estimulación cortical. Esto ha permitido que el tratamiento de los pacientes con dichos tumores mejore la tasa de morbilidad, la calidad de vida libre de enfermedad y la supervivencia global. Conclusiones: las técnicas de diagnóstico como la tractografía, la fusión integral de imágenes intraoperatorias y el mapeo cerebral electrofisiológico con estimulación cortical y subcortical han mejorado el diagnóstico y tratamiento de los gliomas difusos.

Objective: to present the diagnostic, molecular, radiological, and therapeutic advances, to address diffuse gliomas, made at Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá D.C., Colombia, in the last 5 years (2018-2023). Materials and methods: diagnostic and therapeutic techniques to address diffuse gliomas are described through illustrative cases. Results: the advances in diagnostic and therapeutic tools for managing diffuse gliomas, are shown. Discussion: in the last 5 years progress in characterizing, diagnosing, and treating diffuse gliomas, thanks to technological breakthroughs, such as molecular markers, tractography, image fusion for neuronavigation, and cortical stimulation techniques, has been achieved. This has allowed improving morbidity rate, disease-free quality of life and overall survival through the treatment provided to patients afflicted with gliomas. Conclusions: Diagnostic techniques based on tractography, comprehensive intraoperative image fusion, and electrophysiological brain mapping with cortical and subcortical stimulation, have improved the diagnostic and therapeutic approaches for diffuse gliomas.

Reconstruction of the Ascending Reticular Activating System with Diffusion Tensor Tractography in Patients with a Disorder of Consciousness after Traumatic Brain Injury.

This work describes the reconstruction of the ascending reticular activating system (ARAS) with diffusion tensor tractography in three patients with altered consciousness after traumatic brain injury. A diffusion tensor tractography was performed in three patients with impaired consciousness after a severe traumatic brain injury. A 1.5 T scanner was used to obtain the tensor sequences; axial tensors were acquired. Post-processing was performed, and the mean fractional anisotropy (FA) values were recorded. The FA maps were used to do a manual tracing of the following regions of interest (ROIs): the ventromedial midbrain, the anterior thalamus, and the hypothalamus. Case 1 presented destruction of the right dorsal and ventral tegmental tracts as well as destruction of the right middle forebrain bundle, case 2 had destruction of the right dorsal tegmental tract, and case 3 had destruction of the bilateral ventral and dorsal tegmental tracts, as well as destruction of the right middle forebrain bundle. The affected fibers of the ascending reticular activating system with diffuse axonal injury and the FA values abnormalities in the ascending reticular activating system in three patients with a disorder of consciousness (DOC) after traumatic brain injury are described.

Microvascular Decompression for a Patient with a Glossopharyngeal Neuralgia: A Technical Note.

The glossopharyngeal neuralgia (GPN) constitutes approximately 0.2-1.3% of all facial pain syndromes. The GPN is a syndrome of neuropathic pain characterized by paroxysmal pain episodes localized in the posterior tongue, tonsil, throat, or external ear canal. The first-line treatment is pharmacological. Patients who are refractory to medical therapy can be treated surgically with microvascular decompression (MVD) or sectioning the IX nerve and the upper rootlets of the X nerve. We aim to describe the technical nuances of MVD of the IX cranial nerve with a targeted inferior mini-craniotomy in a patient with a neurovascular compression.

Trauma intracraneal penetrante trans-orbitario: anatomía relevante, las dinámicas del trauma y los puntos clavepara el tratamiento / Trans-orbital intracranial penetrating trauma: relevant anatomy, trauma dynamics and treatment key points

Las lesiones intracraneales penetrantes trans-orbitarias representan pocos casos de todos los Traumas Craneo-encefálicos, sin embargo, representan del 25 al 50 por ciento de todos los traumas penetrantes craneales. Este tipo de traumas trans-orbitarios se han reportado por diferentes tipos de objetos, incluyendo objetos de metal y de madera. Muchos de estos traumas intracraneales pueden pasar desapercibidos en casos donde el material que ingresa no queda expuesto posterior al trauma y cuando no se presenta lesión neurológica que requiera examinación exhaustiva adicional con neuro-imágenes.

Trans-orbital penetrating intracranial injuries represent few cases of all Traumatic Brain Injuries, although they represent between 25 to 50 percent of all penetrating brain injuries. Trans-orbital intracranial penetrating injuries have been reported caused by different types of objects, including metal and wooden objects. Many of these intracranial traumas can be dismissed, especially in those cases where the material is not exposed after the injury and there is no need of further examination with neuroimaging in absence of neurological deficit.

Stent-assisted Embolization of a Giant Aneurysm of the Middle Cerebral Artery Using Small and Large Coils (Penumbra Coil 400).

Giant aneurysms have been treated with endovascular approaches like general, balloon-assisted and stent-assisted coiling, and flow diverter stent-assisted techniques. Few cases have been reported to be treated with both normal and large coils. Despite the mass effect, an adequate revascularization has been reported. An initial use of these coils is being reported in the current study. This is a case which has been successfully treated using a stent-assisted coiling with both small and large coils i.e., Penumbra Coil 400 (Penumbra, Inc., Alameda, California).

Detection and characterization of intracranial aneurysms: a 10-year multidetector CT angiography experience in a large center.

BACKGROUND: CT angiography (CTA) is increasingly used for the detection, characterization, and follow-up of intracranial aneurysms. A lower threshold to request a CT angiogram may render a patient population that differs from previous studies primarily evaluated with conventional angiography. Our objective was to broaden our knowledge of the factors associated with aneurysm rupture and patient mortality in this population. METHODS: All CTA studies performed over a 10-year period at a large neurovascular referral center were reviewed for the presence of an intracranial aneurysm. Patient demographics, mortality, CTA indication, aneurysm location, size, and rupture status were recorded. RESULTS: 2927 patients with aneurysms were identified among 29 003 CTAs. 17% of the aneurysms were ruptured at the time of imaging, 24% of aneurysms were incidentally identified, and multiple aneurysms were identified in 34% of patients. Aneurysms most commonly arose from the supraclinoid internal carotid artery (22%), the middle cerebral artery (18%), and the anterior communicating artery (13%). Male sex, age <50 years, aneurysms >6 mm, and aneurysms arising from the anterior communicating artery, posterior communicating artery, or the posterior circulation were independent predictors of aneurysm rupture. Independent mortality predictors included male sex, posterior circulation aneurysms, intraventricular hemorrhage, and intraparenchymal hemorrhage. CONCLUSIONS: These results indicate that aneurysms detected on CTA that arise from the anterior communicating artery, posterior communicating artery, or the posterior circulation, measure >6 mm in size, occur in men, and in patients aged <50 years are associated with rupture.

Diagnóstico de muerte cerebral: uso de la angiografía por tomografía axial computarizada como herramienta diagnóstica no invasiva al alcance de todos / Diagnosis of Brain Death: Use of Computed Tomography Angiography as a Non-invasive Diagnostic Tool Available to Everyone

Introducción: La muerte cerebral (MC) se define como la pérdida irreversible de la función cerebral y la ausencia de reflejos del tallo cerebral y de movimientos respiratorios. Objetivo: Describir los hallazgos en la angioTAC cerebral en pacientes con signos clínicos de MC, para evaluar su aplicabilidad como método diagnóstico. Métodos: Se realizó un estudio retrospectivo, entre septiembre de 2013 y abril de 2015; se incluyeron pacientes entre 21 y 60 años, a quienes se les practicó angioTAC para verificar MC. El diagnóstico clínico de MC se realizó mediante el examen neurológico y el test de apnea. Adicionalmente se realizó una angioTAC con tomógrafo multicorte de cuatro detectores, con tres adquisiciones, mediante cortes axiales de 2 mm desde el cuerpo vertebral de C6 hasta 5 cm arriba. El diagnóstico escanográfico de MC se hizo basado en criterios de ausencia completa de circulación intracraneal con una escala de 6 puntos. Resultados: Se identificaron 12 pacientes que cumplían con los criterios de inclusión (5 hombres y 7 mujeres), con edad media 46,6 años (21-60). Los diagnósticos de base fueron: neurovascular (n=8), trauma craneoencefálico (n=2), meningioma (n=1) y paro cardiorespiratorio (n=1). Solo un paciente no cumplió con los 6 puntos de los criterios propuestos para la evaluación con angioTAC. Conclusiones: La angioTAC puede suministrar información suficiente para realizar el diagnóstico confirmatorio imaginológico de MC en los pacientes con duda diagnostica clínica; sin embargo, es necesario compararlo en el futuro con la angiografía por catéter.

Introduction: Brain death (BD) is defined as an irreversible loss of brain function, and the absence of reflexes of the brain stem and of respiratory movements. Objective:To describe the brain CT angiography findings in patients with clinical signs of brain death (BD) and to evaluate its applicability as a diagnostic method of BD as well. Methods: A retrospective study was performed between September 2013 and April 2015, which included patients between the ages of 21 and 60, who underwent CT angiography with BD protocol. The clinical diagnosis of BD was made by neurological examination and with an apnea test. Additionally, a multi-slice CT angiography was performed with a 4-detectors tomograph, with three acquisitions, with 2mm axial slices from the vertebral body of C6 to 5 cm above. The BDscan diagnostic criteria was performed based on criteria of complete absence of intra-cranial circulation with a 6 point scale. Results: 12 patients that met the inclusion criteria (5 males and 7 females), with a mean age of 46.6 years (21-60) were identified. The initial diagnosis of the patients were neurovascular (n = 8), head trauma (n = 2), meningioma (n = 1) and cardiopulmonary arrest (n = 1). Only one patient did not meet the 6 points of the proposed criteria for the evaluation with CT angiography. Conclusions: CT angiography could provide enough information to perform confirmatory diagnostic imaging of BD in patients with clinical doubts of diagnosis of BD, however it is necessary in the future to compare it with catheter angiography.

Procedimientos neuroquirúrgicoscerebrales guiados por estereotaxiarealizados en el Hospital Universitario de San Ignacio (HUSI): evolución a corto y mediano plazo / Neurosurgical Brain Estereotactic- Guided Procedures Performed at Hospital Universitario San Ignacio (HUSI): Development in the Short and Medium Term

Objetivo: Describir los resultados postoperatorios de los pacientes a los que se lesrealizaron procedimientos neuroquirúrgicos cerebrales guiados por estereotaxia enel Hospital Universitario de San Ignacio durante el periodo julio del 2009-julio del2011. Materiales y métodos: Se revisaron las historias clínicas de 78 pacientes,sus características clínicas, la localización de las lesiones en las neuroimágenes,el tipo de procedimiento, los resultados funcionales y los desenlaces a corto ymediano plazo. Resultados: 78 pacientes tuvieron procedimientos neuroquirúrgicosguiados por estereotaxia entre julio del 2009 y julio del 2011. El 64,1 % (n = 50)eran hombres. La localización de las lesiones fue en orden de frecuencia: gangliossubtalámicos, lóbulo frontal, lóbulo temporal, tálamo, unión córtico-subcortical, tallocerebral, ubicación frontotemporal, lóbulo occipital, ubicación parieto-occipital ybase del cráneo. Discusión: La implementación de procedimientos neuroquirúrgicosguiados por estereotaxia sigue siendo una de las mejores opciones en el abordaje depatologías cerebrales profundas o de difícil acceso. Tanto en Colombia como en elresto del mundo son procedimientos con una baja tasa de morbilidad y mortalidad.Conclusiones: Independientemente del tipo de procedimiento guiado por estereotaxiala tasa de complicaciones no excede el 5 %, tasas similares a las obtenidas en laliteratura mundial...

Objective: Retrospective description of postoperativeoutcomes of patients who underwentneurosurgical brain stereotactic guided proceduresat the Hospital Universitario San Ignacioduring the period July 2009-July 2011. Materialsand Methods: A review of medical recordsof 78 patients who were taken to neurosurgicalstereotactic guided procedures at the HospitalUniversitario San Ignaci. We reviewed the clinicalcharacteristics of patients, the location of thelesions on neuroimaging, management, type ofprocedure of each patient, functional results andoutcomes in the short and medium term. Results:78 patients who underwent neurosurgical brainstereotactic guided procedures between July2009 to July 2011 at the Hospital UniversitarioSan Ignacio. The 64.1 % (n = 50) were men. Thelocation of the lesions were in order of frequencysub-thalamic ganglia, frontal lobe, temporallobe, thalamus, cortico-subcortical junction, brainstem,fronto-temporal location, occipital lobe,parieto-occipital location, and at the skull’s base.Discussion: Implementing guided stereotacticneurosurgical procedures remains one of the bestoptions in dealing with deep brain pathologies ordifficult access. In both Colombia and the rest ofthe world, these are procedures with low morbidityand mortality. It must, however, developmulticenter studies that allow us to observe thedevelopment of stereotactic neurosurgery in ourcountry, also develop studies with a larger continuityto assess the long-term outcomes. Conclusions:Whatever type of stereotactic guidedprocedure the rate of complications does not exceed5 %, similar rates to those obtained from theglobal literature...