Gamma knife radiosurgery on the trigeminal ganglion for idiopathic trigeminal neuralgia: Results and review of the literature.

BACKGROUND: In the present study, we evaluate the results of gamma knife surgery (GKS) for the treatment of trigeminal neuralgia (TN) using the trigeminal ganglion (TG') and the adjacent fibers of trigeminal nerve as a target. METHODS: From February 2013 to July 2017, we treated 30 cases of TN with GKS. In this group, all patients had an idiopathic typical TN. The radiosurgical target was conformed through two isocenters, 8 and 4 mm at the cavum de Meckel. The maximum dose was 86 Gy using the isodose line of 50%. The median age of the patients was 58.5 (range 28-94) years old, and the median time from diagnosis to GKS was 94 months (range 13-480 months). The median follow-up was 28.5 (range 12-49) months. Clinical outcomes were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome. RESULTS: The mean time to relief of pain was 7 (range 1-40) days. The percentage of patients with significant pain relief was 93.3%. Relapse in pain was noted in four patients at 3, 16, 19, and 36 months. Nine patients were treated in acute status. Fourteen patients had intense pain between 1 and 7 days before the procedure. Among those with the recurrence of their symptoms, one patient had a microvascular decompression. Multivariate regression adjusted for age and sex suggests that, by 40 months, 70% of the patients treated with radiosurgery will remain pain free. At the last follow-up, GKS resulted in pain relief in 86.6% of patients. Our analysis suggests that, using this technique, we can expect that approximately 70% of patients with TN will have some degree of pain improvement at 3 years' post radiosurgery. CONCLUSIONS: GKS on TG appears to be a reasonable treatment option with short latency period, minor collateral effects, and high percentage of pain control. The mechanism of action of radiosurgery could be related to the inactivation of the satellite glial cells in the TG.

Gamma knife radiosurgery to the trigeminal ganglion for treatment of trigeminal neuralgia secondary to vertebrobasilar ectasia.

BACKGROUND: We report the result obtained using Gamma knife stereotactic radiosurgery on the trigeminal ganglion (TG) in a patient with trigeminal neuralgia (TN) secondary to vertebrobasilar ectasia (VBE). CASE DESCRIPTION: Retrospective review of medical records corresponding to one patient with VBE-related trigeminal pain treated with radiosurgery. Because of the impossibility of visualization of the entry zone or the path of trigeminal nerve through the pontine cistern, we proceeded with stereotactic radiosurgery directed to the TG. The maximum radiation dose was 86 Gy with a 8-mm and a 4-mm collimator. The follow-up period was 24 months. The pain disappeared in 15 days, passing from Barrow Neurological Institute (BNI) grade V to BNI grade IIIa in 4 months and then to grade I. The patient did not experience noticeable subjective facial numbness. CONCLUSIONS: This experience showed that Gamma knife radiosurgery was effective in the management of VBE-related trigeminal pain, using the TG as radiosurgical target.

Quiste óseo aneurismático simulando tumoración de rinofaringe / Aneurismatic bone cyst simulate rhino pharyns tumor

Los quistes óseos aneurismáticos del área de cabeza y cuello representan menos del 5% de todos los tumores óseos. Son lesiones benignas, que comúnmente afectan las metáfisis de los huesos largos y las vértebras como en el caso que se describe a continuación, simulando una lesión de la rinofaringe. Se describe su manejo y tratamiento.

The aneurismal of bone cyst of the head and neck localization, represent less than the 5% of the all bone tumors. They are benign lesions, and commonly affecting the metaphysis of the long bones and vertebrae, like in the case we described below, it simulating the rhino pharynx lesion. We describe the management and treatment.

Neurocitoma central a propósito de un caso diagnósticado por biopsia estereotáxica / Central neurocytoma a purpose of one case diagnostic for biopsy stereotaxic

El neurocitoma central (NC) es un tumor neuronal frecuentemente intraventricular, que generalmente afecta adultos jóvenes y suele cursar con una evolución clínica favorable. Varios cortes de un bloque celular, obtenido mediante biopsia estereotáxica de una mujer de 29 años con un tumor en el septum pellucidum, fueron evaluados por microscopía convencional e inmunocitoquímica. El tumor estuvo compuesto por células redondas pequeñas dispuestas en una matriz fibrilar y separadas por capilares ramificados, con presencia de pseudorosetas perivasculares. La sinaptofisina y proteína ácida glial fibrilar fueron positivas. Los NC pueden ser indistinguibles de los oligodendrogliomas y ependimomas, por lo cual es importante reconocerlos, dada las implicaciones pronósticas y terapéuticas. El conocimiento de las características clínicas y citomorfológicas del NC es fundamental en la evaluación de tumores intraventriculares de células redondas pequeñas, especialmente cuando se trata de biopsias estereotáxicas

Hemangioma vertebral: posibilidades terapéuticas; presentación de un caso / Vertebral hemangioma: therapeutic posibilities; a case report

Presentación de un caso clínico de un paciente con hemangioma vertebral dorsal, se discute la clínica y las alternativas terapéuticas ante esta patología haciendo especial referencia a la radioterapia, sus ventajas y complicaciones

Revisión de 2.584 pacientes traumatizados de craneo en el Servicio de Neurología del Hospital "Miguel Pérez Carreño" durante el lapso 1978-1983 / Review of 2.584 skull fractures in the Servicio de Neurología del Hospital Miguel Pérez Carreño from 1978 to 1983

Se presenta una revisión de 2.584 casos de pacientes traumatizados de craneo atendidos en el Servicio de Neurocirugía del Hospital "Miguel Pérez Carreño", durante el lapso 1978-1983; se analizan los aspectos estadísticos más importantes en relación a edad, sexo, frecuencia, tipo de accidente, asociación al alcohol, mortalidad e incapacidad producida, etc. se enfatiza que este Hospital es el primer Centro de atención de traumatizados a nivel nacional y se puntualiza la gravedad de los accidentes y sus implicaciones