Neurosurgery March 2015

Blevins LS Jr. The art of medicine. Neurosurgery. 2015 Mar;11 Suppl 2:1-2. doi: 10.1227/NEU.0000000000000637. PubMed PMID: 25706375.

Hurlbert RJ, Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Rozzelle CJ, Ryken TC, Theodore N. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2015 Mar;76 Suppl 1:S71-83. doi: 10.1227/01.neu.0000462080.04196.f7. PubMed PMID: 25692371.

Parker SL, McGirt MJ. Determination of the minimum improvement in pain, disability, and health state associated with cost-effectiveness: introduction of the concept of minimum cost-effective difference. Neurosurgery. 2015 Mar;76 Suppl
1:S64-70. doi: 10.1227/01.neu.0000462079.96571.dc. PubMed PMID: 25692370.

Desai A, Ball PA, Bekelis K, Lurie J, Mirza SK, Tosteson TD, Weinstein JN. SPORT: Does Incidental Durotomy Affect Longterm Outcomes in Cases of Spinal Stenosis? Neurosurgery. 2015 Mar;76 Suppl 1:S57-63. doi:10.1227/01.neu.0000462078.58454.f4. PubMed PMID: 25692369.

Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery. 2015 Mar;76 Suppl 1:S42-56. doi: 0.1227/01.neu.0000462077.50830.1a. PubMed PMID: 25692368.

Karikari IO, Nimjee SM, Hodges TR, Cutrell E, Hughes BD, Powers CJ, Mehta AI, Hardin C, Bagley CA, Isaacs RE, Haglund MM, Friedman AH. Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery. 2015 Mar;76 Suppl 1:S4-S13. doi: 10.1227/01.neu.0000462073.71915.12. PubMed PMID:
25692367.

Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2015 Mar;76 Suppl 1:S33-41. doi:
10.1227/01.neu.0000462076.73701.09. PubMed PMID: 25692366.

Debernardi A, DʼAliberti G, Talamonti G, Villa F, Piparo M, Collice M. The craniovertebral junction area and the role of the ligaments and membranes. Neurosurgery. 2015 Mar;76 Suppl 1:S22-32. doi:
10.1227/01.neu.0000462075.73701.d2. PubMed PMID: 25692365.

Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP; ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2015
Mar;76 Suppl 1:S14-21. doi:  0.1227/01.neu.0000462074.66077.2b. PubMed PMID:
25692364. Continue reading Neurosurgery March 2015

Calendario actualizado

2015


 Marzo



17th Hands-On Workshop Endoscopic Transnasal Approaches to the Skull Base

04.03.2015 – 06.03.2015

Trier, Germany

Course Program


 

leon2015


andaluza

Descargar Programa


Hands-On Training Courses on Surgical Anatomy of the Neck, Larynx and Parotid Gland and the Nose and Paranasal Sinuses, the Lacrimal System, the Orbit and the Skull Base

March 11 — March 13

Barcelona, Spain

For more information please click here


Annual Meeting of the Israel Neurosurgical Society in conjunction with the Israel Spine Society and the Israeli Trauma Association

March 11 — March 13

Upper Galilee, Israel


neuroraquis2015


15º Congreso Brasileño de Cirugía de Columna

São Paulo

12 al 14 de marzo 2015

1º Encuentro IberoLatinoAmericano de Cirujanos de Columna
FLANC-WFNS / SILACO

El Comité de Columna FLANC participa del 15º Congreso Brasileño de Cirugía de Columna, São Paulo, 12 al 14 de marzo 2015 en Reunión Conjunta con SILACO (Sociedad Ibero latino americana de columna) con discusión de casos complejos seleccionados. La Reunión tiene el apoyo y participación del Comité de Columna de la WFNS.

Enlace al Congreso

Programa


 RA-UK Ultrasound in Pain Medicine

March 13, 2015 — March 14, 2015

London, UK

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6th Fred J. Epstein International Symposium on New Horizons in Pediatric Neurology, Neurosurgery and Neurofibromatosis

15.03.2015 – 19.03.2015

Eilat, Israel

Further Information
www.newhorizons2015.net


8th Milano Masterclass – Special Expo Edition

March 20, 2015 — March 24, 2015

Milan, Italy

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3dneuroanatomy2015


 Abril


5th International Congress Biotechnologies for Spinal Surgery 2015

Berlin

08.04.2015 – 11.04.2015

www.biospine.org

Neurosurgical Society of America Annual Meeting

APRIL 12-15, 2015
Newport Beach, CA

WEB SITE: www.cns.org/meetings/
neurosurgical-society-america-annualmeeting


Asian Australasian Congress of Neurological Surgeons

15 – 18 April 2015

International Convention Centre Jeju, Jeju Island, Korea

More Information


universitypittsb1

 Course Directors

Carl Snyderman, MD, MBA
Paul Gardner, MD
Juan Fernandez-Miranda, MD
Eric W. Wang, MD

April 15-18, 2015: (Guest Faculty: Drs. Roy Casiano and Jacques Morcos)


5th International Course Basic Neurosurgical Approaches

Arezzo, Tuscany, Italy

15.04.2015 – 17.04.2015

Invitation || Program || Brochure


The European Stroke Organisation Conference 2015

April 17, 2015 — April 19, 2015

Glasgow, UK

More Information


35th Workshop on Basic Techniques of Microsurgery

General Hospital Vienna, Medical University of Vienna

20.04.2015 – 22.04.2015

Program


SBNS Spring Meeting 2015

April 22, 2015 — April 24, 2015

Southampton, UK

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ONCO_20115

 


16th World Congress of Rhinology

April 30, 2015 — May 2, 2015

Sao Paulo, Brazil

More Information


 Mayo


eans2015skullbase


 83rd AANS Annual Meeting

May 2, 2015 — May 6, 2015

Washington DC, USA

More Information


83rd American Association of Neurological
Surgeons Annual Scientific Meeting

MAY 2-6, 2015
Washington, DC

WEB SITE: www.aans.org/Annual%
20Meeting/2015/Main/Home.aspx


ESPN Course 2015

May 4, 2015 — May 8, 2015

Segovia, Spain

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 XIII Congreso Internacional de Neurocirugia, México – Mayo 2015

Mayo 19 al 23, 2015

Sede: Av. Baja Velocidad No. 284, San Jerónimo Chicahualco, Metepec, Estado de México.

Paises invitados: Brasil. Argentina. Colombia

Avales académicos: Sociedad Mexicana de Cirugía Neurológica S.A., Universidad Autónoma del Estado de México , Colegio de Enfermeras del Estado de México Hospital de Alta Especialidad Centro Medico ISSEMyM Toluca Mexico

Más informacion


 



31st Annual Meeting of the Cervical Spine Research Society – European Section

London/GB

27.05.2015 – 28.05.2015

Further Information

Announcement || www.csrs-london2015.com


Junio

EANS HandsOn Course – Lyon

June 1, 2015 — June 5, 2015

Lyon, France

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Microscopic and Endoscopic Approaches to the Skull Base

June 3, 2015 — June 5, 2015

Strasbourg, France

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Overview in Neurooncology. Current state in te management of brain gliomas and new perspectives. Ten Years of Neurosurgery in Ciudad Real

Ciudad Real
13 y 14 de junio

Programa


 

2nd International Endoscopic Skull
Base Course

JUNE 17-19, 2015
Amsterdam,
Netherlands
WEB SITE: www.cns.org/meetings/


IV International Conference on Interventional Pain Medicine & Neuromodulation & VIII Hands-on Cadaver Workshop

June 18, 2015 — June 20, 2015

Torun, Poland

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NSpine 2015: the Craniocervical to Cervicothoracic Spine

June 22, 2015 — June 28, 2015

Nottingham, UK

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4th International Moyamoya Meeting

JULY 2-4, 2015

Berlin, Germany

WEB SITE: www.cns.org/meetings/
4th-international-moyamoya-meeting


 2015 Symposium

June 28 – July 1, 2015

Santa Fe, New Mexico

Scientific Sessions: Santa Fe Convention Center

http://www.nationalneurotraumasociety.org/symposium/symposium-current/


 Agosto

XXIII Congreso Mexicano de Cirugía Neurológica “POR LA EXCELENCIA EN CIRUGÍA NEUROLÓGICA”

Puerto de Mazatlán del 2 al 7 de agosto del 2015


 

universitypittsb1

 Course Directors

Carl Snyderman, MD, MBA
Paul Gardner, MD
Juan Fernandez-Miranda, MD
Eric W. Wang, MD

August 16-19, 2015: (Guest Faculty: Drs. James Evans and Marc Rosen)

zurich23

 


WFNS – 15th Interim Meeting of the World Federation of Neurosurgical Societies 

SEPTEMBER 8-12 | 2015

Rome-Italy

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65th CNS Annual Meeting

September 26, 2015 — September 30, 2015

New Orleans, Louisiana, USA

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EANS 2015 Annual Meeting

October 18, 2015 — October 21, 2015

Madrid, Spain

More Information


 

senroctubre


5th ISIN Congress and Educational Course

November 9, 2015 — November 14, 2015

Rio de Janeiro, Brazil

More Information


 


universitypittsb1

 Course Directors

Carl Snyderman, MD, MBA
Paul Gardner, MD
Juan Fernandez-Miranda, MD
Eric W. Wang, MD

November 18-21, 2015: (Guest Faculty: Drs. Franco DeMonte and Ehab Hanna)


2016

66th CNS Annual Meeting

September 24, 2016 — September 28, 2016

San Diego, California, USA

More Information


12th EANO Congress

October 13-16 2016
Heidelberg, Germany

More information

2017

Agosto

WFNS 2017

 

Pérdida de oportunidad en el diagnóstico y tratamiento de un cáncer cerebeloso

La Sección Primera de la Sala de lo Contencioso-Administrativo del Tribunal Superior de Justicia de La Rioja ha estimado parcialmente el recurso interpuesto por un paciente contra la resolución dictada por la Consejería de Salud del Gobierno de la Rioja que desestimó la reclamación de aquel, derivada de la asistencia sanitaria recibida en el diagnóstico y tratamiento de un tumor cerebeloso, solicitando una indemnización por importe de 222.121,43 euros.

El paciente fue valorado en su centro de salud en 10 ocasiones entre el día 06/10/2005 y el 10/07/2007. El día 07/07/2007 sobre las 13:40 horas acudió al servicio de urgencias por un cuadro de vómito acompañado de cefaleas, sudoración, estado presincopal y dolor de cabeza. Refirió antecedentes de cefaleas de repetición. Las exploraciones y pruebas complementarias fueron normales. Se pautó analgesia y se derivó al paciente a control por su médico de cabecera si bien con una recomendación de derivación a consulta de neurología. El paciente acudió de nuevo a urgencias el mismo día 7 de julio sobre las las 23:02 horas con un cuadro de similares características. En este caso se recomendó el mismo tratamiento farmacológico, observación domiciliaria y volver de nuevo al servicio de haber un empeoramiento.

El día 10 acudió al neurólogo. En la anamnesis el paciente refirió que la cefalea episódica había cambiado haciéndose continua y presentando a la exploración física discreta dismetría en la prueba dedo-nariz, que no había sido objetivada en las exploraciones previas realizadas en otros hospitales públicos.

Se practicó una resonancia magnética craneal que informó de tumoración de gran tamaño (45 mm de diámetro) en fosa posterior, en lóbulo izquierdo de cerebelo, introduciéndose en IV ventrículo, produciendo hidrocefalia triventricular. El paciente fue intervenido quirúrgicamente el día 09/08/2007 de un astrocitoma juvenil quístico del cerebelo, siendo derivado a Logroño para continuar seguimiento por los servicios de Rehabilitación, Oncología y Neurología de su zona.

De la prueba practicada la Sala concedió mayor importancia al informe emitido por el perito de la parte demandante, quien consideró que tras diversas asistencias dependientes del Servicio Riojano de Salud no se consideró la posibilidad diagnóstica ni terapéutica adecuada. No se consideró la realización seriada y continua de pruebas complementarias tal y como indican los protocolos de actuación en pacientes con cefaleas y otros síntomas de repetición, ya que con signos y síntomas de alarma, los protocolos y documentos de consenso recomiendan realizar pruebas diagnósticas y de seguimiento de manera protocolizada. Lo cual implica que no se han aportado los medios materiales y humanos disponibles para llegar a un correcto diagnóstico y pronóstico de la patología.

Ello ha determinado un daño desproporcionado, un error (diagnóstico), una falta de estratificación del riesgo y un error / retraso (en el tratamiento), lo que ha conllevado a un periodo en el que el proceso tumoral se encontró más avanzado y el estado clínico del paciente más deteriorado. Ello implica una pérdida de oportunidad de una terapia que hubiese conllevado una posibilidad de curación, de mejorar el cuadro, la evolución y/o la calidad del informado.

La Sala, como decíamos, estimó como más ajustadas a la realidad médica y jurídica, el informe del perito de la parte actora, porque de los datos obrantes en el expediente, se infiere que ante los dolores de cabeza de carácter reiterativo, se tenía que haber enviado al servicio de neurología

En consecuencia, la Sala consideró que se había producido un error médico con la consiguiente pérdida de oportunidad terapéutica, concediendo una indemnización en concepto de daño moral por importe de 40.000  euros.

Update: Choroid plexus cyst of the third ventricle

Choroid plexus cyst of the third ventricle

J.Sales-Llopis

Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain

Choroid plexus cysts are frequent benign intraventricular lesions that infrequently cause symptoms, usually in the form of obstructive hydrocephalus 1).

Difficult to detect on routine investigations and may lead to the wrong choice of treatment.

These instances are even less common in the adult population.

Although these lesions may float freely within the ventricle leading to intermittent obstruction of the cerebrospinal fluid (CSF) circulation at variable points in a single patient, such a phenomenon has only been documented using cranial ultrasonography and observed intraoperatively by Azab et al. 2).

When warranted, treatment seeks to reestablish cerebrospinal fluid flow and does not necessarily require resection of the cyst itself. Hence, endoscopic exploration of the ventricles with subsequent cyst ablation is the current treatment of choice for these lesions.

The extension of the cyst and whether the hemisphere involved is dominant or not, determines the ideal endoscopic trajectory 3).

Case Reports

1998

In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ballvalve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. According to the literature this case is only the third ever described in a child 4).

2001

A 53-year-old woman with a history of hypertension who sustained a blunt traumatic injury to the occipital region and subsequently developed a progressively worsening right-sided headache. Radiological examinations over the next 2 years revealed an enlarged right lateral ventricle and, ultimately, a choroid plexus cyst in its anterior and middle third, near the foramen of Monro, which is a rare location for these lesions. The cyst was removed en bloc, and follow-up examinations showed a significant improvement in her headache and a minimal differences in size between right and left ventricles 5).

2002

Unusual small choroid plexus cyst obstructing the foramen of monroe 6).

2007

A 2-year-old boy. The patient presented with markedly declining mental status, vomiting, and bradycardia over the course of several hours. Computed tomography scans demonstrated enlarged lateral and third ventricles with sulcal effacement, but no obvious mass lesions or hemorrhage. There was no antecedent illness or trauma. A right frontal external ventricular drain was placed in the patient, resulting in decompression of only the right lateral ventricle. Magnetic resonance (MR) imaging demonstrated a lobulated cyst arising from the choroid plexus of the left lateral ventricle and herniating through the foramen of Monro into the third ventricle, occluding both the foramen of Monro and the cerebral aqueduct. The patient underwent an endoscopic fenestration of the cyst, and histological results confirmed that it was a choroid plexus cyst. Postoperative MR imaging showed a marked reduction in the cyst size. The cyst was no longer in the third ventricle, the foramen of Monro and the aqueduct were patent, and the ventricles were decompressed. The patient was discharged home with no deficits. This case is illustrative because it describes this entity for the first time, and more importantly highlights the need to obtain a diagnosis when a patient presents with acute hydrocephalus without a clear cause 7).

2008

A 3-year-old female child presented with rapid loss of consciousness for the first time. Computed tomography and magnetic resonance imaging scans only showed triventriculomegaly. Endoscopy revealed a cyst of the third ventricle, which was excised, leading to good recovery 8).

2009

11-week-old girl presented to the emergency department with a 1-day history of projectile vomiting, lethargy, and dysconjugate gaze. Hydrocephalus was confirmed on head CT. During hospitalization, the symptoms resolved with a decrease in ventricular size. One week later, the patient again presented with similar symptoms, and MR images with 3D-constructive interference in steady state sequences revealed that a cyst was blocking the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with resolution of hydrocephalus and symptoms 9).

2011

A patient was seen in the emergency department with fevers, acute onset of headaches, and lethargy. Computed tomography demonstrated dilated lateral and third ventricles with a relatively normal-sized fourth ventricle. An external ventricular drain was placed. Despite decompression of the lateral ventricles, follow-up magnetic resonance imaging demonstrated a dilated third ventricle with a possible thin-walled mass extending from the foramen of Monro into the posterior portion of the third ventricle. The patient subsequently underwent endoscopic fenestration of the cyst with endoscopic third ventriculostomy. Although two other cases of symptomatic choroid plexus cysts of the third ventricle have been previously reported in children, our paper highlights the possibility of endoscopic cyst fenestration together with a third ventriculostomy as a treatment option in cases where the cyst extends into the posterior third ventricle. Despite adequate decompression, we were concerned that due to CSF pulsations the remnant cyst wall could result in acute aqueduct obstruction and subsequent hydrocephalus 10).

2013

In a case of a 25-year-old female patient with a 3-week history of intermittent headaches, the computerized tomography (CT) of the head detected supratentorial hydrocephalus, with enlargement of the lateral and third ventricles. Magnetic resonance imaging revealed a homogeneous cystic lesion in the third ventricle. A right-sided, pre-coronal burr hole was carried out, followed by endoscopic exploration of the ventricular system. A third-ventriclostomy was performed. With the aid of the 30-degrees endoscope, a cyst arising from the choroid plexus was visualized along the posterior portion of the third ventricle, obstructing the aqueduct opening. The cyst was cauterized until significant reduction of its dimensions was achieved and the aqueduct opening was liberated. Postoperative recovery was without incident and resolution of the hydrocephalus was confirmed by CT imaging. The patient reports complete improvement of her headaches and has been uneventfully followed since surgery. The video can be found in http://youtu.be/XBtj_SqY07Q. (http://thejns.org/doi/abs/10.3171/2013.V1.FOCUS12332). 11).

2015

Azab et al. endoscopically treated a case of third ventricular choroid plexus cyst in a 9-year-old boy who presented with headaches and disturbed conscious level. He underwent a transventricular approach through a single burr hole.

During the procedure, the cyst was noted to intermittently herniate into the lateral ventricle and recede back through the foramen of Monro. Endoscopic ablation of the cyst was achieved and followed by endoscopic third ventriculostomy (ETV). The patient made an excellent recovery after the procedure 12).

1) van Baalen A, Stephani U. Flexible and floating choroid plexus cyst of the third ventricle: an ultrasonographic video documentation. Childs Nerv Syst. 2007 Feb;23(2):259-61. Epub 2006 Nov 15. PubMed PMID: 17106747.
2) , 12) Azab WA, Mijalcic RM, Aboalhasan AA, Khan TA, Abdelnabi EA. Endoscopic management of a choroid plexus cyst of the third ventricle: case report and documentation of dynamic behavior. Childs Nerv Syst. 2015 Feb 26. [Epub ahead of print] PubMed PMID: 25715839.
3) Xi-An Z, Songtao Q, Yuping P. Endoscopic treatment of intraventricular cerebrospinal fluid cysts: 10 consecutive cases. Minim Invasive Neurosurg. 2009 Aug;52(4):158-62. doi: 10.1055/s-0029-1239587. Epub 2009 Oct 16. PubMed PMID: 19838968.
4) Parízek J, Jakubec J, Hobza V, Nemecková J, Cernoch Z, Sercl M, Zizka J, Spacek J, Nemecek S, Suba P. Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child. Childs Nerv Syst. 1998 Dec;14(12):700-8. Review. PubMed PMID: 9881622.
5) Hanbali F, Fuller GN, Leeds NE, Sawaya R. Choroid plexus cyst and chordoid glioma. Report of two cases. Neurosurg Focus. 2001 Jun 15;10(6):E5. PubMed PMID: 16724823.
6) Radaideh MM, Leeds NE, Kumar AJ, Bruner JM, Sawaya R. Unusual small choroid plexus cyst obstructing the foramen of monroe: case report. AJNR Am J Neuroradiol. 2002 May;23(5):841-3. PubMed PMID: 12006289.
7) Nahed BV, Darbar A, Doiron R, Saad A, Robson CD, Smith ER. Acute hydrocephalus secondary to obstruction of the foramen of monro and cerebral aqueduct caused by a choroid plexus cyst in the lateral ventricle. Case report. J Neurosurg. 2007 Sep;107(3 Suppl):236-9. PubMed PMID: 17918533.
8) Kariyattil R, Panikar D. Choroid plexus cyst of the third ventricle presenting as acute triventriculomegaly. Childs Nerv Syst. 2008 Jul;24(7):875-7. doi: 10.1007/s00381-008-0622-8. Epub 2008 Apr 18. PubMed PMID: 18421462.
9) Filardi TZ, Finn L, Gabikian P, Giussani C, Ebenezer S, Avellino AM. Treatment of intermittent obstructive hydrocephalus secondary to a choroid plexus cyst. J Neurosurg Pediatr. 2009 Dec;4(6):571-4. doi: 10.3171/2009.7.PEDS08247. PubMed PMID: 19951046.
10) Eboli P, Danielpour M. Acute obstructive hydrocephalus due to a large posterior third ventricle choroid plexus cyst. Pediatr Neurosurg. 2011;47(4):292-4. doi: 10.1159/000336046. Epub 2012 Feb 22. PubMed PMID: 22378105.
11) de Lara D, Ditzel Filho LF, Muto J, Prevedello DM. Endoscopic treatment of a third ventricle choroid plexus cyst. Neurosurg Focus. 2013 Jan;34(1 Suppl):Video 9. doi: 10.3171/2013.V1.FOCUS12332. PubMed PMID: 23282159.

New Book:Traumatic Brain Injury, Part I, Volume 127: Handbook of Clinical Neurology

Traumatic Brain Injury, Part I, Volume 127: Handbook of Clinical Neurology (Series Editors: Aminoff, Boller and Swaab)Traumatic Brain Injury, Part I, Volume 127: Handbook of Clinical Neurology (Series Editors: Aminoff, Boller and Swaab)

Price:$232.63

ADD TO SHOPPING CART

The Handbook of Clinical Neurology volume on traumatic brain injury (TBI) provides the reader with an updated review of emerging approaches to traumatic brain injury (TBI) research, clinical management and rehabilitation of the traumatic brain injury patient. Chapters in this volume range from epidemiology and pathological mechanisms of injury, and neuroprotection to long-term outcomes with a strong emphasis on current neurobiological approaches to describing the consequences and mechanisms of recovery from TBI. The book presents contemporary investigations on blast injury and chronic traumatic encephalopathy, making this state-of-the-art volume a must have for clinicians and researchers concerned with the clinical management, or investigation, of TBI.

  • Internationally renowned scientists describe cutting edge research on the neurobiological response to traumatic brain injury, including descriptions of potential biomarkers and indicators of potential targets for treatments to reduce the impact of the injury
  • Explores cellular and molecular mechanisms as well as genetic predictors of outcome
  • Offers coverage of various diagnostic tools – CT, MRI, DDTI, fMRI, EEG, resting functional imaging, and more
  • State-of-the-art traumatic brain injury management and treatment principles are presented for both civilian and military care

Product Details

  • Binding: Hardcover
  • 490 pages

Editorial Reviews

About the Author

Jordan Grafman, PhD, is director of Brain Injury Research at the Rehabilitation Institute of Chicago. Before joining RIC, Dr. Grafman was director of the Traumatic Brain Injury Research at Kessler Foundation. His investigation of brain function and behavior contributes to advances in medicine, rehabilitation, and psychology, and informs ethics, law, philosophy, and health policy. His study of the human prefrontal cortex and cognitive neuroplasticity incorporates neuroimaging and genetics, an approach that is expanding our knowledge of the impact of traumatic brain injury, as well as other diseases that impair brain function, such as stroke, multiple sclerosis and degenerative diseases. Dr. Grafman aims to translate his research into more effective, targeted rehabilitation to achieve the best outcomes for people with cognitive disabilities. Dr. Grafman’s background includes 30 years of experience in brain injury research. He has studied brain function in dementia, depression, and degenerative neurological diseases, as well as TBI. He has authored more than 300 research publications, co-editor of the journal Cortex, and provides peer review for numerous specialty journals. At the National Institutes of Health, he served as chief of the Cognitive Neuroscience Section at the National Institute of Neurological Disorders and Stroke. While in the US Air Force, he served at Walter Reed Army Medical Center as neuropsychology chief of the Vietnam Head Injury Project, a long-term study of more than 500 soldiers with serious injuries of the head and brain. He is the leading expert on the long-term effects of penetrating brain injuries in military personnel. His expertise includes the scope of challenges faced during recovery, including behavioral changes like aggression, late sequelae such as seizures, and the impact on TBI on family life and employment, and legal implications. He is an elected fellow of the American Psychological Association and the New York Academy of Sciences. Dr. Grafman is the recipient of many prestigious awards including the Department of Defense Meritorious Service Award, the National Institutes of Health Award of Merit, 2010 National Institutes of Health Director’s Award, and the Humboldt Reserach Award. He is a frequent speaker at national and international conferences. His expert opinion is often sought by national media on issues related to brain function and behavior, cognitive rehabilitation, and policy and legal issues related to brain-behavior research.

Tres pacientes renuncian a una mano inútil a cambio de una biónica

El uso de las prótesis inteligentes ha cruzado una nueva frontera: amputar una mano atrofiada para sustituirla por una biónica y ganar de esta forma movilidad. La revista The Lancet analiza en un artículo de su último número esta polémica y arriesgada estrategia, cargada de condicionantes éticos, que se ha empleado ya en tres personas (el primer caso es de abril de 2011 y el último de mayo de 2014). La conclusión, que exponen los responsables de estas intervenciones, es que la apuesta ha valido la pena.

En los tres pacientes, con lesiones para las que no existe tratamiento, “la reconstrucción biónica ha supuesto una forma de recuperar la función a la mano”, explican. Gracias a ello, han sido capaces de acometer tareas sencillas como verter agua de una jarra, recoger una pelota, usar una llave, cortar comida con un cuchillo o, con la ayuda de la otra mano, desabrochar un botón.

“Que yo sepa es la primera vez que se hace algo así; es un trabajo muy significativo y rompedor”, comenta José Luis Pons, del grupo de neurorehabilitación del Instituto Ramón y Cajal del CSIC. “Se trata de un paso muy importante”.

Lo habitual es partir de la falta de una extremidad. Y, ante esta circunstancia, recurrir a dispositivos que, a través de una sofisticada combinación de electrónica, informática, robótica y cirugía, traten de suplir algunas de las funciones de la pierna, brazo, pie o mano perdida y mejoren la calidad de vida del paciente al permitir manipular objetos o desplazarse.

En los casos incluidos en la revisión de The Lancet, sin embargo, los pacientes habían sufrido un accidente que no les había llevado a perder la mano, sino su función. Padecían desgarros en el plexo braquial, la red nerviosa que transmite las señales desde la columna hasta el hombro, y de la que depende la movilidad de todo el brazo. Como consecuencia de ello, eran incapaces de usar la mano, que tenían gravemente atrofiada.

Ante la falta de soluciones médicas, el equipo de Oskar Aszmann, del Laboratorio Christian Doppler para la recuperación de la Función de las Extremidades de la Universidad de Medicina de Viena (Austria), junto a ingenieros de la Universidad de Gotinga (Alemania) ofrecieron a estas personas la posibilidad de cortar la extremidad a la altura del antebrazo para sustituirla por una prótesis con la que ganarían funcionalidad.

La tecnología que se emplea no es nueva. Consiste en utilizar los impulsos eléctricos que contraen los músculos (en la jerga, la señal electromiográfica) para activar unos sensores que controlan los movimientos de la prótesis. De esta forma, el cerebro transmite al nervio la orden de activar un músculo que, a su vez, traslada la señal al sensor que activa el dispositivo.

Debido a la naturaleza de la lesión de los tres pacientes, los tejidos musculares estaban muy dañados por lo que los cirujanos tuvieron que modificar la técnica convencional empleada hasta el momento. Para conseguir una intensidad en los impulsos musculares suficiente como para activar los sensores de la prótesis, los investigadores tuvieron que trasplantar e inervar (conectar un nervio a un músculo distinto) tejidos musculares sanos en la zona de contacto con la prótesis.

Finalmente, cada paciente cuenta con dos grupos musculares activos capaces de interactuar con el dispositivo. Es decir, dos señales de control, lo que permite una habilidad en la mano artificial relativamente limitada (cada señal de control activa un movimiento).

“El hecho de que el mecanismo no ofrezca demasiada movilidad es un tema menor, siempre que aporte funcionalidad”, indica José Luis Pons. Este investigador, que ha participado en distintos proyectos de prótesis de este tipo (mioeléctricas), pone el acento en otras cuestiones. Por ejemplo, en el hecho de que esta estrategia implica asumir una decisión tan agresiva y radical como es la amputación y “descartar que en el futuro se pueda desarrollar alguna técnica que permita devolver la movilidad a la mano sin llegar a estos extremos”. “Es una decisión con muchas implicaciones éticas”, destaca.

En un comentario al trabajo, Simon Kay, el cirujano que practicó el primer trasplante de mano en el Reino Unido, plantea que tanto este como otros trabajos similares ofrecen nuevas posibilidades a los pacientes. Aunque cuestiona la validez de las prótesis, sobre todo, respecto a su uso a largo plazo. “La clave [del éxito] de estos dispositivos está en el uso continuado, y suele decaer con el paso del tiempo ya que son pesados, necesitan energía, suelen ser ruidosos y, cuando se averían, requieren personal especializado para arreglarlos”.