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Objective: The objective of this work is to assess the discrepancy in distance between the target chosen by magnetic resonance imaging (MRI) and the final electrode placement after intraoperative microrecording in patients submitted to deep brain stimulation (DBS) for alleviating the Parkinson's disease (PD)., Methods: Thirty patients with PD and motor complications were operated with stereotactic surgery by MRI and microrecording. In 19 patients, the target chosen was the subthalamic nucleus (STN) and in 11 others the target was globus pallidus internus (GPi). In this work it is considered that the electrode has a current field below usual parameters of 1.5 mm radius. Consequently, when the distance error between the final physiological target and the MRI target, is between 1.5 and 3 mm was considered as partial discrepancy and distances of 3 mm or more were considered as total discrepancy., Results: Partial discrepancy for STN and GPi were in 25 and 33% of the cases respectively and total discrepancy was 57 and 42% for each nucleus. The average distance error between both targets, final and image, for X stereotactic coordinate (mediolateral distance) was 1.54 mm for STN and 0.8 mm for GPi. The average distance for Y coordinate (anteroposterior distance) was 2.3 mm for STN and 2.2 mm for GPi., Conclusion: There is a significant discrepancy between the final physiological target after microrecording and the target chosen by MRI during surgery for alleviating PD that may induce variations or absence of clinical efficacy in parkinsonian patients submitted to the DBS surgery. Authors suggest the necessity of the microelectrode recording in order to reach the surgical target with the best clinical condition.

We describe a previously diagnosed tuberous sclerosis patient that arrived to the hospital with an intracerebral hemorrhage whose origin was an arteriovenous malformation (AVM). A craniectomy was performed and the hematoma was evacuated with the alleviation of the patient. Although the association between tuberous sclerosis and intracerebral hemorrhage is known in the literature it has never been described associated with an AVM.

We review the present status of surgery for Parkinson's disease. Surgical options for Parkinson's disease are rapidly spanding. The main objectives of surgical techniques are to restore the dopaminergic deficit in the striatum (transplantation) and to normalize the neuronal activity of the subthalamic-pallidal circuit (pallidotomy and deep brain stimulation). Whereas cell transplantation is still considered an experimental procedure, ablative procedures and deep brain stimulation are widely used. Both types of surgical procedures are supported by strong scientific data. However, much work remains to be done in order to understand several aspects not clearly elucidated at present. The results and current indications for pallidotomy and deep brain stimulation are analyzed.

Background: There is a renewed interest in pallidotomy as a treatment for complicated Parkinson's disease (PD)., Aim: To present the clinical results as well as the analysis of prognostic factors obtained in 28 patients with PD and motor complications submitted to pallidotomy and followed by one year (n = 28) and 2 years (n = 12)., Results: The total motor score (Unified Parkinson's Disease Rating Scale [UPDRS]) in the off state improved by 33 and 23% at one and two years, respectively (p < 0.01). All the cardinal signs of the disease were significantly improved (p < 0.01): tremor (92%), rigidity (67%), bradykinesia (46%) and axial symptoms (21%). A slight tendency to worsening in axial symptoms was observed. Dyskinesias disappeared in all but one patient. The Schawb & England Scale in off was improved by 21%. No improvement in the non-operated side was observed. The subgroup of patients with an improvement of less than 30% in the UPDRS was older than the one with larger clinical benefit. The observed tendency to worsening in the total motor score was related mainly to the progression of the symptoms in the non-operated side. Complications were mild and transient., Conclusions: Pallidotomy is a relatively safe and effective therapeutic option for complicated PD patients. An adequate selection of patients is necessary, since efficacy is partial and limited to one hemibody.

Stereotactic surgery for Parkinson's disease (PD) has regained interest due to the recently described hyperactivity of the subthalamic-pallidal pathway. Many patients suffering from complications associated with the chronic use of levodopa may benefit from surgical treatments. There are different surgical targets and techniques (ablative and deep brain stimulation). The choice of one particular target and technique relies on the clinical symptoms of the patient. The risk/benefit ratio of surgery is related to the careful selection of patients and the technical accuracy. Intraoperative microrecording is considered the best method to avoid side effects and partial results. A series of patient's selection and follow-up assessment criteria are proposed.

Spinal epidural abscesses (SEA) are an infrequent disease which should be suspected in patients with spinal and/or radicular pain, neurologic deficits and fever. We present 3 patients with SEA (two lumbar and one dorsal) who recovered following exclusively antibiotic treatment. The complete disappearance of the abscess was proven by magnetic resonance. Patients with SEA and discrete, stable deficits and with known germs, are susceptible to medical and not surgical treatment.

In rats with a lesion of the dopaminergic nigrostriatal pathway induced by 6-hydroxydopamine (6-OHDA), the histologic and functional viability of the striatal implant of fetal mesencephalic substantia nigra has been demonstrated. In the same model, the implant of adrenal medulla is also effective but less lasting. In monkeys with parkinsonism induced by MPTP there are suggestions of effectiveness of the fetal mesencephalic implant and also of other tissues such as placenta and sympathetic ganglion or sural nerve. Now the possibility of a better functional recovery by acting on the neuronal growth factors is being evaluated. In patients with Parkinson's disease, the accumulated experience indicates that 32% are improved with adrenal medulla implant, but the best candidates are those who also benefit from the available drug therapy without the risks of surgery. The implant of fetal tissue has been carried out in about 90 patients, with very variable results. In the most thoroughly investigated patients the improvement has been moderate. The future research points to the identification of the factors that control and regulate striatal reinnervation and the use of genetically determined cells. That would permit a more precise reposition of the biochemical deficiency in Parkinson's disease, without the ethical and practical problems derived from the use of fetal tissue.

The authors evaluate subarachnoid hemorrhage (SAH) in the autonomous community of Navarra during 3 years. Ninety-five patients were evaluated (mean age (MA) 51.47 years). They were divided in groups depending on angiographic findings. Thirty-four had an intracranial aneurysm (MA 5%.23 years) with a female preponderance (66.7% vs 33.3%). Eight patients had an arteriovenous malformation (AVM) (MA 33.7 years); in 35 patients the angiographic study was negative (MA 44 years) and in 18 angiography was not carried out (MA 66.66 years). Computed tomography was positive in 40% of patients and there was a correlation between the amount of blood in the cisterns and poor outcome of patients after 6 months. In the discussion, the authors emphasize the high incidence of SAH without angiographic findings.