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Introduction: Craniofacial dysplasia is a benign condition in which bone is replaced by structurally defective fibro-osseous tissue. It is caused by a postzygotic activating mutation of the gene encoding the α subunit of the stimulatory G protein. Imaging studies suggest the diagnosis, which must be confirmed through pathology. There is currently no specific drug treatment available. Objective: To report a clinical case of craniofacial monostotic fibrosis. Clinical case report: We report the case of a 50-year-old female patient who was treated in the Neurosurgery service at the Neurology and Neurosurgery Institute in October 2022. In 2019, she began to present inflammation of the lower right eyelid, she was first seen by an ophthalmology service where she was treated for a probable allergic condition. Six months ago she noted volume increase in her right eyeball plus a decrease in ipsilateral visual acuity. In the simple skull tomography study, a hyperdense image was observed that could be correlated to a fibrous lesion. The surgical procedure was performed and the anatomopathological study with hematoxycillin and eosin staining revealed curved, disorganized bone trabeculae with background of fibrous tissue. Conclusions: Craniofacial monostotic fibrous dysplasia is a rare disease with slow progression and low incidence, which requires efficient multidisciplinary diagnostic analysis for its management. Early diagnosis and optimal adjustment of treatment are important to obtain favorable surgical and clinical results. [ABSTRACT FROM AUTHOR]

El profesor José Rafael Estrada González es considerado el "Padre de la Neurología cubana". Su formación como neurólogo y neuropatólogo en el Massachusetts General Hospital de EE. UU., después de graduarse como médico en la Universidad de La Habana, junto a su reconocido intelecto, hicieron que fuera pionero en el desarrollo de la Neurología en el país desde comienzos de la década de los cincuenta. Al triunfo de la Revolución, el Ministerio de Salud Pública lo designó para organizar los servicios neurológicos y neuroquirúrgicos, junto a los escasos especialistas de Neurocirugía que quedaron en el país. Fundó el Hospital de Neurología en enero de 1962, en el puesto de director, que a partir de 1966 pasó a ser el Instituto de Neurología y Neurocirugía. Se distinguió como neurólogo, docente e investigador, y sus enseñanzas se han extendido no solo a las generaciones de neurólogos y neurocirujanos, sino también a toda la comunidad de neurocientíficos que formó. El presente trabajo tuvo como objetivo describir algunos aspectos de la trayectoria del Prof. José Rafael Estrada González en lo que concierne a su vida personal, como médico, científico, educador y revolucionario. Professor José Rafael Estrada González is considered to be the father of Cuban Neurology. His training as a neurologist and neuropathologist at the Massachusetts General Hospital in the USA, after graduating as a doctor at the University of Havana, together with his renowned intellect, made him a pioneer in the development of Neurology in the country from the beginning of the fifties. At the triumph of the Revolution, the Ministry of Public Health appointed him to organize neurological and neurosurgical services, alongside the few neurosurgery specialists that remained in the country. He founded the Neurology Hospital in January 1962, in the position of director, which from 1966 became the Institute of Neurology and Neurosurgery. He distinguished himself as a neurologist, professor, and researcher, and his teachings have extended not only to generations of neurologists and neurosurgeons, but also to the entire community of neuroscientists that he trained. The present paper aimed to describe some aspects of Prof. José Rafael Estrada González path in regard to his personal life, as a doctor, scientist, professor and revolutionary. [ABSTRACT FROM AUTHOR]

Antes del triunfo de la Revolución en enero de 1959, la Neurología en Cuba no había alcanzado ningún desarrollo como especialidad médica. En aquellos momentos la dirección del país buscó asesoría con el objetivo de desarrollar estas especialidades e hizo énfasis inicialmente en la formación de los recursos humanos necesarios. Se designó al profesor José Rafael Estrada González (1921-1991), un médico joven graduado en 1946 y con una sólida formación de posgrado en Neurología y Neuropatología, para dirigir esta tarea, que comenzó con la inauguración del Hospital de Neurología el 29 de enero de 1962, que después pasó a ser Instituto de Neurología y Neurocirugía en 1966. El objetivo del presente trabajo fue describir la labor del profesor Rafael Estrada como director fundador del Instituto de Neurología y Neurocirugía, y su papel en la extensión de la atención neurológica y neuroquirúrgica en el país. Before the triumph of the Revolution in January 1959, Neurology in Cuba had not reached any development as a medical specialty. At that time, the country's management sought advice in order to develop these specialties and initially emphasized the training of the necessary human resources. Professor José Rafael Estrada González (1921-1991), a young doctor graduated in 1946 and with solid postgraduate training in Neurology and Neuropathology, was appointed to lead this task, which began with the opening of the Neurology Hospital on January 29, 1962, which later, in 1966, became the Institute of Neurology and Neurosurgery. The objective of this article was to describe the work of Professor Rafael Estrada as founding director of the Institute of Neurology and Neurosurgery, and his role in the extension of neurological care and neurosurgical care in the country. [ABSTRACT FROM AUTHOR]

Objective: To describe the most important aspects of Harvey Cushing's life, as well as, his work "Surgery of the head". Results: Graduated from medical school in 1895, after traveling to foreign lands, Cushing proposed to divide brain surgery from the rest of surgeries. He is considered the founder of Neurosurgery as a specialty. His merits were recognized with several decorations and awards. His scientific publications were very prolific, integrated by 24 books and 658 articles. One of his centennial writings is "Surgery of the head", which has a relevant validity. Impressive scientific analyses and medical illustrations can be seen in the text. Conclusions: Harvey Cushing was an American neurosurgeon of high international prestige. Among his main literary contributions "Surgery of the head" stands out, considered as the most complete text on the specialty, where he comprehensively dealt with all the basic aspects of Neurosurgery and, more than one hundred years after its publication and eighty years after his death, it still has a relevant validity. [ABSTRACT FROM AUTHOR]

Objective: To characterize the main variables of intracranial tumors through intraoperative ultrasound. Methods: Thirty-eight patients, who underwent multislice computed tomography of the skull, magnetic resonance imaging with tractography, prior to surgery, were included. The intraoperative ultrasound equipment used was an Aloka alpha 5 Pro-Sound. The type and topography of the tumor, the characteristics of the ultrasound, the degree of resection and the evolution were studied. Results: The age range was between 19 years and 74 years. There was a predominance of lesions with high degree of malignancy (57.9 %). Glioblastoma multiform prevailed with 15 patients (39.5 %), followed by metastases and benign tumors with 7 cases each. All lesions were observed by ultrasound and in 34 cases (89.5 %) the edges were well defined. Total tumor resection was performed in 34 patients, 17 of them with localization in eloquent areas. The four partial surgeries were two lesions in motor areas, a bi-frontal butterfly wing glioma and a giant olfactory groove meningioma. Karnofski scale at 30 days was greater than preoperative in 35 cases (92.1 %). It remained the same in one patient and in two cases was lower. Conclusions: The use of intraoperative ultrasound allowed to characterize all lesions in real time. It was useful to plan the corticotomy and verify the level of the resection at all times. The clinical status and level of validity, according to Karnofski scale, improved in the majority of patients in the first 30 days. [ABSTRACT FROM AUTHOR]

Introduction: It provides a perspective on the publication of scientific articles about Neurology and Neurosurgery in Cuban medical journals during the period of activity of Revista Cubana de Neurología y Neurocirugía (RCNN: 2011 - 2017). Data are presented in relation to productivity, comparisons are made, and factors that could explain trends and recommendations are formulated. Development: The behavior for years of different modalities of scientific articles published in RCNN shows a curve with its upper phase during the period 2013-2015. With respect to the year 2015 there was a decrease close to a fifth and a third in 2016 and 2017, respectively. The main topics of the scientific articles are: Vascular Neurology (24%), Neuro-oncology (23%), Neuro-traumatology (13%), and Neuropsychology/Neuropsychiatry (13%). Neuropediatry scope was addressed in 23% of scientific articles (16.4%). When comparing types and themes of neuroscientific articles in RCNN with the set of Cuban medical journals not specialized in Neurology and Neurosurgery analyzed, it is observed that RCNN production is surpassed in almost one third in originals articles and even more so in case presentations. It was similar to the frequency of articles devoted to Vascular Neurology, Epilepsy, Neuro-oncology, Neuro-traumatology, and Neuropsychology/Neuropsychiatry. In other areas, RCNN was exceeded in more than twice as far as the production of scientific articles. Conclusions: The weakening of scientific potential can explain the findings. The dispersion of initiatives among so many specialtiesrelated journals, as well as methodological shortcomings and rigor in editorial politics, is worrisome. Specific strategies are recommended to stimulate the scientific potential and Cuban medical journals impact. [ABSTRACT FROM AUTHOR]

Objective: To assess basal characteristics and surgical outcome in patients with aneurismatic subarachnoid hemorrhage managed with one dynamic protocol based mostly on transcranial Doppler ultrasound. Methods: A descriptive longitudinal study was carried out in 233 patients with aneurismatic subarachnoid hemorrhages, who received neurosurgical clipping in the years 2006Â-2010 and were followed during one year. Results: Mean age was 49.19 years. Female were 66%. At the admission, 58.4% of cases were in grade 1 according to the modified scale of World Federation of Neurosurgical Societies (WFNS). Preoperatively 69.5% of patients become grade 1. Patients were mostly Fisher 3 according to CT scan results, and this was statistically associated with vasospasm. Angiographic vasospasm was present in 28.8% of the cases, but increased to 49.4% by using transcranial Doppler. In 25.8% of cases vasospasm was symptomatic, and 15.9% develop delayed ischemic deficit. Single aneurysms on the anterior Willis circle were most relevant statistically and accounted for 73.4% of the cases. Aneurysms were mostly of relatively small size, and in 79.4% of the patients they ranged between 4 and 10 mm. Outcome was favorable in 93%, and mortality was 4.29%. Outcome was significant associated with: neurological status at the admission, Fisher scale, numbers of aneurysms, vasospasm, and reÂ-bleeding. Most frequents surgical and medical complications were vasospasm, reÂ-bleeding, cerebral infarct urinary infection, hydrocephalus and intraoperative rupture. Conclusions: Compared with several series from specialized literature, outcome in this series was good. These suggest the utility of one dynamic protocol based on transcranial Doppler in patients with aneurismatic subarachnoid hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: To explore some opinions about handling of brain metastases as well as the decisions taking in punctual cases in a group of neurosurgeons, neurologists, radiotherapeutics and oncologists. Methods: It was carried out an exploratory study based in survey application to neurosurgeons, neurologists, radiotherapeutics and oncologists group. Opinions about treatment options in patients with brain metastases and treatment option selected in four problem cases were evaluated. The biggest number of brain metastases considered as reasonable to treat with radiosurgery and whole brain radiation therapy were tabulated. Also, the percent of test used to assess neurocognitive damage was determined. Results: 45 interviewed (62%) would not send patient to neurosurgery; 22 interviewed (30%) would not send patient to oncologists; 30 interviewed (41%) would send the patient directly at the radiotherapeutics, and 19 interviewed (26%) would not send patient to neurooncologists. Only 7 interviewed (10%) would send patients to all the specialties with statistical significance (p=0.001). About the use of whole brain radiation therapy like therapeutic modality, 52 interviewed (71%) considered that their use should be carried out in precise indications. In contrast, 12 specialists (16%) declared that it should be used in all cases. Current study showed preference of neurosurgeons than oncologists and radiotherapeutics to indicate radiosurgery. 38 interviewed (52%) ignore some tests used to assess neurocognitive damage and 6% interviewed would indicate none. Conclusions: Discrepancies among specialties to select best treatment modality and some positions don't correspond to current scientific evidence regarding brain metastasis management. We also intend to design future studies that involve all regions of the country for to obtaining more precise scientific evidence. [ABSTRACT FROM AUTHOR]

Objective: To identify prognostic factors in the selection of therapeutic modalities in patients with brain metastases according to the criteria of a group of Cuban specialists. Methods: It was carried out a descriptive study about prognostics factors related with selection of therapeutic modality in patients with brain metastases based in the application of a survey in a group of neurosurgeons, neurologists, radiotherapeutics and oncologists. It was estimate the graded of importance in the definition of therapeutic modality in a patient with brain metastases of the following factors: age, sex, Karnofsky scale punctuation, Glasgow scale punctuation, focal neurological deficit, histology, primary disease control, proliferative potential, number of brain metastases, moment of apparition, localization, mass effect, size, solidity, antecedents of steroid use and recursive partitional analysis. Results: 73 professionals were interviewed (23 neurosurgeons, 26 oncologists, 12 radiotherapeutics, and 12 neurologists). The average of years of experience in the handling of patients with brain metastases was 14. 8. 79% affirmed to have much, middle or some experience in the handled of these patients. In general, it was signaled the following factors within influent factors in the selection of a therapeutics modalities: Karnofsky scale punctuation, Glasgow scale punctuation, histology, number of brain metastases, localization, mass effect and size. It was large discrepancies according to the age and solidity. Conclusions: The opinions about prognosis factors of patient with encephalic metastasis have differences between specialties, as well as among the members of oneself specialty. In some punctual cases they are not in correspondence with the current scientific approaches. The prognostic index in patient with encephalic metastasis should not be interpreted in an isolated way. The heterogeneity of these patients imposes the realization of individualized prognostic index for each histology subtype. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical-pathologic and neuroimaging characteristics of brain metastases. Methods: It was done a retrospective longitudinal descriptive study from 1.01.2012 to 1.01.2014 according to clinical, anatomopathologic and neuroimaging variables from clinical histories of patients from Luis Diaz Soto Hospital and National Institute of Oncology and Radiobiology. The distributions of frequencies were analyzed to describe the qualitative variables and for quantitative variables with medium and range. The Fisher exact test was utilized with a confidence interval of 95 %. Results: 32 patients and 70 lesions were identified. The age average was 53.9 years. The most frequent localizations were lung (44 %), breast (22 %), colorectal (10 %) and prostate (6 %). Single lesions were predominant in 60 % of cases. Oligo-metastasis was more frequent in breast, colorectal and prostate (p=0.007). Average volume of metastasis was 8 cm3 (0.1-46 cm3). 88 % were solid lesions and 76 % were lesions with low surrounding edema. Mainly lesions were below de 5 cm3 originated in lung and breast (p=0.004), but local cerebral edema was more frequent in relation with this primary sites (p=0.000). Conclusions: It was found a strong association between the primary organ and these variables: form of presentation, sex, number of lesions, volume and surrounding edema. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical characteristic of brain metastases. Methods: It was done a retrospective longitudinal descriptive study from January 1 of 2006 at December 31 the 2008 according to demographic variables and other related with the primary cancer. All the death certificates were revising in bigger than 18 years with brain metastases in anyone of the causes of death. This information was paired with the databases of the National Registration of Cancer to look for information of the moment of the diagnosis. They were 359 cases reported, of which information was obtained in 245 clinical histories. The distributions of frequencies were analyzed to describe the qualitative variables, and average with range for quantitative variables. Results: 945 died by brain metastases were identified. The medium age was 65 years. The most frequent localizations were lung (41 %), breast (12 %) and prostate (11.3 %). Single brain metastases occurred in 50.6 % of the sample. The applied treatments were whole brain radiotherapy (48.2 %), single steroids (38.4 %), surgery (11 %) and chemotherapy (2.4 %). The halftime among the diagnosis of them brain metastases and the death was of 5.6 months. Death cause confirmation by autopsy was done in 29.4 % of the cases. Conclusions: The brain metastases presented from a similar way to that reported in other studies with the particularity of being presented a bigger number of these in the cases with diagnosis of head cancer and neck. [ABSTRACT FROM AUTHOR]

Introduction: Carotid-cavernous fistulae is an abnormal communication between the carotid artery and the cavernous sinus, it can be of spontaneous or traumatic origin and it can be classified in direct or indirect fistulae. Clinical case: Male patient, 62 years old, treated in neurosurgery service of University Hospital in Morón (Ciego de Ávila) with a diagnosis of direct traumatic carotid-cavernous fistulae. The treatment applied includes the intracavernous carotid trapping and vascular sacrifice technique. The results were satisfactory. Exophthalmos fully disappeared, but right amaurosis persist and a slight clinical recovery in left hemiparesis. Conclusions: The trapping and vascular sacrifice technique is a surgical option for selected patients with direct carotid-cavernous fistulae in hospital without endovascular treatment. [ABSTRACT FROM AUTHOR]

Introduction: Extraskeletal Ewing sarcomas are a rare type of soft tissue tumors and represent the two percent of neoplasm in adults. It is characterized by the aggressiveness, high incidence of local recurrence and metastases. Central nervous system affection is uncommon. Clinical cases: Two patients of 21 and 27 years old each are presented treated by the Neurosurgery service of the University Hospital "Manuel Ascunce Domenech" of Camagüey in 2012 and 2013. They complaint dorsal pain followed by a dorsal incomplete medullar compression syndrome. The Magnetic Resonance Imaging showed the presence of intraspine tumors, that's why surgical treatment was mandatory for decompression of neurologic structures and tumor removal. The anatomopathologic diagnosis suggests an extra skeletal Ewing sarcoma and inmunohistochemistry techniques confirmation were required. Two month after surgery, recurrence appeared with unfavorable clinic evolution. Multidrug chemotherapy did not control local reappearance of the disease. Conclusions: the highly malignance of this kind of tumor required wide removal, supported by transoperatory histopathology to guarantee surgery effectiveness, followed by multidrug chemotherapy to help systemic control and prevent recurrence. The key for better results are a precocious diagnosis before metastases appearance and a multidisciplinary multimodal treatment. [ABSTRACT FROM AUTHOR]

Introduction: Sacrococcigeal cordoma represents more than 50 percent of the cordomas. The total resection in block combined with radiotherapy in high dose has shown to prolong the recurrence. Clinical case: Male, 58 years old operated of sacrococcigeal cordoma is presented by means of total resection in block for posterior approach. The postoperative image studies confirmed the total removal. It presented cerebrospinal fistulae and local infection treated with spinal drainage and antibiotics. Also, transient urinary incontinence occurred for 6 months. After that he received cobalt radiotherapy. Until now he stayed asymptomatic and free of illness in resonance magnetic images. Conclusions: The best treatment options are obtained with a focus multidisciplinary, in specialized centers and with advanced neurosurgical and radiotherapy techniques. [ABSTRACT FROM AUTHOR]

Introduction: The inherent complexity of diseases demands a multidisciplinary attention to assure better results for patients. Intraspinal neoplasms are an example of this affirmation and however they don't have the highest frequency, the clinical and radiological characteristics could become in a challenge for medical staff. Objective: to present a patient with an uncommon lumbar intraspinal neoplasm. Clinical case: A 31 year old white male patient with an onset of back and sciatic pain and left leg paresthesias and signs of radicular entrapment of the fourth and fifth lumbar roots. Lumbar spine radiological study by computerized tomography and magnetic resonance imaging showed the presence of a neoplasm who invaded the spinal canal and infiltrated the third lumbar vertebral body. Surgical treatment was decided by a staff of orthopedics and neurosurgeons. A laminectomy of the second to forth lumbar vertebrae was made, total complete removal of the neoplastic lesion, curettage of the affected vertebral body, followed by vertebral fusion with spinous apophysis and Luque technique. The trans-operatory pathological diagnosis was Hodgkin lymphoma. The post-operatory follow up included hematology management with specific chemotherapy. The patient has a favorable evolution with two years of asymptomatic survival and without handicap. Conclusions: The precocious diagnosis of spine neoplasm toward an opportune and suitable treatment by a multidisciplinary team, assures the best results with a favorable repercussion in patients prognosis. [ABSTRACT FROM AUTHOR]

Objective: To asses surgical results in patients with anterior circulation intracranial aneurysms treated by two different approaches, the supraorbital keyhole and pterional craniotomy. Methods: A non-randomized surgical trial was carried out in which the patients was assigned to KHSO group if the approach selected was supraorbital Keyhole or CPT group if the approach was pterional craniotomy. Results: 125 cases were studied, 77 (61.60 %) in KHSO group and 48 (38.40 %) in CPT group. 153 aneurysmal sacs were treated, 93 in KHSO group and 60 in CPT group, 119 rupture (77.77 %) and 34 without rupture (22.23 %). Conclusions: There were no significant differences between the two groups. The supraorbital Keyhole is an alternative option in surgical treatment of anterior circulation intracranial aneurysms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe presentation clinical forms of chronic subdural hematoma in elderly persons. METHODS: A retrospective study was conducted at the Provincial Hospital of Quelimane (Mozambique) in a period of four years (June 2009 to June 2013) of all cases diagnosed as chronic subdural hematoma with axial CT scan. The variables studied were: sex, age, hematoma side, risk factors and presentation clinical forms. RESULTS: The study sample consisted of twelve patients with age between 60 and 82 years old. 58.3 % of cases have hematomas located in the left side. Most patients were male (75 %). Among the risk factors that preceded the disease head trauma was the most frequent (66.6 %). Alcoholism was detected in six patients (50 %) and oral anticoagulants treatment in five patients (41.6 %). Progressive headache was more frequent in chronic subdural hematomas clinical presentation (41.6 %). Less frequency was detected of mental confusion (25 %), motor deficit (16.6 %) and uncal herniation syndrome (16.6 %). CONCLUSIONS: The clinical presentations of chronic subdural hematoma can be variable. Recognition of classical forms and risk factors can influence in a positive way in early diagnosis of these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence in the last 5 years of occipitoatlantal dislocation, to analyze the kinematics that cause him, associated clinical manifestations and evolution of these patients after their admission in the hospital. Methods: An observational, descriptive, retrospective and transverse study was carried out of all patients with diagnosis of occipitoatlantal dislocation in the provincial Hospital of Quelimane in a five year period. The sample was constituted by 13 patients. The main clinical variables were related to each other. Results: Occipitoatlantal dislocation was presented with more frequency in the pediatric ages. The automobile accidents and falls of elevations were responsible for 76.8 % of the luxations. In 7 of the accident victims an II type luxation was diagnosed. Cardiorespiratory instability occurred in 5 cases. The clinical evolution was unfavorable in 76.8 % of the sample. Conclusions: The diagnosis and opportune treatment, as well as the appropriate use of the diagnostic tools can improve the results of these patients. [ABSTRACT FROM AUTHOR]

Introduction: Microendoscopic discectomy has been accepted for treatment of lumbar disc herniation since its introduction in the 1990s, but this technique has not been widely used for cervical spine disorders. Clinical cases: The first case is a female, white, 36 years old with bilateral C6 radiculopathy due to medial disk herniation in C5-C6 space. The second case is a male patient, white, 45 years old, with diffuse arm pain due to medial disk herniation in C5-C6 space and another right lateral disk herniation in C6-C7 space. Both cases were treated by cervical disc herniation using microdiscectomy guided by endoscopy. Conclusions: The procedure can be performed with great security and good outcome when the surgeon is specially trained and the patients are properly selected. [ABSTRACT FROM AUTHOR]

Objective: To show the clinical-surgical results related with two patients with Chiari I malformation and syringomyelia treated in Universitary Hospital "Manuel Ascunce Domenech" (Camagüey, Cuba) with reduced posterior fossa decompression focused mainly in achieving the restitution of normal cerebrospinal flow in the craniospinal union. Clinical cases: Two female patients with cervical unilateral pain, accompanied by motors and sensitive dysfunctions in the superior limbs are presented. Cranial and cervical magnetic resonance imaging demonstrated tonsils cerebellar herniation of more than 5 mm toward the spinal canal with cervical syringomyelia. Posterior fossa decompression was carried out in both cases. Clinical and radiological evolution was favorable. Conclusions: In the presented cases, good results have been achieved with the performance of posterior fossa decompression and high cervical laminectomy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the results of the application of ambulatory surgery for treatment of lumbar disc herniation in Camagüey. Methods: A cuasiexperimental investigation was carried out with patients treated by means of lumbar discectomy in an ambulatory way at the neurosurgery department in the "Manuel Ascunce Domenech" University Hospital in Camagüey from the first January 2010 up to December 31 2012. Patients that could not be located for an interview after two months minimum starting from the moment of the intervention were excluded. Using the statistical package S.P.S.S v 18.0 distribution of frequencies and percent's, median comparison test, ANOVA and binomial logistical regression was applied. Results: 80 patients were studied, most were males between 41 and 50 years, with disc herniation located at L4-L5 or L5-S1. A significant values reduction on visual analogical scale for lumbar pain, radicular pain and Oswestry's index after the treatment was proven. All patients referred high satisfaction with the ambulatory procedure. Necessity of hospital admission was related with postoperative complications and ambulatory treatment failure with low values on visual analogical scale for preoperative radicular pain. Conclusions: Ambulatory surgery for lumbar disc herniation is more efficient than the traditional method of hospitalization. The bases for success reside fundamentally on appropriate selection of patients, the correct estimation of anesthetic risk and performing a proper surgical technique. [ABSTRACT FROM AUTHOR]

Introduction: Schwannomas of the central nervous system usually originate from the vestibular nerve and occasionally from the trigeminal nerve. Those that originate within the cavernous sinus are extremely rare and the literature is scanty. Case report: We present the report of the first case managed at our neurosurgery service of Hospital México (Costa Rica). We review the pertinent anatomy, and also the pre and post-operatory images. Conclusions: Spheno-cavernous sinus schwannomas are rare and should surgically approach by trained surgeons with a great knowledge of microsurgical anatomy and skull base surgery and also with the availability of a microsurgical lab. [ABSTRACT FROM AUTHOR]

Objective: To analyze presentation and evolution of 26 adult's patients with spinal ependymoma assisted in Neurology and Neurosurgery Institute (La Habana, Cuba). Methods: A study of 26 patients with diagnosis of spinal ependymomas treated with microsurgical methods. Parameters such as clinical presentation and long time before diagnostic, radiographs characteristic, surgical resection strategy, postoperative results and prognostic factors were examined. Results: The age of patients was between 30 and 65 years, with 61.5 % between 41-50 years. Sensitivity disorders was the first symptoms and more persistent in admission in 21 patients (80.7 %). The majority of ependymomas occur in the filum terminal, conus and caudal equine region. The radical extirpation of the tumor was achieved in 22 patients. In only 2 cases there is evidence of recurrent and improves the outcome with radiation therapy. At a follow-up time, more than 80 % patients (20 cases) were functioning at a grade 1 of the McCormick Scale. Conclusions: The early diagnosis and the radical surgery of the tumor are decisive factors for minimum or null neurology morbidity. [ABSTRACT FROM AUTHOR]

Objective: To review the epidemiology, etiology, physiopathology, diagnosis and the treatment of brain abscess according to the current available evidence. Evidence acquisition: References were identified by PubMed search of last five years publications with English term: "Brain abscess". Results: Brain abscess constitutes a focal and dynamic form of intracranial suppuration that represents a medical emergency. With high incidence rates in developing countries, it is a global health problem that carries high morbidity, mortality and economic burdens for the health service. Mortality trends for this cause have diminishes notoriously from 50 % to 20 % and even more, thanks to the introduction of the computerized tomography, allowing earlier and more precise diagnosis and location. Overall, with the advent of antibiotics therapies, Streptococcus spp have become the commonest isolated organisms. Etiologic distinction can be made taking into account the abscess origin and the patient immune state. Currently the most important diagnostic tools are the imaging modalities despite clinic and raised serum markers high suspicious index. Its management requires a multidisciplinary approach. In this review are provided the epidemiology, physiopathology, etiology, clinical context, diagnosis, treatment, mortality trends and prognosis of brain abscesses. Conclusions: Brain abscess continued to be a serious entity with high mortality rates, from which is expected a more difficult treatment, due to the raising of inmunocompromised and elderly population. [ABSTRACT FROM AUTHOR]

A review was carried out about the Cuban neurosurgery history. The key contribution of Carlos M. Ramírez Corría, father of Cuban neurosurgery, was highlighted. Also was considered the involvement of relevant neurosurgeons until now, and educational and internationalism contribution. [ABSTRACT FROM AUTHOR]

Objective: To evoke some remarkable aspects of Professor Carlos Manuel Ramírez Corría life (February 24 of 1903- March 27 of 1977) Development: Professor Carlos Manuel Ramírez Corría, the first president of Cuban Society of Neurology and Neurosurgery, generate various projects related with family, sciences, education, social development and politics. He guided Cuban neurosurgery to creep, and in 1947 it began to run with the foundation of the first neurosurgery service in the "Calixto García" Hospital. Also he promotes stereotaxic, neuroendoscopy, reduced access surgery, and models for neurosurgery training. Conclusions: A teacher like Ramírez Corría must live between us because we repeat the anecdotes related with him and the influence in our capacity of thinking, in our perspective of life, in the way of our work. [ABSTRACT FROM AUTHOR]

Introduction: Lumbosacral mielomeningocele is an affection taken place by defect in the closing of the tube neural in the first weeks of the pregnancy. The natural course of this illness is toward the death for infection of the central nervous system or toward a degree of inability of motor and sensitive function. Diverse clinical forms of this congenital malformation have been described and the diagnosis is based on the physical exam and radiographic and neurophysiologic studies. It is very important to know the content of the hernial sack and to determine the surgery type to carry out. Case report: In our case he had to be intervened surgically only according to physical exam and the simple radiographic study of the lumbosacral column due to the economic impossibility of the parents of carrying out the rest of the complementary exams. A magnified dissection of the roots lumbosacral housed in the hernial sack with reinstatement to the channel vertebral and repair of the cutaneous plane muscle was done. The evolution was satisfactory, and no hydrocephaly occurred in postoperatory 6 months period. Conclusions: It was highlighted the importance of early neural tube defect reparation, for avoiding complications and death. [ABSTRACT FROM AUTHOR]

Objective: Our interest is to investigate through the history of our specialty by the review of bibliographical sources and documents in prestigious provincial, national and international institutions related fundamentally to the neurosciences. Development: Skull trepanation is the most ancient surgical procedure that we know. The first skull trepanations were found in Peru 500 or more years B. C. Since then there's a long way about neurosurgical report cases in the history of humankind. In Cuba since the first half of the XIX century began to appear articles about patient with neurological pathologies, but it was not until 1891 that the fact of a neurological procedure was published in the Cuban medical press as a remarkable deed. We searched about the first work of scientific character, appeared in the Cuban medical literature dealing with a procedure on the brain. His author is Dr. Manuel Moreno de La Torre and the clinical discussion of the case, and the details of surgical procedure are in volume 17 of the magazine "Crónica Médico-Quirúrgica de la Habana" of 1891 under the title· "Abceso cerebral, trepanación, curación, recidiva y muerte". Conclusions: We hope that our investigation will be a source of motivation for doctors and historians to go deep in the roots of each of the medical specialties, a lovely and instructive way to respect our predecessors. [ABSTRACT FROM AUTHOR]

Objective: A descriptive study was carried out about facts related with the neurosurgery practice in Mali. Methods: A descriptive study about all patients treated with neurosurgery in Gabriel Touré Hospital (Bamako, Mali) between 2002 to 2004 related with diseases detected, age groups of patients and mortality. Qualitative investigation techniques were applied under participative observation perspective. Results: 348 patients received neurosurgery treatment in this period, general mortality was 6.3%. A chronicle was presented about history of neurosurgery assistant in Mali and some particularities of neurosurgeons job in this country. Conclusions: Cuban neurosurgery is an essential part of health help of Cuba to Mali, and in same time these interrelations have great impact in professional and human side of neurosurgeon. [ABSTRACT FROM AUTHOR]

Introduction: Spinal schwannomas are 25 % of all primary intraspinal tumors. Nevertheless, cyst schwannomas are rare. Case report: Male white patient, 60 years old with complaints of severe lumbar pain irradiated to left inferior extremity by the posterior area of thigh and leg associated with paresthesias in second and third finger of both inferior extremities. Lumbosacral magnetic resonance shows a cystic lesion behind L5 body of 36.4 x 19.5 x 18.4 mm. The surgical intervention removes completely this cyst. With hematoxylin-eosin stain and inmunochemistry study for S100 protein the diagnosis was cystic lumbar schwannoma. [ABSTRACT FROM AUTHOR]