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Introducción: La cirugía estereotáctica es una técnica quirúrgica con múltiples aplicaciones diagnósticas y terapéuticas que, en comparación con la cirugía convencional, permite al neurocirujano realizar procedimientos más precisos y menos invasivos con el fin de evitar lesiones en áreas funcionales. Metodología: Se realizó un estudio descriptivo retrospectivo de corte transversal en el cual se revisaron las historias clínicas de los pacientes mayores de 18 años intervenidos quirúrgicamente por medio de cirugía estereotáxica entre enero de 2000 y diciembre de 2020 en el Hospital Militar Central (Bogotá, Colombia). Resultados: En el periodo de estudio comprendido entre enero del año 2000 y diciembre del año 2020 se encontraron un total de 119 pacientes intervenidos por medio de estereotaxia con objetivos diagnósticos y terapéuticos, de los cuales 44 son mujeres y 75 son hombres. La mayoría de los pacientes fueron llevados a resección y biopsia de tumores intracraneales. Se obtuvo una tasa de complicaciones del 4,2%. Conclusiones: La cirugía estereotáctica es una técnica quirúrgica útil en el diagnóstico y tratamiento de diversas patologías que tiene buen rendimiento diagnóstico y baja tasa de complicaciones. En el presente estudio se presentan tasas de complicaciones similares a las reportadas en la literatura mundial siendo esta serie la única que analiza los resultados obtenidos con dicha técnica quirúrgica en la población de las Fuerzas Militares de Colombia. [ABSTRACT FROM AUTHOR]

Objective: To correlate the histopathological findings with the use of 9G needles in stereotactic vacuum-assisted-breast biopsies (VAB) with those observed in the mammograms. Material and methods: Descriptive and retrospective study. 117 VAB with 9G needle were included, all guided by stereotaxia, diagnosed with suspected malignancy lesions in the period comprised from August 2013 to December 2014. We evaluated, their main risk factors for breast cancer, mammographic findings, pathological anatomy of the radiological and surgical biopsy, as well as diagnostic underestimation. Results: 117 samples of patients aged 31 to 82 years were included. The most frecuent mammographic finding was suspicious calcifications of malignancy in 94 (80.3%) of the samples, of which 56 (47.9%) were diagnosed as benign lesions and 38 (32.4%) as malignant lesions. The predominant morphology of malignant lesions was 17(14.5%) in BI-RADS 4B, 9 (7.6%) in BI-RADS 4C y 12 (10.2%) in BI-RADS 5. The lesions associated or not with suspicious calcifications were 23 (19.7%), of which 19 (16.3%) corresponded to malignant lesions, 1 (0.85%) distributed in BI-RADS 4B, 11(9.35%) in BI-RADS 4C and 7(5.95%) in BI-RADS 5. Among malignant lesiones, the most frequent risk factor was not having breastfed (49.1%), the use of hormonal therapy (26.3%), a family history of breast cancer (22.8%) and smoking (12.3%). Conclusions: Our study coincides with the recommendations found in the diagnosis choice guidelines in suspected non-palpable malignancy lesions since stereotaxiaguided VAB is a diagnostic method of choice in the management of suspected nonpalpable breast lesions, it decreases biopsy with scisions, resizing surgical time for therapeutic surgery. [ABSTRACT FROM AUTHOR]

In the implantation of deep brain electrodes, the great challenge for the surgeon is the most precise implantation of electrodes in the selected place. We present the analysis of the international standard surgical technique and analysis of a cohort of implanted patients in terms of precision achieved in an observational study. descriptive retrospective of twelve patients, the precision in electrode implantation was analyzed with the international standard surgical technique, comparing the position of the electrodes in the immediate postoperative period with the position of the electrodes planned before the surgical procedure. The study includes twelve patients with Parkinson's disease (9), cervical dystonia (1), late syndrome (1) and Gilles de la Tourette's disease (1), implanted with international standard surgical technique. All patients were implanted bilaterally, for a total of 24 implanted electrodes. In the measurement of the distance between the planned surgical target in the preoperative period and the final location of the electrode, we found an average distance of 0.89 millimeters, with a range between 0 and 2.5 millimeters. We found that the implantation of brain electrodes by stereotaxy, images, software and microregistration, in an awake patient, with micro and macro stimulation, is a precise and safe procedure with an average difference of 0.89 millimeters. [ABSTRACT FROM AUTHOR]

El cáncer de la glándula mamaria se ha convertido en un problema de salud pública en los países desarrollados. En nuestro medio representa la tercera causa de mortalidad por cáncer en el sexo femenino. Los programas de detección precoz basados en el uso frecuente de la mamografía en poblaciones seleccionadas, han demostrado que se puede alcanzar una disminución de la mortalidad por esta entidad entre el 25 y el 32%. El uso frecuente de la mamografía en pacientes asintomáticas, plantea la necesidad de que se establezcan criterios claros para el tratamiento de las lesiones sospechosas de ser carcinomas no palpables en esta glándula. Se presenta la experiencia en 135 lesiones clasificadas como sospechosas no palpables, detectadas por mamografía y/o ecografía mamaria. Se analizan los diferentes métodos empleados para obtener un diagnóstico definitivo y se describen los hallazgos de anatomía patológica. El valor predictivo positivo de esta serie fue de 37% que se encuentra dentro de los valores informados en la literatura.

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Introduction: The reliability of percutaneous biopsy guided by imaging method is high, it shows 87-96% of concordance between percutaneous biopsy guided by imaging methods and excisional biopsies, in these procedures there is a possibility of false negatives and possible undervaluation of the injury. Objective: Establish the concordance in the report of histopathological findings between biopsies guided by imaging methods and excisional biopsies in the breast pathology. Material and method: Cross-sectional, retrolective, observational and comparative study, of patients diagnosed with breast cancer from 2015 to 2019, who underwent biopsies guided by imaging methods with subsequent excisional biopsy, later were took the pathology reports and then their concordance was then analyzed. Results: 98.8% (n = 81) of the reports of both types of biopsy agreed on the diagnosis. When statistically evaluated, a very good degree of agreement was found between both techniques (kappa = 0.9862; p < 0.001). Also, an almost perfect convergence was found when we were evaluating the correlation of the reports of the two types of biopsy (t = 0.9959; p < 0.001). Conclusions: The results found a high concordance between histopathological reports by image-guided biopsy and excisional biopsy. [ABSTRACT FROM AUTHOR]

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Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50% for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7% and 83.4%, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8% cases of the first group and 9.8% cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.O manejo das lesões intracranianas tumorais está relacionado ao seu diagnóstico histológico adequado. Foi realizado estudo retrospectivo com 32 pacientes submetidos a 36 biópsias cerebrais por neuronavegação e 44 pacientes por estereotaxia com arco. A idade média foi 46,6 e 49,3 anos respectivamente. Nos dois grupos a distribuição por sexo foi 50% para cada. A maioria das lesões biopsiadas eram lobares nos dois grupos. A positividade diagnóstica foi 91,7% para neuronavegação e 83,4% para a estereotaxia com arco, respectivamente (p=0,26). Identificou-se hemorragia intracraniana na TC pós-operatória em 13,8% dos casos no primeiro grupo e em 9,8% no segundo, a maioria de pequena monta sem provocar piora neurológica. Ocorreu uma morte relacionada ao procedimento em cada grupo. Os diagnósticos mais freqüentes foram astrocitomas e adenocarcinomas metastáticos. A positividade diagnóstica, taxas de hemorragia pós-operatória e de mortalidade foram equiparáveis estatisticamente entre os dois métodos e se assemelham com as descritas na literatura.

OBJECTIVE: In the majority of cases, the correct treatment of brain lesions is possible only when the histopathological diagnosis is made. Several deep-seated lesions near eloquent areas are not safely approached by the classical neurosurgical procedures. These patients can get benefit by a minimally invasive procedure. METHOD: We present a series of 176 consecutive patients submitted to stereotactic biopsies due to a great variety of brain lesions. RESULTS: Histological diagnosis found in this series: glioma in 40.1% of the patients, other neoplasms in 12.2% and infectious or inflammatory diseases in 29.1 %. The result was inconclusive in 5.2% of the procedures. One patient died (0.6%) and two (1.2%) presented operative complications. The criteria, advantages and risks of the stereotactic biopsies are discussed. CONCLUSION: The efficacy of the method is adequate and morbid-mortality rates were low.OBJETIVO: O diagnóstico anatomopatológico das lesões encefálicas é muitas vezes necessário para a instituição do tratamento adequado. Entretanto, muitas lesões localizadas profundamente no encéfalo ou em centros nervosos de grande importância funcional não podem ser acessadas sem riscos, com a aplicação dos procedimentos neurocirúrgicos habituais. MÉTODO: Apresentamos uma série de 176 doentes submetidos a biópsias estereotáxicas de lesões encefálicas. RESULTADOS: Em 40,1% dos casos, o diagnóstico foi de glioma, em 12,2% de outras neoplasias e em 29,1%, de doenças infecciosas ou inflamatórias. O resultado foi inconclusivo em 5,2% dos doentes. Um (0,6%) doente faleceu e dois (1,2%) apresentaram graves complicações operatórias. Os critérios de seleção, as vantagens e os riscos da biópsia estereotáxica são discutidos. CONCLUSÃO: A eficácia do método é boa e a morbimortalidade das biópsias estereotáxicas é baixa.

São analisados 106 procedimentos em pacientes submetidos à estereotomografia. Os procedimentos foram realizados para obtenção de biópsias cerebrais, orientação de craniotomias, colocação de cateter em cavidade tumoral, drenagem de hematoma e de abscesso intracerebrais. As orientações de craniotomia foram realizadas para localizar más-formações arteriovenosas, tumores e processos inflamatórios, em 21 pacientes. As biópsias cerebrais estereotáticas, realizadas em 82 casos para diagnóstico anatomopatológico, apresentaram índice de positividade de 87,5%, com complicações em 1,2% dos casos. São analisadas estatisticamente as variáveis, como: idade, sexo, procedimento realizado, diagnóstico anatomopatológico e volume das lesões. É discutida a imprecisão na aquisição e cálculo das coordenadas estereotáticas com a tomografia computadorizada do encéfalo e verificada a precisão do método estereotomográfico com a utilização de um phanton. O maior erro das coordenadas foi de 6,8 mm com cortes tomográficos axiais de 4 mm a 5 mm.

Apresenta-se uma simplificação dos métodos gráfico e aritmético usualmente utilizados para determinação das coordenadas estereotáxicas de um alvo na tomografia computadorizada. O cálculo aritmético, além de mais simples, é teoricamente mais preciso por medir as coordenadas do alvo a partir de um ponto real do espaço estereotáxico. O diagrama (método gráfico) proposto apresenta a vantagem de permitir a determinação das coordenadas estereotáxicas do alvo independentemente do tamanho das imagens da tomografia computadorizada.

OBJETIVO: Apresentamos os resultados preliminares da estimulação cerebral profunda crônica no núcleo subtalâmico para os sintomas motores da doença de Parkinson. MÉTODO: 8 pacientes com doença de Parkinson há mais de 5 anos, apresentando tremor incapacitante, oligocinesia e rigidez acentuada com predomínio unilateral, 3 à direita e um à esquerda, refratários à medicação adequada, foram submetidos ao implante bilateral de eletrodo cerebral profundo permanente subtalâmico, Itrell 2. Estes pacientes foram avaliados segundo as escalas: UPDRS, Schwab e England. RESULTADOS: Os resultados preliminares (6 meses), mostraram melhora significativa dos sinais e sintomas avaliados pelas escalas acima. Não houve complicações com os procedimentos. CONCLUSÃO: Os resultados preliminares indicam que a estimulação subtalâmica é uma boa opção terapêutica, estando de acordo com os resultados da literatura.

As características funcionais e morfológicas da face, aliadas à complexidade do fenômeno doloroso, tornam favorável a existência de inúmeras fontes de dor facial, como procuraram demonstrar as várias classificações existentes a respeito. A nucleotratotomia trigeminal consiste na ablação cirúrgica de núcleos trigeminais de segunda ordem e tratos. Dois casos de dor facial atípica refratários ao tratamento medicamentoso ou a outras formas nãooperatórias são discutidos. A intensidade da dor pré e pós-operatória foi avaliada pela Escala Visual Analógica. A técnica operatória é descrita. Os resultados imediatos foram satisfatórios em ambos os casos. Um doente teve recidiva da dor, com menor intensidade, dois meses após o procedimento e o outro estava assintomático oito meses depois. Um doente apresentou ataxia transitória que regrediu em dois meses; o outro teve meningite bacteriana no pós-operatório. Aspectos terapêuticos e as bases fisiopatológicas da indicação cirúrgica são apresentados.

Os angiomas cavernosos intracerebrais são lesões que podem causar hemorragias, crises convulsivas e déficits neurológicos. Essa patologia passou a ter diagnóstico mais precoce com o advento da ressonância magnética. A remoção radical por cirurgia é o melhor método de tratamento. Devido a frequente localização subcortical ou profunda, a utilização de métodos de localização por imagem como a estereotaxia apresentam várias vantagens como: menor incisão de pele, craniotomia e manipulação do tecido cerebral, consequentemente com menor morbidade. Apresentamos uma série de nove angiomas cavernosos tratados por ressecção cirúrgica radical guiada por estereotaxia. Em todos os casos o diagnóstico foi realizado por ressonância magnética e houve confirmação anátomo-patológica. A média de idade dos pacientes foi 30 anos, variando entre 20 e 54 anos. Como morbidade transitória, um paciente teve uma crise convulsiva no 3° dia pós-operatório e uma paciente apresentou disfasia e hemiparesia no 2° dia pós-operatório, com recuperação total na evolução. No total, a remoção foi radical em todos os casos e os pacientes permanecem sem nenhum déficit neurológico relacionado à cirurgia.

Apresentamos o caso de uma paciente com epilepsia refratária ao tratamento medicamentoso e submetida à monitorização em vídeo-eletrencefalografia por eletrodos de profundidade intracerebrais. A história, o exame clínico, a ressonância magnética (RM), a vídeo-eletrencefalografia e o estudo neuropsicológico não foram suficientes para a determinação da área cerebral de origem das crises convulsivas. Eletrodos de profundidade intracerebrais colocados por estereotaxia guiada por RM possibilitaram o registro de forma muito clara da atividade epileptiforme, determinando com precisão a área cerebral epileptogênica a ser removida por cirurgia. Após lobectomia temporal anterior direita com amígdalo-hipocampectomia realizada há três meses, a paciente permanece sem crises convulsivas. Segundo informações obtidas durante o último Congresso da Liga Brasileira de Epilepsia, esta é a primeira cirurgia estereotáxica para colocação de eletrodos de profundidade intracerebrais em epilepsia no Brasil.

Paresthesiae-producing deep brain stimulation (stimulation of ventrocaudal nucleus - VC, medial lemniscus - ML or internal capsule - IC) is one of the few procedures to treat the steady element of neural injury pain (NIP) currently available. Reviewing the first 60 patients with NIP submitted to deep brain stimulation (DBS) from 1978 to 1991 at the Division of Neurosurgery, Toronto Hospital, University of Toronto, we observed that 6 patients complained of unpleasant paresthesiae with paresthesiae-producing DBS, preventing permanent electrode implantation in all of them. Such patients accounted for 15% of the failures (6 out of 40 failures) in our series. In an attempt to improve patient selection, we reviewed our patients considering a number of parameters in order to determine risk factors for unpleasant paresthesiae elicited by paresthesiae-producing DBS. The results showed that this response happenned only in patients with brain central pain complaining of evoked pain, secondary to a supratentorial lesion. Age, sex, duration of pain, quality of the steady pain, size of the causative lesion and site (VC,ML,IC) and type (micro or macroelectrode) of surgical exploration were not important factors. Unpleasant paresthesiae in response to dorsal column stimulation, restricted thalamic lesion on computed tomography and the occurrence of associated intermittent pain were considered major risk factors in this subset of patients and the presence of cold allodynia or hyperpathia in isolation and the absence of sensory loss were considered minor risk factors. It is our hope that the criteria here established will improve patient selection and so, the overall results of DBS.A estimulação cerebral profunda (ECP) de sítios cuja estimulação elicita parestesia (núcleo talâmico ventrocaudal - VC, lemnisco medial - LM e cápsula interna - CI) é um dos poucos métodos atualmente disponíveis para o tratamento do elemento constante da dor por injúria neural (DIN). Revendo os primeiros 60 pacientes com DIN submetidos à ECP na Division of Neurosurgery, Toronto Hospital, University of Toronto, no período 1978/ 1991, observamos que 6 destes pacientes apresentaram parestesia dolorosa à estimulação de VC/LM/ CI, prevenindo a definitiva implantação do sistema em todos eles e totalizando 15% (6 dentre 40) das falhas em nossa série. Em uma tentativa de se melhorar a seleção de pacientes para a ECP e, com isto, seus resultados globais, revimos nossos casos, considerando uma série de parâmetros, de modo a determinar os fatores de risco para parestesia dolorosa. Os resultados mostraram que esta resposta à estimulação de VC/LM/CI é exclusiva de pacientes com dor central cerebral, secundária a lesão supratentorial, apresentando dor evocada como parte do quadro doloroso. Nem todos os pacientes com estas características, porém, apresentavam parestesia dolorosa. O estudo comparativo destes dois subgrupos (dor central cerebral + dor evocada + parestesia dolorosa e dor central cerebral + dor evocada + parestesia dolorosa) permitiu definir que: 1. Parestesia dolorosa à estimulação da coluna dorsal da medula espinhal, lesão restrita ao tálamo à tomografia computorizada e dor intermitente como parte do quadro doloroso são fatores de risco maiores para parestesia dolorosa à estimulação de VC / LM / Cl; 2. Alodínia ao frio ou hiperpatia isoladamente e ausência de deficit sensitivo ao exame neurológico são fatores de risco menores; e 3. Idade, sexo, duração da dor, qualidade da dor constante, dimensões da lesão causal e sítio (VC, LM ou Cl) ou tipo (macro ou microeletrodo) da exploração cirúrgica não parecem ser fatores de risco relevantes. O autor sugere também os prováveis mecanismos fisiopatológicos envolvidos na gênese da parestesia dolorosa à estimulação de VC / LM / Cl.

Os autores apresentam série 50 pacientes submetidos a cirurgia estereotáctica para processos expansivos intracranianos. Em 12 casos realizou-se um procedimento terapêutico: ressecção tumoral guiada em 5 pacientes e aspiração do conteúdo da lesão nos outros 7. Neste estudo confirmam-se a grande precisão e a baixa morbidade relacionadas com as técnicas estereotácticas. A tomografia computadorizada e a ressonância magnética determinam com acurácia as coordenadas estereotácticas, mas em certos casos a estereo-angiografia cerebral deve ser realizada. As ressecções tumorais guiadas por estereotaxia permitem o tratamento de lesões cerebrais profundas ou em áreas funcionais anteriormente consideradas como inoperáveis. A literatura pertinente é discutida.The authors present a study about 50 stereotactic procedures for intracranial lesions. In 12 cases stereotaxis was used as a treatment: stereotactic surgical resection (5 patients) and aspiration of lesions (7 patients). This study confirms the great accuracy and low morbidity of the stereotactic techniques. Computed tomography and magnetic resonance imaging determinate the precise stereotactic coordinates, but in some cases it is necessary to perform stereo-angiography. The stereotactic surgical resection of brain tumors allows the treatment of deep lesions or located at functional areas and considered to be inoperable before. The related literature is discussed.

A radiocirurgia consiste na irradiação precisa de um volume alvo intracraniano com uma alta dose de energia, preservando o tecido nervoso adjacente. O desenvolvimento tecnológico dos aceleradores lineares, dos equipamentos estereotáxicos e da ciência de computação simplificaram o procedimento e tornaram-no acessível. Suas indicações principais são as lesões intracranianas inoperáveis como malformações artério-venosas, schwanomas vestibulares e de outros nervos cranianos, meningeomas da base do crânio, gliomas e metástases cerebrais. Mais recentemente o desenvolvimento da radioterapia estereotáxica fracionada ampliou o espectro" de indicações da radiocirurgia para lesões maiores e adjacentes a estruturas nervosas críticas. Apresentamos a nossa experiência inicial com estas técnicas no tratamento de 31 pacientes. Observamos controle adequado das lesões neoplásicas tratadas e aguardamos o tempo necessário para a observação de resultados nas malformações artério-venosas.

Despite its use for a long time, the way thalamic ventrobasal (VB) stimulation acts to produce pain relief is still unknown. One of the most accepted hypotheses, sponsored by Tsubokawa among others, proposes that VB stimulation excites raphespinal and reticulospinal neurons of the rostroventral medulla which in turn send respectively inhibitory serotonergic and noradrenergic axons through both dorsolateral funiculi (DLF) to the dorsal horn ( DH) nociceptive neurons; this pathway would be the same as is involved in periventricular-periaqueductal gray (PVG-PAG) stimulation induced inhibition of DH nociceptive neurons. This hypothesis implicates the necessity of DLF intactness; in fact, it was showed that section of bilateral DLF inhibits the response of DH nociceptive neurons to VB stimulation. If the above mentioned hypothesis is correct, one could expect that unilateral VB stimulation would produce bilateral pain relief, VB and PVG stimulation would be useful for treating the same modalities of pain and that in patients with central cord-based pain harboring complete cord transection, VB stimulation would not work at all. In order to check these possibilities, the patiens with central cord-based pain admitted to the Division of Neurosurgery, Toronto Hospital between June 1978 and July 1991 to undergo deep brain stimulation (DBS) were reviewed. Sixteen patients were operated on. Based on clinical criteria, four out of these sixteen patients were thought to present complet cord transection (all four were men, with an average age of 48 years and pain secondary to cord injury). The effectiveness of the procedure was evaluated in this subset of patients: 75% of them enjoyed excellent pain relief with VB stimulation; PVG stimulation, however, performed in three out of these four patients, did not produce pain relief. Besides, our clinical experience has demonstrated that VB stimulation is effective in treating only contralateral pain.These results, as well as certain experimental data provided by a review of the literature, seem to provide evidence enough to contest Tsubokawa's hypothesis.

Os linfomas primários do SNC são raros, mas sua incidência tem aumentado nos últimos anos, Estes tumores frequentemente se localizam nos gânglios da base e tálamo ou se apresentam de forma multifocal. O tratamento atual para eles é a radioterapia, associada ou não a quimioterapia. Devido à sua extremamente baixa morbidade, a biópsia estereo-táxica é o método ideal para determinar o diagnóstico histológico em pacientes com suspeita de linfomas do SNC. Os autores apresentam estudo de 49 casos de linfomas primários do SNC, diagnosticado por biópsia estereotáxica.

Subthalamic nucleus (STN), an important structure in the extrapyramidal motor circuit, is hyperactive in patients with Parkinson's disease (PD) and useful in its surgical treatment. Its tiny volume, complex spatial location and strategic location, require an accurate planning for its identification and subsequent stereotactic approach. The anatomical programming based on Magnetic Resonance Images (MRI), not always coincide with the most representative region of the nucleus for the final electrode implantation, which is identified by the intraoperative semi-microrecording. The aim of this work is to compare the spatial location at coordinates x, y, z of the STN resulting from MRI anatomical programming and that obtained intraoperatively through semi-microrecording as well as to determine the discrepancy between both modalities in absolute and relative terms. A literature search for the location, relations and volume of the STN was performed according to classical literature and scientific publications of the past ten years. We studied twenty (20) STNs in 10 patients with Parkinson's disease using MRI. The images were processed in a computer program (WinNeus) performing the three-dimensional reconstruction and the ideal anatomic location in relation with the intercommissural line (AC-PC). Each one of the nuclei was subjected to neurophysiological assessment using intraoperative semi-microrecording with a range from three to six trajectories for each explored nucleus. The final location of the quadripolar electrodes for chronic stimulation was determined based on the response obtained by such recording. The results obtained by the initial anatomical programing and the intraoperative semi-microrecording were tabulated and compared with each other. The ideal location for implantation of chronic electrical stimulation electrodes in 20 STNs of 10 patients with PD was identified. A discrepancy between the initial anatomical programming and the definitive neurophysiological target was shown, with an average variation of 0.125 mm, 1.9 mm, and 1.2625 mm in the X, Y and Z coordinates, respectively. Bilateral STN deep brain stimulation (DBS) has become an elective treatment for the control of motor symptoms, particularly tremor, rigidity and akinesia. We infer that the anatomical identification of the STN is less accurate than that obtained with intraoperative semi-microrecording. We infer that the anatomical identification as unique method for the approach of the STN does not allow the accuracy achieved by its neurophysiological location. This latter technique optimizes the final target location for the implant, allowing improving clinical outcomes and reducing the risk of side effects due to incorrect position of the stimulation electrode. [ABSTRACT FROM AUTHOR]

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Purpose. Report the experiment with stereotactic core-needle breast biopsy. Material and methods. Stereotactic core-needle biopsies were taken from 58 lesions. The results were validated with excisional biopsy or mastectomy in 17 lesions. Forty-one lesions were radiologically and histologically correlated or patients were given image follow-up for at least 18 months. Results. The histological diagnosis with stereotactic core-needle biopsy was possible in 58 lesions with 91% sensitivity for diagnosing breast cancer and 100% specificity. Minor complications occasionally arose during the procedure. Conclusion. Stereotactic core-needle breast biopsy is precise enough to obtain histological samples of lesions observed mammography and ultrasound studies, and the patient's therapeutic plan can be changed and expedited accordingly. [ABSTRACT FROM AUTHOR]

From the cellular, biochemical and functional point of view the pedunculopontine nucleus (PPN) is an heterogeneous structure. The PPN is part of the «mesencephalic motor region» and it has been found to participate in initiating and maintaining movement. From the therapeutic point of view, it has been found that Parkinson's disease animal models show improvement with activation and worsening with inhibition of this nucleus. Only recently have some neurosurgical teams made the first surgical interventions on this structure on human beings, and with these interventions gathered information about registering and clinical response to electrical stimulation during surgery. To locate this structure, we have the aid of images, stereotaxic atlases, micro registering and clinical response of the patient during surgery. All of these tools must be used in a cooperative fashion in order to obtain the best clinical response and to reduce risk as much as possible. Today, the intervention on this nucleus is seen as a possible therapy for L-Dopa resistant axial symptoms in patients with Parkinson's disease and other parkinsonic syndromes. [ABSTRACT FROM AUTHOR]

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Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to analyze retrospectively and prospectively, the clinical and angiographic evolution of the patients with the diagnosis of AVM treated with radiosurgery. Methos: between 1998 and 2001, we studied all the patients at the National Medical Center "20 de Noviembre" ISSSTE with the diagnose of cerebral AVM, that counted with clinical and angiographic pursuit by three years, included only 16 patients. The main signs and neurological symptoms relate to the MAV's were valued. The adverse effects to the treatment that were considered, were those that appeared in the interval between the principle of radiosurgery and the obstruction of nidus. All the previous treatment were considered that had a direct influence on the structure of the AVM. Results: the clinical manifestation were: vascular headache in 12 (75%), epeileptic crises in 5 (31.2%), motor deficit in 6 (37.5%) and cranial hypertensive syndrome, in 10 (62.5%. The percentage of distribution according to the SM scale was the following one: 43.7% degree II, 25% degree III, 18.7% degree IV and 18.7% degree V. The dose of treatment was of 19,5 +/- 3 Gy. The average of the percentage of diminution of volume of the AVM to 6 months valued with angiography was of 9,68%, to the 12 months it went of 36%, and to 3 years of 71%. Altogether the 93,1% was improving clinically at the three years of the treatment. Conclusions: we considered that stereotactic radiosurgery is a clinical and radiological treatment acceptable to the cerebral AVM. [ABSTRACT FROM AUTHOR]

Composition and quantity of food in-taken varies considerably between one meal and another, or between one day and the following. Non biological factors — such as emotional, social, day time, feasibility in the type of food, and cost- are, among others, factors that in some way affect the degree of energy in-take by food, which generally is not related with daily energy expenditure. These phenomena represent an active process of regulation that is characterized by the balance between signs that stimulate hunger, called orexigenics and those that produce satiation to stop intake, called anorexigenics, that promotes the stability in the quantity of corporal energy manifested as fat. In this feeding regulatory process there are many molecular signs that participate and regulate the in-take of behaviour food for homeostasis. [ABSTRACT FROM AUTHOR]

Today, psychosurgery is a minimally invasive and highly selective treatment performed only on some patients with severe, refractory treatment, affective, anxious, or obsessive-compulsive disorders. Recent advancements in technology and functional neuroanatomy as well as economic pressures to lower the cost of caring for the chronically ill may provide an opportunity for psychosurgery to become a more attractive option in the treatment of psychiatric disease. [ABSTRACT FROM AUTHOR]

Apresentamos estudo de dez pacientes com doença de Parkison, que foram submetidos a procedimentos ablativos estereotáxicos percutâneos e que desenvolveram síndrome de Horner ipsilateral imediatamente após a lesão. Sete pacientes foram submetidos a palidotomia, dois a subtalamotomia (campotomia de Forel) e talamotomia e um paciente a subtalamotomia. Sete desenvolveram miose e os dez desenvolveram semiptose ipsilateral à lesão. A ocorrência da síndrome de Horner resulta possivelmente de lesão de fibras simpáticas entre o hipotálamo, campo de Forel e tálamo.We present ten patients with Parkinson's disease who underwent stereotactic ablative radiofrequency procedures. Seven patients underwent pallidotomy, two subthalamotomy and VIM, and one subthalamotomy. Seven developed miosis and all semiptosis ipsilateral immediately after the procedure. The occurrence of Horner's syndrome is probably due to the lesion of sympathetic fibers among hypothalamus, Forel's field and thalamus after the stereotactic procedure.

Background: Stereotactic biopsy has been reported as a useful and safety procedure in pediatric patients. In adult patients exist more controversy because a greater number of diagnostic options., Objective: To demonstrate its usefulness and safety in adult patients with posterior fossa pathology., Method: From 2006-2014, 23 patients were operated from posterior fossa. Variables: age, gender, state, pre- and postoperative diagnosis, stereotactic device, location and complications., Results: 52.2% females and 47.8% males. The location was ponto-mesencephalic 43.5%, cerebellum 39.1%, bulbar 13% and pineal region 4.3%. The preoperative diagnosis was brainstem glioma 78.2%, lymphoma 8.7%, and meningioma, metastasis and abscess 4.3% each one. In 73.9% Zamorano-Dujovni device was used and in 26.1% the CRW. The definitive diagnosis was pilocytic astrocytoma 17.4%, diffuse astrocytoma 13%, inflammatory response 13%, anaplastic astrocytoma 8.7%, gliosis 8.7%, glioblastoma, neuroectodermic primitive tumor, germinoma, pineocytoma and cryptococcosis 4.3% each one. In 17.4% there was no diagnosis. The preoperative diagnosis was concordant in 43.5%. One transient deficit and one pin displacement 4.3% were present. 91.4% without complications., Conclusions: It is a useful, necessary and safety procedure in adult patients., (Copyright: © 2019 Permanyer.)

Introduction and Aim: Remote magnetic navigation has proved to be effective in the ablation of most supraventricular and ventricular arrhythmias. Initial studies reported worse results with this system compared to conventional ablation for atrial flutter. The aim of this study was to assess the acute and long-term success of atrial flutter ablation with remote magnetic navigation and to retrospectively compare the results obtained with an 8-mm tip catheter versus an irrigated catheter., Methods: We studied 38 consecutive patients, mean age 61 ± 15 years, 28 male, who underwent ablation of typical atrial flutter with the Niobe II remote magnetic navigation system (Stereotaxis). Ablation was performed with an 8-mm tip catheter in 17 patients and with an irrigated-tip catheter in 21 patients. Acute success was defined as the presence of bidirectional isthmus block, and long-term success as absence of symptoms and atrial flutter during Holter monitoring., Results: Bidirectional isthmus block was achieved in 37 patients (97%), and the success rate was similar in both groups. Total procedure time was not significantly different between the groups but fluoroscopy time was shorter in the irrigated tip group (13.4 ± 3.7 min vs. 6 ± 4.4 min; p<0.01). The number of applications and total radiofrequency time did not differ. There were no complications. During a follow-up of 32 ± 19 months there were two relapses, one in each group., Conclusions: The Niobe II remote control system for ablation of typical atrial flutter is safe and effective in both the short and long term. The 8-mm and irrigated-tip catheters showed similar safety and efficacy., (Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Objective: The aim of this study was to assess the efficacy and potential complications of a remote-controlled magnetic navigation system (Niobe II, Stereotaxis) for mapping and ablation of right or left ventricular outflow tract ventricular tachycardia or premature ventricular contractions., Methods: We studied 32 consecutive patients, mean age 43±11 years, 24 female. Mapping of the arrhythmia was performed using the CARTO RMT mapping system, remotely guided by the Niobe II. Radiofrequency ablation was performed at the site of earliest ventricular activation with pacemapping of at least 11/12 leads. Acute success was defined as suppression and non-inducibility of the arrhythmia after stimulation with isoprenaline. After a minimum 3-month follow-up, we assessed clinical success (absence of symptoms and suppression of the arrhythmia on Holter recording), defined as less than 50 premature ventricular contractions/24 hours., Results: The origin of the arrhythmia was in the right ventricular outflow tract in 28 patients (88%), in the left in three, and in the epicardium in one. Acute success was achieved in 26 patients (81%). Two patients underwent a second successful procedure, in one of which an epicardial approach was necessary. The overall clinical success rate, after two repeat procedures, was 88%. No complications occurred. There were two recurrences during a mean follow-up of 307±204 days., Conclusion: The Niobe II remote control system for mapping and ablation of ventricular outflow tract arrhythmias is effective and safe, and provides precise mapping and a high success rate, with no complications., (Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)