Journal of Neurosurgery March 2014

Featured Article
Nonfunctioning pituitary adenoma
Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management.
Treatment
Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In
Lee et al, evaluated the efficacy and safety of initial GKRS for NFAs.
An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs.
Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2-25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025).
GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma ((Lee CC, Kano H, Yang HC, Xu Z, Yen CP, Chung WY, Pan DH, Lunsford LD, Sheehan JP. Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas. J Neurosurg. 2014 Jan 3. [Epub ahead of print] PubMed PMID: 24405068.)).
Spine
Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients.
Cervical arthroplasty
Cervical arthroplasty with an artificial disc (AD) has emerged as an alternative to anterior cervical discectomy and fusion (ACDF) for the management of cervical spondylosis.
It is an effective, reliable, and safe procedure for the treatment of cervical degenerative disc disease. However, there is no definitive evidence that DCI arthroplasty has better intermediate-term results than anterior cervical discectomy and fusion (ACDF).
3D motion analysis data comparing patients after ACDF and AD replacement in ten patients who underwent C5-6 ACDF and 7 who underwent C5-6 AD replacement were enrolled. Using biplanar fluoroscopy and a model-based track technique (accurate up to 0.6 mm and 0.6°), motion analysis of axial rotation and flexion-extension of the neck was performed. Three nonoperative segments (C3-4, C4-5, and C6-7) were assessed for both intervertebral rotation (coronal, sagittal, and axial planes) and facet shear (anteroposterior and mediolateral). Results There was no difference in total neck motion comparing ACDF and AD replacement for neck extension (43.3° ± 10.2° vs 44.3° ± 12.6°, p = 0.866) and rotation (36.0° ± 6.5° vs 38.2° ± 9.3°, p = 0.576). For extension, when measured as a percentage of total neck motion, there was a greater amount of rotation at the nonoperated segments in the ACDF group than in the AD group (p = 0.003). When comparing specific motion segments, greater normalized rotation was seen in the ACDF group at C3-4 (33.2% ± 4.9% vs 26.8% ± 6.6%, p = 0.036) and C6-7 (28.5% ± 6.7% vs 20.5% ± 5.5%, p = 0.009) but not at C4-5 (33.5% ± 6.4% vs 31.8% ± 4.0%, p = 0.562). For neck rotation, greater rotation was observed at the nonoperative segments in the ACDF group than in the AD group (p = 0.024), but the differences between individual segments did not reach significance (p ≥ 0.146). Increased mediolateral facet shear was seen on neck extension with ACDF versus AD replacement (p = 0.008). Comparing each segment, C3-4 (0.9 ± 0.5 mm vs 0.4 ± 0.1 mm, p = 0.039) and C4-5 (1.0 ± 0.4 mm vs 0.5 ± 0.2 mm, p = 0.022) showed increased shear while C6-7 (1.0 ± 0.4 mm vs 1.0 ± 0.5 mm, p = 0.767) did not.
This study illustrates increased motion at nonoperative segments in patients who have undergone ACDF compared with those who have undergone AD replacement. Further studies will be required to examine whether these changes contribute to adjacent-segment disease  (( McDonald CP, Chang V, McDonald M, Ramo N, Bey MJ, Bartol S. Three-dimensional motion analysis of the cervical spine for comparison of anterior cervical decompression and fusion versus artificial disc replacement in 17 patients. J Neurosurg Spine. 2013 Dec 20. [Epub ahead of print] PubMed PMID: 24359000.)).
Pediatrics
The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants.
In infants with hydrocephalus, a greater 1-year CSF diversion failure rate may occur after ETV compared with shunt placement. This risk is most significant for procedures performed within the first 90 days of life. Further investigation of the need for multiple reoperations, cost, and impact of surgeon and hospital experience is necessary to distinguish which treatment is more effective in the long term ((Jernigan SC, Berry JG, Graham DA, Goumnerova L. The comparative effectiveness of ventricular shunt placement versus endoscopic third ventriculostomy for initial treatment of hydrocephalus in infants. J Neurosurg Pediatr. 2014 Jan 3. [Epub ahead of print] PubMed PMID: 24404970.))

Neurosurgery March 2014

March 2014 Issue of Neurosurgery is Online

03 March 2014The March 2014 issue of Neurosurgery is now online and full-text access is available for print subscribers. Non-subscribers may access all article abstracts and the full-text of selected articles.
Read more 
 
 
Artículo especial
Tracking and Sustaining Improvement Initiatives: Leveraging Quality Dashboards to Lead Change in a Neurosurgical Department
Cada vez más, hospitales y  médicos  adquieren conocimiento de estrategias y herramientas para mejorar la calidad empresarial.
En el 2007 el departamento de Neurocirugía de la Universidad de California Los Angeles (UCLA) creó unos indicadores de calidad para ayudar a gestionar las medidas de proceso y resultados con la finalidad de mejorar el rendimiento clínico y la atención al paciente .
En el 2009 , la dirección del departamento y la dirección médica trabajó  para alinear las prioridades de mejora de calidad de inversión. El contenido se ha rediseñado para incluir 3 áreas de prioridades: calidad y seguridad,  satisfacción del paciente , eficiencia y uso de los recursos. A través del tiempo , la calidad de la neurocirugía ha sido reconocida por su claridad y su éxito en las estrategias de gestión.
Se describe la creación, el diseño y  un resumen de la evolución del proceso, e ilustra la forma en que se puede utilizar como una herramienta poderosa de mejora y cambio.
También se discuten los posibles retos y orientaciones futuras de este conjunto de estrategias y llaves enfocadas a la administración y creación de conocimiento sobre el medio, a través del análisis de los datos existentes en un servicio de neurocirugía.

Calendario actualizado

2014

Marzo

Curso Teórico-Práctico de Base del Cráneo

Para más información (programa, inscripciones, colaboradores y más información) le recomendamos visitar la web del curso.
Tendrá lugar los próximos días 13 y 14 de Marzo de 2014 en Barcelona,
Organizado por los Drs. Pere Tresserres y Fernando Muñoz del Servicio de Neurocirugía del Hospital de Sant Pau de Barcelona.
Se trata de uno de los principales cursos a nivel nacional y que desde el año 2005 viene formando a los neurocirujanos especialistas en base de cráneo.

IBNC 2014, Term I, Course III: Spine and Peripheral Nerve

March 15 — March 19
Antalya, Turkey
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Percoutaneous Endoscopic Surgery of the Lumbar and Thoracic Spine – Training Course

March 17 — March 18
Tubingen, Germany
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INTS 2014 – The 11th Symposium of The International Neurotrauma Society

March 19 — March 23
Budapest, Hungary
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30th International Congress of Clinical Neurophysiology (ICCN) and 58th Annual Meeting of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN)

March 20 — March 23
Estrel Hotel & Convention Center Berlin, Germany
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SBNS Spring Meeting

March 26 — March 28
Oval Cricket Ground, London, UK
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Abril

 
BritSpine 2014
April 1 — April 4
Warwick, UK
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Alicante 10 – 12.4 2014

3rd International Multidisciplinary Postgraduate Course on Childhood Craniopharyngioma

April 24 — April 27
Bad Zwischenahn, Germany
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24th Biennial Congress of the European Society of Pediatric Neurosurgery

May 4 — May 7
Rome, Italy
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XXXVI Congreso Latinoamericano de Neurocirugía (CLAN)

Se llevará a cabo desde el 11 al 16 de  mayo de 2014 en la Isla de Margarita.
http://clan2014.com/

WFNS Symposium 2014

May 28 — May 30
Lisboa, Portugal
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EFNS-ENS Joint Congress of European Neurology

May 31 — June 3
Istanbul, Turkey
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EANS HandsOn Course – Lyon

June 3 — June 6
Lyon, France
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The 2nd World Arterio-Venous Malformation Congress

June 18 — June 20
Nancy, France
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Microscopic and Endoscopic Approaches to the Skull Base

June 23 — June 25
IRCAD Institute in Strasbourg, France
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11th European Skull Base Society Congress

June 26 — June 28
Paris, France
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Basic & Clinical Science for the Management of Patients with Chronic Pain and Severe Spasticity: Intrathecal Drug Delivery – Course IV

June 27 — June 28
Barcelona, Spain
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2014 ISHN 19th Annual Meeting

June 30 — July 5
Brussels, Belgium
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53rd ISCoS Annual Scientific Meeting

September 2 — September 4
Maastricht, Netherlands
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Percoutaneous Endoscopic Surgery of the Lumbar and Thoracic Spine – Training Course

October 6 — October 7
Tubingen, Germany
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EANS 15th European Congress of Neurosurgery (2014)

October 14 — October 17
Prague, Czech Republic
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Se celebrará en Sevilla los días 23, 24 y 25 de Octubre de 2014.
La XLIII Reunión Anual de la Sociedad Española de Neurorradiología (SERN) contará con ponentes de especial categoría como Dr. Michael Söderman de Estocolmo y la Dra. Alexandra Borges de Lisboa como así también neurólogos nacionales de reconocida capacidad docente.
Del programa destaca el Curso Monográfico pre-Reunión, dedicado a la base del cráneo, con la intención de profundizar en el intracraneal, el raquis cervical y las estructuras cervicofaciales.
Fecha: 23, 24 y 25 de Octubre de 2014
Web: http://www.geyseco.es/senr2014/

7th Congress of the Croatian Neurosurgical Society

November 20 — November 22
Zagreb, Croatia
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