Ivan Domènech

Resultados en el tratamiento quirúrgico de los neurinomas del acústico gigantes

INTRODUCTION AND OBJECTIVES To compare the results obtained in the resection of 21 giant vestibular schwannomas via retrosigmoid (RS) and combined retrosigmoid/translabyrinthine (RS/TL) approaches with respect to intra- and postoperative complications, facial nerve preservation and postsurgical sequelae. METHODS This was a retrospective study of 21 patients who underwent a resection of a giant vestibular neuroma according to the Tos & Thomsen Scale (greater than or equal to 4 centimetres) in a tertiary care centre in the period between 2000 and 2008. We present the most significant characteristics of the series studied and the analysis of the advantages and inconveniences of each approach. We also analyse the results regarding facial nerve function preservation. RESULTS We highlight the absence of mortality in the 21-patient group. There were no important intraoperative complications. Total resection of the lesion was achieved in the 87% of the cases, with facial nerve preservation of 73% using the combined RS/TL approach, in comparison to 40% using the RS. Facial nerve function after two years was acceptable or good in 67% (including those with heteronerve anastomosis). A global percentage of 14.3% of cerebrospinal liquid fistula was observed, as well as 9.5% of meningitis. CONCLUSIONS The results of the study demonstrate that the combined retrosigmoid translabyrinthine approach for giant schwannoma treatment offers increased facial nerve preservation and lower morbidity, constituting an important option in the treatment of this kind of tumours thanks to a multidisciplinary approach.

Tic convulsivo doloroso como manifestación de dolicoestasia y aneurisma vertebrobasilar

The patient is a 64 year old male, with no clinical history of interest, who was assessed in a different centre 5 years ago after presenting with left hemifacial spasms (HFS, which initially manifested as blepharospasm and later affected the frontal and ipsilateral perioral muscle system). He was treated with Pramipexole and Clonazepam, which led to improvement. Two years ago the patient started having associated with clinical symptoms of trigeminal neuralgia (TN) which affected the left maxillary nerve branch. Nuclear magnetic resonance (NMR) showed a vascular lesion with compression of the anterior margin of the protuberance and left cerebellopontine angle (Figs. 1 and 2). The TN was controlled initially with analgesics and subsequently with Pregabalin 75 mg/8 h (Lyrica) and Amitriptyline 10 mg/24 h. The therapeutic option of an intravascular stent was considered, but was rejected due to its high risk factor. One year ago the patient was referred to our department with hearing loss, presenting a normal audiometric

Cocleotoxicidad por cisplatino en un modelo experimental

Cisplatin is a chemotherapeutical agent that is highly effective in the treatment of solid organ tumours, such as ovarian, testicular, bladder, non-small cell pulmonary, and head and neck tumours. The main side effects associated with the use of cisplatin are gastrointestinal toxicity, nephrotoxicity, myelotoxicity, peripheral neurotoxicity and ototoxicity. Ototoxic lesions cause bilateral neurosensory hearing loss, which is irreversible, cumulative and dosage-dependent from