https://repositorio.fleni.org.ar/xmlui/handle/123456789/44 2026-05-08T14:32:37Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1491 Evaluation by Stereoelectroencephalography (SEEG) of the Insular Region in Drug-Resistant Focal Epilepsies: Diagnostic Experience and Technique in the First Reported Cohort in Argentina Villamil, Facundo; Slame, Yamila; Silva, Walter; Ugarnes, Gabriela; Marone, Abril Maria Laura; Piccirilli, María Victoria; Fariña, Sofia; Bartuluchi, Marcelo Introduction: The insula, due to its deep location, complex anatomy, and clinical interpretation, represents a challenge in the study of drug-resistant epilepsies. Method: Seventeen patients implanted between 2018 and 2025 with suspected insular involvement were included. Micromar® frames (2020–2023) and Leksell® frames (2023–2025) were used. Trajectories, number of contacts, ictal onset zone, thermocoagulations, and complications were analyzed. In addition, dissections were performed on six human hemispheres (Klingler technique) to validate safe trajectories. Results: During the study period, 218 electrodes were implanted, of which 56 (25.7%) targeted the insula, with 128 contacts in insular cortex. Accumulated experience enabled a transition from orthogonal trajectories (32 trajectories, covering opercular and insular regions, average of 2 insular contacts) to planning with both orthogonal and oblique trajectories (26 trajectories, exclusively insular coverage, average of 7 contacts). Discussion: Insular SEEG exploration has been increasingly reported worldwide, yet data from Latin America remain scarce. Our series, the largest in Argentina, confirms the feasibility and safety of insular implantation in drug-resistant focal epilepsy. Indications were based on semiology suggestive of insular onset or early propagation, and SEEG confirmed an insular ictal onset zone in one-third of cases. Technical refinement from orthogonal to oblique trajectories allowed denser sampling (up to 7 contacts/electrode) while avoiding vascular injury, with only one hematoma unrelated to insular electrodes. No procedure-related morbidity was observed. These findings reinforce the role of systematic insular exploration in SEEG protocols, given the limitations of non-invasive studies and the potential for therapeutic thermocoagulation when the insula is the primary ictal onset zone. Conclusions: Insular SEEG implantation is safe and feasible. Progressive technical optimization allowed denser coverage without increased morbidity. The possibility of identifying primary ictal activity and treating it through thermocoagulation supports its systematic inclusion in SEEG studies, despite its challenging anatomy. 2025-11-18T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1469 Introducing e-Motions: a novel intraoperative test for social cognition mapping. Triple validation in normative, schizophrenia, and autism spectrum disorder populations Martín-Fernández, Jesús; Caballero-Estebaranz, Nayra; Félez, Esteban; Pérez Del Rosario, Pedro; Rodríguez Pulido, Francisco; Navarro-Peris, Natalia; Martínez, Fernando; Cervio, Andrés Eduardo; Martín-Monzón, Isabel Background: Social cognition is essential for daily functioning, as it influences quality of life, return to work, and interpersonal communication. While schizophrenia and autism spectrum disorder (ASD) have been the paradigmatic conditions in which social cognition is markedly impaired, emerging evidence suggests that up to 30% patients with brain tumors may experience persistent deficits in this domain. Despite its clinical relevance, social cognition remains insufficiently studied in neuro-oncology and lacks dedicated intraoperative assessment tools specifically tailored for its use during awake brain surgery. Method: This study introduces e-Motions, a new test designed ad hoc to address this gap. The e-Motions test comprises 34 four-second video stimuli depicting two hyper-realistic avatars (one male, one female) expressing complex emotions. These avatars were developed using an AI-based facial motion capture system applied to 60 professional actors. Validation was performed in three groups: (1) healthy adults (n = 226), (2) individuals with schizophrenia (n = 33), and (3) ASD (n = 30). Results: Internal consistency (KR-20), test-retest reliability (ICC), and correlations with established social cognition tools (Reading the Mind in the Eyes [RMET], Ekman-60 faces test [Ekman-60F], and the Movie for the Assessment of Social Cognition [MASC]) were evaluated. The e-Motions test demonstrated high global internal consistency (KR-20 = 0.86) and good test-retest reliability (ICC₂,₁ = 0.73). Scores showed positive moderate correlations with both lower-level mentalizing tests (RME: ρ = 0.44; Ekman-60F: ρ = 0.48) and higher-level mentalizing test (MASC: ρ = 0.57). Discriminative power was strong for distinguishing healthy participants from individuals with schizophrenia (AUC = 0.89) and ASD (AUC = 0.79). Conclusions: e-Motions test is the first AI-based test created ad hoc for awake brain mapping. Its good internal consistency and significant correlation with low-level and high-level mentalizing tests make this tool a novel, ecological and promising way to identify critical regions involved in social cognition during awake brain mapping. Future studies should be performed to demonstrate its validity preserving this complex higher-order cognitive construct during and after brain tumor surgery. 2025-09-30T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1452 “En Plaque Meningioma” masked by Chronic Serous Otitis Media with Effusion Ruella, Mauro Emiliano; Villamil, Facundo; Marengo, Ricardo; Carnevale, Martín Diego; Cervio, Andrés Eduardo Objective To highlight a rare but clinically significant cause of persistent unilateral otitis media with effusion (OME) through a case series of patients ultimately diagnosed with skull base “en plaque” meningioma. Emphasis is placed on the otologic presentation, its diagnostic approach and management. Methods Single-center, retrospective study of a cohort of patients with persistent unilateral OME ultimately diagnosed as en plaque meningiomas involving the temporal bone. A review of medical records, images, and operative videos was conducted. Results Five patients (4 females, 1 male; age 45–70) presented with longstanding and refractory hypoacusia, aural fullness tinnitus and othorrea. Delay between symptom onset and referral to our center reached 2 years. CT scans and MRIs showed evidence of sphenotemporal and middle-ear involvement. Prior management included unsuccessful procedures such as VTs, mastoidectomy, and exploratory myringotomy. Four patients underwent biopsy confirming WHO grade I meningioma. Neurosurgical decompression was required in three cases. Adjuvant therapy was employed in selected cases. Conclusion Persistent unilateral OME that is refractory to treatment should prompt suspicion for underlying skull base lesions, including meningioma en plaque. Awareness of this association helps expedite diagnosis. Otolaryngologists play a pivotal role in early recognition and timely referral can prevent progression. Imaging with CT and MRI aids diagnosis. Individualized approach is required. Surgery may be considered for histologic confirmation and decompression of neural structures with or without postoperative adjuvant therapies. However, total resection is difficult and often achieved at the expense of significant morbidity. Conservative management and surveillance are often the best alternative for asymptomatic lesions. 2025-07-30T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1435 Global Rostral Midbrain Syndrome (GRMS) and Corpus callosum infarction in the context of shunt overdrainage Villamil, Facundo; Varela, Francisco José; Caffaratti, Guido; Ricciardi, Mario Emiliano; Cammarota, Ángel Norberto; Cervio, Andrés Eduardo We report 3 cases of Global rostral midbrain syndrome (GRMS) and Corpus Callosum (CC) infarction, in the context of hydrocephalus followed by shunt dysfunction and slit ventricles. Prior shunt implantation had been indicated for adult-onset hydrocephalus secondary to aqueductal stenosis of varying causes. All three patients had been stable for months before developing repeated shunt dysfunctions, ultimately progressing to parkinsonism, Parinaud syndrome, akinetic mutism, pyramidal signs, cognitive impairment, CC infarction and slit ventricles, in the context of CSF overdrainage. Parkinsonism-related symptoms responded to dopa in all cases, but Parinaud syndrome and cognitive impairment persisted. Although GRMS has been described in the context of a transtentorial pressure gradient after shunt blockage, in these three cases with similar clinical presentation, reverse transtentorial pressure gradient and slit ventricles due to shunt overdrainage was the likely cause. The authors discuss the role of CC infarction and provide a detailed analysis after gathering previously described data, to unify information under a recognizable clinical entity and better understand the underlying pathophysiology, treatment options and outcome. 2021-12-26T00:00:00Z