Neurocirugía

Percheron Artery Implicance in Bi-Thalamic Stroke Following Endoscopic Endonasal Approach for Infundibulo-Neurohypophysitis : A Combination of Two Rare Entities

2026-01-01T00:00:00Z

Percheron Artery Implicance in Bi-Thalamic Stroke Following Endoscopic Endonasal Approach for Infundibulo-Neurohypophysitis : A Combination of Two Rare Entities Domecq, Lucila; Ruella, Mauro; Villanueva, Pablo Javier; Katz, Débora Adela; Battistone, María Florencia; Cervio, Andrés Eduardo Bi-thalamic stroke is rarely reported in the literature as a complication of an endonasal endoscopic procedure. It has been associated with presence of a Percheron artery variant, as well as with top of the basilar syndrome, both of which significantly increase patient surgical morbidity. Infundibulo-neurohypophysitis in turn, is an unusual inflammatory disorder affecting the infundibulum, the pituitary stalk, and the neurohypophysis. We present the case of a patient with visual impairment and an abnormal hormone profile compatible with infundibulo-neurohypophysitis, in whom tumor resection was conducted through an endoscopic endonasal approach (EEA). Patient developed postoperative bi-thalamic stroke due to Percheron artery infarct. A review of both conditions is included. This is the fourth case reported in the literature of a Percheron artery infarct, and to the best of our knowledge, the first linking it to endoscopic treatment of neurohypophysitis, itself an infrequent condition.

Comparative Anatomical Assessment of the Contralateral Precaruncular Approach to the Supraoptic Triangle : A Cadaveric Study

2026-02-27T00:00:00Z

Comparative Anatomical Assessment of the Contralateral Precaruncular Approach to the Supraoptic Triangle : A Cadaveric Study Gago, Guilherme; Odeibat, Yousef; Monsalve, Martin; Côté, Martin; Champagne, Pierre-Olivier Background: The supraoptic triangle (SOT) is a bony-dural region located along the superior surface of the optic canal, corresponding to the base of the anterior clinoid process. It is bounded inferiorly by the optic nerve, laterally by the upper projection of the lateral border of the lateral optico-carotid recess (LOCR), and superomedially by the planum sphenoidale. Although often targeted endonasally, this region is notoriously difficult to reach without significant manipulation of the optic nerve and internal carotid artery. Even after maximal bone removal via a transtuberculum–transplanum approach, exposure to the SOT remains limited due to its lateral and deep location. This study evaluates whether a transorbital contralateral precaruncular approach can enhance access to this region compared to standard endonasal routes. Methods: Four cadaveric heads (7 sides) were dissected. A transtuberculum–transplanum endonasal approach was performed in all specimens. Surgical access to the SOT was then assessed through three distinct routes: ipsilateral endonasal (IpsiEA), contralateral endonasal (ContraEA), and contralateral precaruncular (CPC). Quantitative metrics included working distance, fencing angle, vertical and horizontal angles of attack (AoA), surgical freedom (calculated as a percentage of the surface area of a reference sphere using a 12-point navigation model), and area of exposure (AOE). Statistical comparisons were made using paired t-tests (α = 0.05). Results: The CPC approach yielded the shortest working distance (51.3 ±8.3mm vs. 78.0 and 78.9 ± mm; p < 0.6). Conclusion: The contralateral precaruncular approach improves angular access and reduces working distance to the supraoptic triangle, supporting its use as a complementary route to reach the lateral optic canal and anterior clinoid region.

Selective Dorsal Rhizotomy for the Treatment of Spasticity Associated with HIV Encephalopathy (Hive) in 15 Pediatric Patients

2025-12-18T00:00:00Z

Selective Dorsal Rhizotomy for the Treatment of Spasticity Associated with HIV Encephalopathy (Hive) in 15 Pediatric Patients Villamil, Facundo; Nazar, Ricardo; Ford, Fernando; Duffy, Clara; Mantese, Beatriz Introduction: Vertical transmission of HIV has decreased in developed countries but remains prevalent in developing nations. HIV-associated encephalopathy (HIVE) leads to severe neurological sequelae, including spasticity. Selective dorsal rhizotomy (SDR) is known to reduce spasticity and improve motor function in children with cerebral palsy, but its use in HIVE has not been well studied. This is the first study to evaluate the outcomes of SDR in children and adolescents with HIVE MATERIALS AND METHODS. A retrospective cohort study was conducted at two specialized centers, including 15 pediatric patients with progressive subacute HIV-associated encephalopathy and spasticity, who underwent selective dorsal rhizotomy between 2010 and 2022. The variables evaluated included the Gross Motor Function Classification System (GMFCS), the Functional Mobility Scale (FMS), the Gillette Functional Assessment Questionnaire (FAQ), and the Ashworth Scale (EAM) to measure muscle tone. Method: 1- Operative Technique Selective dorsal rhizotomy (SDR) was performed under general anesthesia with the patient in the prone position. Subdermal electrodes were placed in specific muscles for intraoperative mapping. A laminotomy was carried out from L2 to S1, and after opening the dura mater, the dorsal roots from L2 to S1 were identified. Radicles with the lowest stimulation threshold were selected for rhizotomy. In most cases, 25% of the root was sectioned, guided by neurophysiological monitoring. The laminae were fixed using titanium bone plates. Patients remained on bed rest for two days before beginning mobilization. All patients underwent intensive motor rehabilitation following SDR. 2- Functional Outcomes The mean age was 11.8 ± 3.12 years. At the 24-month follow-up after SDR, a significant reduction in spasticity was observed across all muscle groups, as measured by the Modified Ashworth Scale (MAS) (p < 0.001). Most children (94%) maintained the same GMFCS level at 24 months postoperatively, while 6% improved by one level. No significant long-term differences were found in the Functional Mobility Scale (FMS). General ambulatory function, as measured by the FAQ, showed a statistically significant improvement in many participants. Discussion: The results demonstrate a significant reduction in spasticity and improvements in functional capacity, suggesting that selective dorsal rhizotomy (SDR) is a viable treatment option for managing spasticity in this patient population. When combined with an intensive physiotherapy program, SDR can lead to substantial improvements in the quality of life of patients with HIV-related encephalopathy. Conclusions: Selective dorsal rhizotomy (SDR) is effective in reducing spasticity and improving motor function in children with HIV-related encephalopathy, offering a promising treatment option to enhance their quality of life. Long-term studies with larger patient cohorts are needed to confirm these findings.

Rizotomía Dorsal Selectiva: Análisis de dos Técnicas de Sección de Raíces Dorsales Sensitivas

2025-11-18T00:00:00Z

Rizotomía Dorsal Selectiva: Análisis de dos Técnicas de Sección de Raíces Dorsales Sensitivas Basilotta, Yamila; Mantese, Beatriz Introducción: La rizotomía dorsal selectiva (RDS) es una cirugía irreversible, cada vez más utilizada para tratar los trastornos de la marcha en niños con encefalopatía crónica no progresiva, mediante la reducción de la espasticidad. Se ha observado que una mayor proporción de raíces seccionadas logra una mejor reducción de la espasticidad, aunque con el riesgo de efectos neurológicos adversos por desafección excesiva. Si bien existen estudios que documentan beneficios y complicaciones de la RDS a corto y largo plazo, no se han comparado técnicas en cuanto a su impacto sobre la marcha y la preservación de la fuerza muscular. Este estudio tuvo como objetivo analizar y comparar la eficacia de dos técnicas de RDS con monitoreo neurofisiológico intraoperatorio, mediante análisis de marcha tridimensional instrumentado. Método: Este estudio retrospectivo, aprobado por el Comité de Ética, incluyó pacientes con parálisis cerebral espástica que cumplieron: SDR realizada por el mismo neurocirujano (2009–2019), análisis de marcha 3D previo (<21 meses) y posterior (2–31 meses) a la cirugía, condición ambulatoria en ambas evaluaciones, ausencia de otras cirugías en ese intervalo y consentimiento para uso de datos. Se compararon dos técnicas bilaterales de L1 a S1: clásica (Peacock, sección de hasta el 50% de las raíces) y conservadora (Molenaers: L1 25%, L2–L4 33%, L5 25%, S1 15%). Todos los pacientes realizaron RM cerebral y de columna, evaluación urológica con ecografía pre y postmiccional (y estudio urodinámico si era necesario) y recibieron rehabilitación intensiva 5 días por semana durante un año. La espasticidad se evaluó con la escala de Ashworth modificada en cinco grupos musculares, y la fuerza muscular con la escala de Kendall. Resultados: Se estudiaron un total de 17 pacientes. Ambos grupos mostraron mejoras en el patrón de marcha y reducción de espasticidad. Sin embargo, los pacientes tratados con la técnica conservadora presentaron un aumento significativo (p = 0,04) en la potencia neta del tobillo (1,37±0,61 W/BW) frente a los operados con la técnica clásica (0,98±0,18 W/BW). Discusión: La rizotomía dorsal selectiva (SDR) reduce la espasticidad en parálisis cerebral, pero la evidencia sobre su impacto funcional a largo plazo es limitada. Este estudio comparó la técnica clásica (sección del 50% de las raíces) con una técnica conservadora (L1: 25%; L2–L4: 33%; L5: 25%; S1: 15%), evaluando resultados mediante análisis tridimensional de la marcha. Ambas lograron reducciones similares del tono y mejoras en el rango articular, sin diferencias clínicamente relevantes en el Gait Deviation Index. Sin embargo, la técnica conservadora preservó mejor la potencia neta del tobillo, evitando debilidad excesiva y optimizando el papel de los flexores plantares en la propulsión y estabilidad durante la marcha, lo que podría favorecer una rehabilitación más eficaz Conclusiones: La técnica conservadora no solo reduce la espasticidad, sino que favorece una mejor recuperación funcional para la rehabilitación y la marcha.