https://repositorio.fleni.org.ar/xmlui/handle/123456789/3 Sat, 27 Jun 2026 01:13:54 GMT 2026-06-27T01:13:54Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1509 Gasserian Ganglion Stimulation in Refractory Trigeminal Neuralgia: A Single-Center Case Series Villamil, Facundo; Solari, Matías; Nuñez, Maximiliano; Stella, Oscar Introduction:Trigeminal neuralgia (TN) is a severe neurological condition characterized by intense, paroxysmal, and disabling facial pain. Management can be especially challenging in patients refractory to pharmacological and surgical therapies. Gasserian ganglion stimulation (GGS) has emerged as a potential alternative in such cases; however, its use remains limited and underrepresented in current literature. Objective. To evaluate the clinical efficacy, pain evolution, and impact on quality of life in a cohort of patients with refractory TN treated with Gasserian ganglion stimulation at our institution. Method:We conducted a retrospective observational study of 10 adult patients with refractory TN who underwent GGS between January 2008 and May 2025. Demographic data, clinical history, TN subtype (according to Burchiel’s classification), affected territories, trigger points, and prior treatments were analyzed. Pain intensity was assessed using the Visual Analog Scale (VAS) and Barrow Neurological Institute (BNI) pain scale preoperatively, immediately postoperatively, at six months, and at final follow-up. Quality of life (QoL) and reduction in medication use were also evaluated. A female predominance (73%) was observed, with a mean age at diagnosis of 50 years. Based on Burchiel’s classification, 50% had type I TN, and 20% had deafferentation pain. Prior interventions were reported in 72% (n=8), predominantly radiofrequency thermocoagulation. Preoperatively, 60% (n=6) experienced severe pain (VAS 8–10), 30% (n=3) moderate pain (VAS 4–7), and 10% (n=1) mild pain (VAS 1–3). Immediately postoperatively, 50% (n=5) reported moderate pain, 30% (n=3) severe, and 20% (n=2) mild. A significant reduction in pain was observed (p=0.002). On the BNI scale, 60% (n=6) had a score of 4 preoperatively; at six months, 80% (n=8) achieved BNI ≤3b. At final follow-up, 50% (n=5) reached BNI 2, 30% (n=3) BNI 3b, and 20% (n=2) BNI 1 (p=0.0018). Following surgery, 90% reported fair to excellent QoL. At six months, 82% had reduced medication use, with only 27% continuing pharmacological treatment at final evaluation. Discussion: GGS appears to be a viable alternative for patients with refractory TN, especially those with multiple failed interventions. Our results align with international findings regarding procedural safety, sustained pain relief, and medication reduction. A trend was observed between the number of trigger points and pain severity, suggesting possible predictive factors, though statistical significance was not achieved in this limited sample. Conclusions:Gasserian ganglion stimulation is a safe and effective option for treating refractory TN, providing significant pain relief, high clinical response, and sustained improvements in quality of life. These findings support its inclusion as a therapeutic alternative in complex, recurrent, or treatment-resistant cases. Tue, 18 Nov 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1509 2025-11-18T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1506 Fully endoscopic approach to cerebellopontine angle tumors: a systematic review and meta-analysis Cotrim Gomes, Fernando; Ferreira, Marcio Yuri; Oliveira Machado Pereira, Maria Antônia; Silveira Ritossa, Leonardo Antônio; Müller, Gean Carlo; Campos Cardoso, Leonardo Januario; Ferreira Reis, Richard Daniel; Mendes Correa, Eduardo; Ruella, Mauro; Champagne, Pierre-Olivier; Cervio, Andrés Eduardo; Gago, Guilherme The cerebellopontine angle (CPA) is a surgically complex region due to its dense neurovascular anatomy. Traditional microscopic retrosigmoid approaches provide limited visualization in deep recesses. The fully endoscopic retrosigmoid approach (FERA) has emerged as an alternative, offering panoramic views and potentially improved functional outcomes. However, its efficacy and safety remain incompletely defined. A systematic review and meta-analysis were performed following PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library were searched through February 2025. Eligible studies reported ≥ 5 patients undergoing CPA tumor resection exclusively with FERA. Data were synthesized using random-effects models, and outcomes included gross total resection (GTR), facial and hearing preservation, and perioperative complications. Risk of bias was assessed using the ROBINS-I tool. 11 studies comprising 282 patients (39.4% male; mean age 31-61 years) met inclusion criteria. Pathologies included 140 epidermoid cysts, 114 vestibular schwannomas, 18 meningiomas, and 21 other tumors. Pooled GTR was achieved in 85% (95% CI 74-92). Facial nerve preservation (House-Brackmann I-II) was 93% (95% CI 87-96), and serviceable hearing preservation (Gardner-Robertson I-II) was 73% (95% CI 49-88). One major complication (postoperative hemorrhage) was reported, while minor complications occurred in 14% of patients, predominantly cerebrospinal fluid leaks and transient neuropathies. Most studies demonstrated moderate risk of bias, with confounding and reporting heterogeneity as major limitations. FERA enables high resection rates with favorable facial nerve and hearing preservation, while maintaining an acceptable safety profile. Although current evidence supports feasibility, prospective comparative trials with standardized reporting are required to define its role relative to microscopic and endoscope-assisted Tue, 18 Nov 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1506 2025-11-18T00:00:00Z 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. Tue, 18 Nov 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1491 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. Tue, 30 Sep 2025 00:00:00 GMT https://repositorio.fleni.org.ar/xmlui/handle/123456789/1469 2025-09-30T00:00:00Z