Epilepsy is one of the more frequent neurologic disorders, with an incidence of 50/100,000/year and prevalence between 0.5 and 2% worldwide. A third of these patients suffer focal epilepsy due to epileptogenic lesions evident by neuroimaging new techniques. Epilepsy surgery is the only treatment that can cure refractory epilepsy. Its goal is to remove the epileptogenic lesion with preservation of eloquent areas, and in this case both surgical experience and neuroimaging technology play a pivotal role. Objective. To demonstrate utility of neuronavigation in presurgical planning and surgery of refractory epilepsy. Method. Descriptive, cross sectional and analytic study of 47 performed surgeries (12 resective, 12 palliative and 3 diagnostic) in patients with refractory epilepsy with an average age of 9.93 years (SD 4.1). In 27 patients (57.44%) neuronavigation was used. In patients operated with assistance of neuronavigation, surgical time diminished in 47.17 minutes (p=0.022), hemorrhage in 111.41 ml (p=0.011) and days of hospitalization in 6.68 days (p=0.005) comparing with group without neuronavigation. Complications in the group with neuronavigation were 29.63% compared with 65% in the group without it. (P=0,034). Conclusions. In this study, using neuronavigation in planning and performing surgery in reducing the amount of blood loss, surgical time, days of hospitalization and post surgical complications.
Neuronavegación
Experiencia Quirúrgica de Dos Años en el Manejo de la Epilepsia Refractaria Multifocal
Objective: To describe the series of patients with multifocal refractory epilepsy who have undergone surgery in our center.
Methods: A prospective analysis of patients with multifocal refractory epilepsy treated in our hospital during the last two years was performed.
Results: In this period we studied 25 patients with multifocal refractory epilepsy who have completed > or =1 year postoperative follow-up after callosotomy. The ages of the patients were between 3.8 and 18.8 years (mean 11, SD 4.46). The most common cause of refractory epilepsy in our series was Lennox Gastaut syndrome (ten patients). We perform 14 callosotomy in 13 patients. Of these, 10 were of the above callosotomías 2/3 and four complete. Overall there was a 66.5% reduction in seizures; in the case of total callosotomías this reduction was 90%. We report two minor complications and death from a pneumonic process.
Conclusion: The surgical management of multifocal refractory epilepsy is a safe procedure that provides good results in controlling the crisis. The complete callosotomy is the most efficient procedure in this population.
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Neuronavegación en Tumores de Fosa Posterior en Pediatría
Introduction. Primary tumors of the central nervous system represent about 2% of the total of the neoplasms in adults and 20% of total neoplasms in children. Posterior fossa tumors represent 48% of pediatric population and are the first cause of malignancy of solid organs in the pediatric age. In our environment, the use of neuronavigation in the excision of posterior fossa tumors in pediatric population has not yet been adequately standardized.
Materials and methods. A retrospective observational study from january 2014 to may 2016 of patients diagnosed with posterior fossa tumors is reviewed. We included 20 patients with diagnosis of space-occupying lesion in posterior fossa.
Results. The relationship man: woman was 1:1. The average age was 4 years and 4 months. The degree of precision of the intraoperative neuronavigation prior to craniotomy had an average error margin less than 1.5 millimeters, varying from 1 to 3 millimeters.
Conclusions. Neuronavigation is useful in performing a precise surgery, reducing risks associated with the intervention and shortening the surgical times. Because of greater tumor resecting, neuronavigation is usefel in increasing survival of oncologic pediatric patients.
