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Figura 1 – Corte coronal a) y sagital b) de RMN potenciada en T1 con gadolinio que muestra una lesión selar que capta
contraste, invadiendo el seno cavernoso derecho a) y erosionando el suelo de la silla, ocupando el seno esfenoidal b).
et al.2 , de exacerbación del asma en un paciente intervenido de
un adenoma hipofisario. Por todo ello, es imprescindible realizar una anamnesis detallada para identificar los pacientes que
puedan requerir la administración de dosis mayores de corticoides para prevenir el agravamiento de patologías previas
silentes.
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5. Uthman I, Senecal JL. Onset of rheumatoid arthritis after
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Nicolás Samprón a , José Undabeitia a,∗ , Sergio Torres-Bayona a
y Enrique Úrculo a,b
a Servicio de Neurocirugía, Hospital Universitario Donostia, San
Sebastián, Guipúzcoa, España
b
1. Quirce S, Bobolea I, Barranco P. Asma Actualización
terapéutica. Med Clin (Barc). 2014;142:317–22.
2. Krysiak R, Kedzia A, Okopien B. Relapse of asthma after
surgical treatment of Cushing’s syndrome. Acta Clin Belg.
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Departamento de Cirugía y Radiología y Medicina Física, Facultad
de Medicina y Odontología, Universidad del País Vasco (UPV/EHU),
San Sebastián, España
∗ Autor
para correspondencia.
Correo electrónico: [email protected]
(J. Undabeitia).
http://dx.doi.org/10.1016/j.neucir.2014.12.001
1130-1473/© 2014 Sociedad Española de Neurocirugía.
Publicado por Elsevier España, S.L.U. Todos los derechos
reservados.
Aesthetically optimal deep brain stimulation
technique in patients with alopecia
Técnica para optimizar el resultado estético de pacientes con
alopecia sometidos a neuromodulación por estimulación cerebral
profunda
Dear Editor,
The effectiveness of DBS is related to chronic stimulation of
specific deep-seated targets in the brain1 . Electrode fixation
is one of the important issues in the effectiveness of this
therapy2,3 . It is also noted that burrhole caps yield unaesthetic elevations over the skull bone of about 0,5 cm, which
can be clearly observed under the skin in hairless patients
(Figure 1). Herein, the authors present two illustrative DBS
cases operated according to the routine technique used in this
center4 , proposing the use of the tissue adhesive Histoacryl®
(Aesculap, Tuttlingen, Germany) as a simple electrode fixation
method. This adhesive is a low cost biocompatible woundclosing agent that, in our experience, saves time during
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n e u r o c i r u g i a . 2 0 1 5;2 6(4):205–208
A
Burr hole and
cyanoacrilate
Burr hole
cap and ring
B
Skin
Bone
Dura
6 mm
14 mm
DBS LEAD
5 mm
Figure 1 – (A and B) Illustration of the lead fixation with the ring-cap anchoring device on the left vs. the proposed method
with sealing adhesive (Histoacryl®) on the right using a smaller bur hole.
Figure 2 – (A and B) Illustration of esthetic results of DBS implants in two hairless patients. Arrowheads point to the
position of bilateral burr holes thephination sites. (C) DBS Lead in place seconds after the application of the adhesive,
sealing the 6mm-burrhole and fixing the lead.
surgery because of its fast polymerization property when in
contact with CSF or distilled water. Once the surgeon has
determined the target site, he irrigates the burr hole in order
to fill the intracranial compartment. This fact also prevents
the glue from entering the skull, avoiding direct contact with
the brain. This simplified method provides a reliable stabilization, firmly attaching the DBS lead onto the skull (Figure 2 C).
It additionally seals the burrhole and rules out elevations over
the skull with outstanding esthetic results (Figure 2 A/B). This
method has been used for many years in our service in over
250 DBS implants with less than 0.5% electrode migration. The
proposed technique also permits a smaller burrhole around
6 mm what also helps to prevent CSF leak and consequently
less brain shifting5 . The adhesive is also easily removable with
blunt instruments spearing the silicon coated lead in reoperations.
Conflict of interest
The authors declare that they have no conflicts of interests.
Acknowledgments
Figure 1 conception: William Omar Contreras Lopez and Erich
T. Fonoff. Drawing: Danilo Costa Barbosa.
bibliograf í a
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3. Contarino MF, Bot M, Speelman JD, de Bie RMA, Tijssen MA,
Denys Det al. Postoperative displacement of deep brain
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Neurosurgery 73:681–688; discussion 188. 2013.
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∗ Corresponding
5. Figueira-Mendez R, Magariños-Ascone C, Regidor I, et al.
Estimulación cerebral profunda: 12 años de experiencia y 250
pacientes intervenidos con un seguimiento de más de un año.
Rev Neurol. 2009;49:511–6.
author: Division of Functional Neurosurgery Department of Neurology–University of Sao Paulo School of
Medicine; São Paulo, Brazil. Rua Dr. Ovídio Pires de Campos,
785, 01060-970, São Paulo–SP–Brasil.
Erich Talamoni Fonoff ∗ , Manoel Jacobsen Teixeira, Clarissa
Nóbrega Gambarra Nascimento, William Omar Lopez
Department of Neurology, Division of Functional Neurosurgery of
the Institute of Psychiatry, University of São Paulo School of
Medicine, São Paulo, Brazil
E-mail address: [email protected] (E.T. Fonoff).
http://dx.doi.org/10.1016/j.neucir.2015.02.004
1130-1473/© 2015 Sociedad Española de Neurocirugía.
Published by Elsevier España, S.L.U. All rights reserved.