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Spasticity is amotor disorder that leads to a resistance to passive jointmovement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There aremany scales that help tomeasure andmonitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safetechnique, possibleto beperformed inmost centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.

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Introducción: El objetivo de este estudio fue evaluar el impacto de la pandemia de Covid-19 en la práctica de la Neuromodulación en Argentina. Material y Métodos: Se envió una encuesta a los profesionales que practican la Neuromodulación en Argentina entre el 19 de julio al 20 de agosto de 2020. Se determinó el impacto de Covid-19 a nivel profesional y personal. Todas las variables fueron comparadas y analizadas. Resultados: Veinticuatro profesionales respondieron a la encuesta completa. La mayoría de ellos eran varones (87,5%), en el grupo de edad de 45 a 59 años (37,5%), con 15 o más años de experiencia (45,83%). Los neurocirujanos fueron la mayoría (87,5%), siendo las técnicas ablativas la práctica predominante (26,47%). La gran mayoría informó una disminución de las prácticas quirúrgicas (83,33%), entre el 50 y el 74% de ellas (40%), siendo la decisión del financiador la razón única más citada (43,47%) y la Estimulación Cerebral Profunda, la técnica quirúrgica más afectada (41,6%). El 100% de los entrevistados declaró que los pacientes habían sido perjudicados por la suspensión de cirugías y que los ingresos económicos se redujeron de alguna manera, también en el 100% de los encuestados. A nivel personal, ninguno de los profesionales reportaron haber sido diagnosticados de la enfermedad. Sin embargo, el 37,5% sufrió algún otro tipo de daño a nivel físico y el 20,83% informó secuelas psicológicas, especialmente ansiedad. Conclusión: La actual pandemia de Covid-19 ha tenido un impacto muy significativo en la práctica de la Neuromodulación en Argentina, tanto a nivel profesional como personal. Este impacto debe ser tenido en cuenta en el futuro, en caso de una nueva pandemia, para prevenir los efectos nocivos que se registraron en este estudio

Background: The objective of this study was to evaluate the impact of the Covid-19 outbreak in the practice of Neuromodulation in Argentina. Methods: A survey was sent to Argentina neuromodulation practitioners from July 19 to August 20, 2020. The impact of Covid-19 on the professional and personal level were determined. All variables were compared and analyzed. Results: Twenty-four practitioners responded to the complete survey. Most of them were male (87.5%), in the 45-59 year age group (37.5%), with 15 or more years of experience (45.83%). Neurosurgeons were in the majority (87.5%), with ablative techniques being the predominant practice (26.47%). The great majority reported a decrease in surgical practices (83.33%), between 50 and 74% of them (40%), with the decision of the financer being the most cited reason (43.47%), and Deep Brain Stimulation the most affected surgical technique (41.6%). 100% of the interviewed declared that the patients had been harmed by the suspension of surgeries, and that the economic income was reduced in some way in 100% of the interviewed. On a personal level, none of the professionals reported having been diagnosed with the disease. However, 37.5% suffered physical manifestations, and 20.83% reported psychological sequelae, especially anxiety. Conclusion: The current Covid-19 pandemic yielded a significant impact on the daily work practice as well as on the personal level of practitioners in neuromodulation in Argentina. This impact must be taken into account in the long term to avoid further harmful effects and their sequels and to take appropriate preventive measures in the event of another pandemic

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The authors describe a case of infratentorial epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a patient with a recent history of cutaneous furunculosis. This 29-year-old male presented with an occipital headache associated with fever, vomiting, and neck stiffness. Admission magnetic resonance imaging showed a retrocerebellar epidural abscess. Antimicrobial therapy was started, and the patient underwent craniectomy for evacuation of the abscess. Cultures of the surgical specimen were consistent with CA-MRSA. Postoperatively, the patient's condition improved with the resolution of symptoms, and he was discharged home with indication of 6 weeks of antibiotic therapy. Furunculosis is a very rare cause of intracranial epidural abscess but should be considered as a source of infection in an immunocompetent patient.

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Objetivo: Comparar la evolución postoperatoria de los hematomas subdurales subagudos (HSDSA) y hematomas subdurales crónicos (HSDC) intervenidos con técnica de 2 trépanos, desde junio 2013 a junio 2015. Material y métodos: Se realizó un análisis prospectivo comparando 2 grupos de pacientes: HSDSA y HSDC. Ambos fueron tratados con la misma técnica quirúrgica: dos orificios de trepano, lavado y drenajes subdurales. Se analizaron y compararon: tiempo de cirugía, resolución de los síntomas, necesidad de re-intervención y días de internación. Las variables se presentan como media y DS y mediana y RI, las comparaciones se realizaron con test o Chi2 según su naturaleza, una p <0.05 se considero significativa. Resultados: Fueron evaluados 66 pacientes, 30 HSDSA y 36 HSDC. La edad fue 75 ±11 años (HSDA 76± 11 y HSDC 74 ±12, p 0.5), masculinos 66% (HSDSA 50% y HSDC 85%, p 0.006). El tiempo medio de cirugía para HSDSA fue 59±12 y HSDC 59±17 minutos, p 0.9. Resolvieron la sintomatología en HSDSA 28 (93,3%) y HSDC 34 (94,4%), p 0.8; y requirieron una segunda cirugía por recidiva HSDSA 2 (6,7%) y HSDC 2 (5,6%), p 0.6. La mediana del tiempo de internación fue HSDSA 10 [9- 12] días y HSDC 7,5 [6-10] días, p 0.01. La sobrevida fue del 100%. Conclusiones: La trepanación es una técnica ampliamente aceptada para el tratamiento de HSDC. En hematomas subdurales agudos no existe discusión sobre la necesidad de realizar un abordaje mayor (craneotomía o craniectomía). En el caso de HSDSA la evidencia publicada no es tan concluyente tendiendo en muchos centros a tratarlos en forma similar a los hematomas subdurales agudos generalmente por considerar que la técnica de trepanación y drenaje podría ser insuficiente. Basado en los resultados obtenidos en el presente trabajo podemos concluir que esta técnica es igualmente efectiva para el tratamiento de HSDC y HSDSA y recomendamos su utilización sistemática.

Objective: To compare the postoperative course of subacute subdural hematomas (SSDH) and chronic subdural hematoma (CSDH) operated upon using two burr holes from June 2013 to June 2015. Methods: A prospective analysis was performed comparing patients with SSDH versus CSDH. Both were treated with the same surgical technique —two burr holes— followed by lavage and subdural drainage. Variables compared were surgery time, resolution of symptoms, the need for re-intervention, and number of inpatient days. Variables are presented as means with SD, medians and range, with statistical comparisons performed via Pearson χ2 analysis or XXXXXXXX, as appropriate, with p <0.05 considered significant. Results: A total of 66 patients were analyzed, 30 with SSDH and 36 with CSDH. Mean overall age was 75 ± 11 years with no difference between the two groups (76 ± 11 versus 74 ± 12, respectively; p=0.5). Overall, 66% were male, including 50% with SSDH and 85% with CSDH (p = 0.006). The average lengths of surgery were 59 ± 12 versus 59 ± 17 minutes, respectively (p = 0.9). No intergroup differences were noted in the rate of symptom resolution (93.3% versus 94.4%; p = 0.8) or need for a second surgery for disease recurrence (6.7% vs. 5.6%, p = 0.6). The median length of stay was somewhat shorter in SSDH patients (10 [9-12] vs. 7.5 [6-10] days; p = 0.01). Overall survival was 100%. Conclusions: Trepanation is a widely-accepted technique for the treatment of CSDH. For acute subdural hematomas, there is no discussion regarding the need for a more aggressive approach (e.g., craniotomy or craniectomy). For SSDH, however, published evidence is not as conclusive; yet many centers treat such patients similarly to those with acute subdural hematomas, usually in the belief that trepanation and drainage would be insufficient. Based upon the results obtained in our series, we conclude that this technique is equally effective for the treatment of CSDH and SSDH, and recommend its routine use.

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