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Socolovsky M, di Masi G, Bonilla G, Lovaglio A, Battaglia D, Rosler R, Malessy M. Brain plasticity in neonatal brachial plexus palsies: quantification and comparison with adults' brachial plexus injuries. Childs Nerv Syst 2024; 40:479-486. [PMID: 37436472 DOI: 10.1007/s00381-023-06072-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the plasticity grading scale (PGS) for detecting differences in brain plasticity between both groups. METHODS To be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the rehabilitation quality scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical significance. RESULTS A total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months). The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically significant (p < 0.001). The RQS was not significantly different between groups. CONCLUSION We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.
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Affiliation(s)
- Mariano Socolovsky
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina.
- Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina.
| | - Gilda di Masi
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina
- Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina
| | - Gonzalo Bonilla
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina
- Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina
| | - Ana Lovaglio
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, 1428, Buenos Aires, Argentina
- Peripheral Nerve & Brachial Plexus Surgery Unit, Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Torre 2 5A, Buenos Aires, Argentina
| | - Danilo Battaglia
- Peripheral Nerve & Brachial Plexus Surgery Program, Department of Physiotherapy and Rehabilitation, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Roberto Rosler
- Department of Neurology, Universidad Abierta Interamericana, Buenos Aires, Argentina
| | - Martijn Malessy
- Department of Neurosurgery, University of Leiden School of Medicine, Leiden, Holland
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Hernández DA, Zaloff Dakoff JM, Auad C, Derechinsky VE, Rosler R, Piccirilo S, Matínez AM, Filomía ML, Rafailovici L. [Stereotactic brain radiosurgery in the treatment of skull base tumors.]. Medicina (B Aires) 2019; 79:453-460. [PMID: 31829947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Stereotactic radiosurgery has shown effectiveness in the multimodal treatment of skull base tumors, however it is suggested that in radiobiologically sensitive areas (eg. optic nerves and brainstem) the radiation dose should be reduced due to radiotoxic effects. To avoid the consequent therapeutic ineffectiveness, a recently implemented alternative is multisession radiosurgery (RCH). We retrospectively analyzed a series of patients with skull base tumors, in order to evaluate the treatment with RCH through tumor control in the post-treatment images. Age, sex, tumor histology, tumor volume, radiation protocol, pre-treatment Karnofsky performance status (KPS) previous neurosurgery and radiant treatment were also evaluated. Eighty-four patients were treated between January 2009 and January 2017. The median age was 51.5 years; females: 53.6%. There was a 92.7% non-progression after treatment, with a median follow-up time of 36 months. Treated tumors were mainly pituitary adenomas, acoustic schwannomas, and skull base meningiomas. Most of the patients received a 5-day fractionated treatment scheme, with a total dose of 25 Gy. No clinically manifest late radiotoxicity was observed. In the multivariate analysis, a high pre-treatment KPS was significantly associated with tumor non-progression. In our series, the high incidence of tumor non-progression would indicate that treatment with RCH could be a therapeutic option in some cases of skull-base tumors, mainly recurrences or tumor residuals of pituitary adenomas, neurinomas and meningiomas.
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Affiliation(s)
- Diego A Hernández
- División Neurocirugía, Hospital Naval Pedro Mallo, Argentina. E-mail:
- Equipo de Radiocirugía, Hospital Naval Pedro Mallo, Argentina
| | | | - Cynthia Auad
- Equipo de Radiocirugía, Hospital Naval Pedro Mallo, Argentina
- Vidt Centro Médico, Buenos Aires, Argentina
| | | | - Roberto Rosler
- Equipo de Radiocirugía, Hospital Naval Pedro Mallo, Argentina
| | - Sebastián Piccirilo
- Equipo de Radiocirugía, Hospital Naval Pedro Mallo, Argentina
- Vidt Centro Médico, Buenos Aires, Argentina
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Peterson S, de Vries P, Piasecki J, Rosler R. Tucatinib, a HER2 selective kinase inhibitor, is active in patient derived xenograft (PDX) models of HER2-amplified colorectal, esophageal and gastric cancers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Rosler R, Young P. [The anatomy Lesson of Dr. Nicolaes Tulp: The beginning of a medical utopia]. Rev Med Chil 2011; 139:535-541. [PMID: 21879195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Anatomy Lesson of Dr. Nicolaes Tulp was painted by Rembrandt Harmen-szoon van Rijn at the early age of 26 years. In the XVII century these paintings were very popular in the Netherlands, and in this country the cities flourished as cultural centers searching the anatomy knowledge. Nicolaes Tulp was one of the persons in the center of Amsterdam's scene during XVII century. In 1632 Tulp was 39 years old, and he was an anatomist and a surgeon. Rembrandt masterly shows an autopsy performed by Dr. Tulp. This picture is the description of the beginning of a medical intellectual utopia: the absolute visibility of the disease. Unfortunately this utopia is blind to the complete visibility of the psycho-socio-cultural dimensions of the ill.
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Affiliation(s)
- Roberto Rosler
- Servicio de Neurocirugía, Hospital Británico de Buenos Aires, Santiago, Chile
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Rosler R, Young P. La lección de anatomía del doctor Nicolaes Tulp: el comienzo de una utopía médica. Rev Med Chil 2011. [DOI: 10.4067/s0034-98872011000400018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thomson A, Rabinowicz A, Rosler R, Shliapochnik J, Matera R. 1-17-29 “Secondary epileptogenesis?”. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)84966-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
An original stereotactic radiosurgical approach coupling a) Talairach's stereotactic methodology, b) a specially devised mechanical system, and c) a linear accelerator is detailed. The authors present their preliminary results on 66 patients with nonsurgical intracranial arteriovenous malformations. The doses delivered for treatment varied from 20 to 70 Gy. Doses of no more than 40 Gy were used in 80% of patients. An angiographic study was performed when the computed tomographic scan controls showed relevant modifications of the lesion volume. Total obliteration was obtained in 27 of the 41 patients (65.8%) who were followed up for at least 24 months. The percentage of the cured patients is significantly higher when a) the entire malformation is included in the 75% isodose (96%) and b) the maximum diameter of the lesion is less than 12 mm (81%). Two patients died of rebleeding at 18 and 29 months after treatment.
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Affiliation(s)
- O O Betti
- Hospital Antártida, Buenos Aires, Argentina
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