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Antecedentes: El cuestionario de discapacidad de brazo, hombro y mano (DASH, Disabilities of the Arm, Shoulder and Hand) mide el impacto de patologías del miembro superior en la calidad de vida. Sin embargo, su uso en la población mexicana no ha sido formalmente validado. Objetivo: Realizar la adaptación cultural y validación del cuestionario DASH para conocer la perspectiva de pacientes con trastornos neurogénicos del miembro superior respecto al impacto en su calidad de vida. Método: Se realizó una adaptación al vocabulario mexicano de la versión española del cuestionario DASH y se aplicó en 478 voluntarios. Se estimaron el efecto techo, el efecto suelo, la correlación ítem-total, las medidas de tendencia central de ítems y el puntaje total, la consistencia interna, la precisión y la validez transversal y longitudinal mediante la comparación de individuos sanos y enfermos con diferente nivel de discapacidad. Resultados: Nuestra versión del cuestionario DASH resultó equivalente a las previamente aprobadas y mostró homogeneidad de los ítems respecto al valor total del cuestionario (alfa de Cronbach > 0.96). Además, tuvo una precisión de 7.25 puntos y se documentó la validez transversal y longitudinal con diferencias significativas entre grupos y subgrupos con diferente nivel de discapacidad. Conclusiones: El cuestionario DASH puede ser empleado con un nivel de confianza alto en la población mexicana.

Objetivo: La obesidad es una epidemia mundial que afecta a países subdesarrollados. Su relación con los resultados de la cirugía de columna lumbar electiva sigue siendo controvertida, especialmente en obesos sin enfermedad mórbida. Métodos: Se revisaron los expedientes de pacientes con degeneración de la columna lumbar sometidos a cirugía. Los datos recuperados incluyeron características demográficas y clínicas, índice de masa corporal (IMC), estado de obesidad (IMC > 30), intervenciones quirúrgicas, sangrado estimado, tiempo operatorio, tiempo de estancia y complicaciones. Los resultados se compararon entre individuos obesos grado I-II y controles. Resultados: Se incluyeron 53 pacientes, 18 con obesidad de grado I-II. La edad media fue de 51 años, sin diferencias en el sexo, las comorbilidades, los parámetros de laboratorio y los procedimientos quirúrgicos recibidos entre grupos. No se encontraron diferencias relevantes entre los participantes obesos y los no obesos en sangrado (300 vs. 250 mL, p = 0.069), tiempo operatorio (3.2 vs. 3.0 horas, p = 0.037) y estancia (6 vs. 5 días, p = 0.3). El IMC no se asoció con hemorragia y larga estancia, pero mostró una correlación modesta con el tiempo operatorio. Conclusiones: La obesidad grado I-II no predispone a complicaciones durante la cirugía de columna lumbar.

Background: Cervical and lumbar tandem spinal stenosis (CLTSS) is a major cause of morbidity secondary to compressive degeneration of the spine. Currently, there is a paucity of studies objectively addressing the best management for this condition in terms of efficacy and cost-effectiveness. Hence, we aimed to conduct a side-by-side retrospective analysis of surgical outcomes, clinical improvement, and cost of care in non-Caucasian Hispanic patients with moderate-to-severe CLTSS subjected to simultaneous or staged cervical and lumbar spine surgery. Methods: Retrospective review of clinical records and postoperative outcomes of adult patients subjected to cervical and lumbar spine surgery either simultaneously or in stages. The surgical pattern was selected based on clinical studies, physical examination, and radiological findings, with monthly follow-up through objective clinical scores for at least six months after the last surgery. Results: Twelve patients received simultaneous cervical and lumbar spine surgery and six staged operations, both groups with comparable baseline comorbidities, manifestations, radiological findings, and receiving similar surgical procedures and postoperative management. Anterior cervical discectomy and fusion and transforaminal lumbar interbody fusion were the standard procedures performed in the cohort. Three patients in the staged-operation group received cervical decompression first. There were no differences between the groups' surgical outcomes, functional recovery, and complication rates. Nonetheless, the total cost of care was significantly lower in patients receiving simultaneous operation, while the clinical improvement was equivalent in both groups. Conclusions: Simultaneous and staged decompression offer similar outcomes for patients with CLTSS, but the one-staged combined surgery has a better cost- effectiveness profile.

The spectrum of autoimmune encephalitis (AE) encompasses several entities characterized by a variable frequency of psychiatric symptoms, cognitive dysfunction, focal deficits, and seizures. Although patients with AE can be categorized in specific syndromes, overlapping manifestations are also common. Furthermore, atypical correlations between clinical phenotypes and autoantibody profiles could occur in rare cases. Here, we report the rare case of a young adult man attending due to new-onset seizures and a history of memory loss, autonomic disturbances, headache, behavioral changes, and visual and olfactory hallucinations. The patient was subjected to a complete diagnostic approach that included a comprehensive laboratory workup, neuropsychological testing, electroencephalogram, cerebrospinal fluid (CSF) analysis, brain MRI, and positron emission tomography/computed tomography scan that revealed a functional and structural compromise of the bilateral medial temporal lobes. Together with the clinical manifestations of the patient, these findings were compatible with the diagnosis of autoimmune limbic encephalitis (ALE). Strikingly, further analysis of the CSF showed autoantibodies against the N-methyl-D-aspartate (NMDA) receptor. We found very few cases of the co-occurrence of anti-NMDA receptor antibodies and nonparaneoplastic ALE in the literature, especially in male patients. Our report exemplifies the complicated differential diagnosis of ALE and adds clinical information of the association with anti-NMDA receptor antibodies.

Background: Current approaches to scalenectomy for brachial plexus decompression can cause nerve injuries in patients with neurogenic thoracic outlet syndrome (nTOS), especially when first rib resection (FRR) is performed. We describe a modified supraclavicular approach for scalenotomy that reduces the postoperative morbidity of nTOS patients. Methods: The patient is placed in supine position with the neck slightly extended and turned to the opposite side of the procedure. The modified incision begins above the clavicle 2.5 cm lateral to its first third, extends in medial direction, and turns upwards along the lateral edge of the sternocleidomastoid muscle (SCM) 2.5 cm from the clavicle. Skin flaps are elevated. The external jugular vein is dissected and retracted. The supraclavicular nerves and omohyoid muscle are conserved if found. The phrenic nerve is identified, dissected, and retracted. The anterior scalene muscle is divided, and the brachial plexus is freed. The clinical data and postoperative outcomes of patients that underwent surgery over the last three years were retrieved. The functionality of the arm after surgery was evaluated using the Disabilities of the Arm, Shoulder, and Hand questionnaire in Spanish (DASHe). Results: Sixteen nTOS patients received surgery with one bilateral procedure (17 procedures). Seventy-five percent were females with a median age of 53 years. Obesity and smoking were observed in 43.75% and 37.5% of patients, respectively. No postoperative complications occurred, except for one partial phrenic nerve palsy. All patients reduced their DASHe scores after surgery (mean reduction 41.09 ± 18.37). Conclusion: Our modified supraclavicular approach for scalenotomy is safe and improves outcomes in patients with nTOS, reducing the need for FRR.

Background: Lesions of sellar, interpeduncular, and petroclival regions represent surgical challenges due to the spatial limitations imposed by the temporal lobe. The pretemporal approach is rarely advocated for this kind of lesions even when it offers a wider operative field than other traditional techniques. Case presentation: Here, we share our experience with the use of the pretemporal approach in a small case series: a giant meningioma of the tentorial notch (case 1), an aneurysm of the left posterior cerebral artery (case 2), and a giant pituitary adenoma (case 3). A frontotemporal incision was made with patients in supine position, their heads turned to the opposite side, and the malar eminence as their upper point. The skin flap and the temporal muscle were retracted anteriorly and inferiorly, respectively. The frontotemporosphenoidal craniotomy was performed and the lesser sphenoid wing removed. For cases 2 and 3, an orbitozygomatic craniotomy was added. After an S-shaped dura matter opening, the access to the interpeduncular fossa was through the sylvian fissure by careful dissection of adhesions between frontal and temporal lobes. Conclusions: On experienced hands, the pretemporal approach is a safe procedure for the management of lesions located in deep brain areas with low postoperative morbidity.