Actualidad

  • A Critical Update of the Classification of Chiari and Chiari-like Malformations | New Publication!

    Chiari malformations are a group of craniovertebral junction anomalies characterized by the herniation of cerebellar tonsils below the foramen magnum, often accompanied by brainstem descent.

    This review aims to examine the various classification approaches employed and proposes a simplified scheme to differentiate between different types of tonsillar herniations. Furthermore, it explores the most appropriate terminology for acquired herniation of cerebellar tonsils and other secondary Chiari-like malformations. Recent advances in magnetic resonance imaging (MRI) have revealed a higher prevalence and incidence of Chiari malformation Type 1 and identified similar cerebellar herniations in individuals unrelated to the classic phenotypes described by Chiari. As we reassess the existing classifications, it becomes crucial to establish a terminology that accurately reflects the diverse presentations and underlying causes of these conditions.
    This paper contributes to the ongoing discussion by offering insights into the evolving understanding of Chiari malformations and proposing a simplified classification and terminology system to enhance diagnosis and management.

    + info

  • SmartCampus 2023 | Métodos diagnósticos para la evaluación de las alteraciones de la dinámica de LCR | 4 septiembre 2023

    Nuevo curso SmartCampus. Hemos abierto inscripción para la primera edición 2023 del curso Métodos diagnósticos para la evaluación de las alteraciones de la dinámica de LCR y su aplicación en la hidrocefalia . En este curso pretendemos avanzar en la utilización de los estudios de la dinámica del LCR y en la monitorización de la PIC para optimizar el diagnóstico y la potencial selección de una determinada válvula en los adultos y niños con hidrocefalia y en los pacientes con alteraciones complejas de la dinámica del LCR (hidrocefalias tabicadas, quistes aracnoideos, etc.).

    Se discutirán a fondo la interpretación y la utilidad de los diferentes tests de dinámica de LCR que se utilizan con mayor frecuencia en el estudio de estos pacientes. También discutiremos técnicas de interpretación avanzada de los registros de PIC y clasificaremos los diferentes tipos de hidrocefalia en función de sus perfiles de PIC. A lo largo del curso se presentarán diferentes opciones de software para monitorizar y analizar la PIC. Las presentaciones teóricas se complementarán con la presentación de casos prácticos que permitan consolidar los conocimientos adquiridos.

    + info

  • Curso | Monitorización de la PIC y de la presión de perfusión cerebral en el paciente neurocrítico

    Este curso pretende aportar información valiosa sobre la fisiología y fisiopatología del LCR y la hipertensión intracraneal, así como actualizaciones y controversias en la monitorización de la PIC. Los contenidos de este curso son aplicables al manejo del paciente pretenden orientar a intensivistas, neurocirujanos, anestesiólogos y personal de enfermería en la monitorización y tratamiento del paciente neurocrítico.

    Este curso, diseñado de forma modular (cuatro módulos y 4 webinars), pretende ser una introducción avanzada a conceptos que deberían ser bien conocidos por todos los implicados en el manejo de estos pacientes y que, sin embargo, por diversas razones, han pasado a ocupar un segundo lugar en los currículos de las diferentes especialidades. En el primer módulo , se revisan y actualizan los principios que regulan la PIC, la curva presión volumen y las últimas novedades en la producción y circulación del LCR, incluido el sistema glinfático. También se incorpora el nuevo concepto de la hipertensión intracraneal como una forma diferenciada de los síndromes compartimentales clásicos. En el segundo módulo se introducen los fundamentos de las señales analógico digital, el procesamiento de la señal de PIC y la descomposición de ésta en los dos componentes fundamentales el cardíaco y el respiratorio.

    + info

  • Proyecto investigación Chiari | Concesión beca FIS

    En la última convocatoria de Becas FIS resuelta en diciembre de 2022 nuestra unidad ha recibido financiación para desarrolar en los próximos tres años el proyecto "Impacto del síndrome afectivo-cognitivo cerebeloso (Síndrome de Schmahmann) en los pacientes con una malformación de Chiari tipo 1" (PI22/01082) .

    En la actualidad se acepta que el cerebelo participa como un modulador de funciones cognitivas como la atención, la memoria, el lenguaje, capacidades visuoconstructivas, funciones ejecutivas y en el afecto y las emociones. El denominado síndrome afectivo-cognitivo cerebeloso descrito en 1998 se caracteriza por déficits en las funciones ejecutivas, en el procesamiento lingüístico, en la cognición espacial y en la regulación afectiva. Nuestro estudio pretende determinar la repercusión de la malformacion de Chiari 1 y 1.5 en la cognición, la regulación afectiva, la personalidad y su impacto en la calidad de vida de estos pacientes. Relevancia: Se pretende que este estudio permita verificar/refutar la existencia de este síndrome en los pacientes con una malformación de Chiari y su perfil cognitivo-afectivo. Esto permitirá, diseñar en un futuro utilizar una herramienta de evaluación adecuada como la escala de Schmahmann para el cribaje de estos pacientes, objetivar las dificultades neuropsicológicas que presentan y programar intervenciones personalizadas dirigidas a mejorarlas.

    + info

  • Post-Doctoral Research position

    VHIR offers a postdoctoral position within the Unidad de Investigación de Neurotraumatologia y Neurocirugia (UNINN). The candidate will participate in projects focused on the basic and clinical research on traumatic brain injury, brain edema and hydrocephalus.

    Main responsibilities and duties:1. Project Management; 2. Project Applications; 3. Writing scientific reports and papers; 4. Attending projects meetings and scientific conferences and 5. Support PhD researchers. Required qualifications: 1. Ph.D. degree with a strong research background in neurobiology within the past 5 years; 2. Bench work experience is required; 3. Proactive, dynamic, and outstanding organizational skills; 4. Good communication skills and fluency in spoken and written English (minimum level in English: C); 5. Experience on international project management and project applications and 6. A demonstrated ability to work in a multidisciplinary and diverse team.

    + info

  • Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury | New publication!

    OBJECTIVE:To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

    + info

  • Noninvasive evaluation of hyperventilation therapy | New UNINN publication!

    The ICFO together with the UNINN have published in the J. Neurotrauma a paper dedicated to non-invasive monitoring of hyperventilation in patients with TBI. Hyperventilation (HV) therapy uses vasoconstriction to reduce intracranial pressure (ICP) by reducing cerebral blood volume. However, as HV also lowers cerebral blood flow (CBF), it may provoke misery perfusion (MP) where the decrease in CBF is coupled with increased oxygen extraction fraction (OEF). MP may rapidly lead to the exhaustion of brain energy metabolites, making it vulnerable to ischemia.. Our study provides pilot data demonstrating that bedside transcranial hybrid near-infrared spectroscopies could be utilized to assess potential misery perfusion.

    + info

  • Nuevo Curso SmartCampus 2023|Fundamentos hipoxia tisular y monitorización del aporte cerebral de oxígeno | Primera edicion 2023

    Está ya abierta la inscripción para el nuevo curso de SmartCampus Fundamentos fisiopatológicos de la hipoxia tisular y monitorización del aporte cerebral de oxígeno (2023).

    Esta nueva edición (SC-NCri1-2023) es una introducción al tema de todo el itinerario formativo dedicado al paciente neurocrítico. Nuestra intención es dar una visión renovada y crítica de los aspectos más fundamentalistas de los postulados de la medicina basada en la evidencia aplicados a la monitorización multimodal, revisar los principios básicos del transporte cerebral de oxígeno y actualizar los diferentes tipos de monitorización cerebral que ayudan al clínico a establecer diagnósticos diferenciales más precisos de la hipoxia tisular cerebral. Esta metodología permite implementar estrategias terapéuticas personalizadas y dirigidas a corregir situaciones en las que el aporte cerebral de O2 se encuentra comprometido. El diagnóstico diferencial y el tratamiento dirigido son siempre un primer paso de la nueva ‘medicina de precisión’ para mejorar el pronóstico del paciente con lesiones cerebrales agudas. Fecha de inicio del curso: 1 de mayo de 2023.

    + info

  • PhD student position

    VHIR offers the possibility of a collaboration with the Unidad de Investigación de Neurotraumatologia y Neurocirugia (UNINN) . The candidate will participate in projects focused on the study of cognitive alterations secondary to traumatic brain injury, hydrocephalus, and in the study of the cerebellar cognitive-affective syndrome in patients with Chiari 1 malformations.

    Requirement for applying to the position are: 1. Degree in Psychology ; 2. Official Master general sanitario; 3. At the time of submitting the application, not to be in possession of any doctoral degree, nor have enjoyed more than 12 months of any other specific contract for pre-doctoral research staff in training;4. Commitment to register the doctoral thesis in the next available period (September 2023).

    + info

  • Nuevo Curso SmartCampus 2023 | Introducción a la hidrocefalia y alteraciones de la dinámica de LCR | Primera edicion 2023

    Está ya abierta la inscripción para el nuevo curso de Introducción a la hidrocefalia y alteraciones de la dinámica de LCR, v2023. Tras la elevada demanda de las anteriores ediciones de este curso, abrimos una nueva edición con algunos cambios en el programa respecto a las anteriores ediciones de este curso.

    Los conceptos que manejamos habitualmente sobre la naturaleza, funciones y dinámica del LCR y el significado de la presión intracraneal (PIC) suelen ser excesivamente simples. En este nuevo curso revisamos a fondo ambos elementos y actualizamos conceptos para así incorporarlos de forma más efectiva en nuestra práctica clínica diaria. Para conseguir este objetivo, además de los aspectos teóricos, en este curso se han incorporado también talleres prácticos. Fecha de inicio del curso: 17 de abril de 2023

  • PhD-fellowship positions | FLIGHT Program | Deadline: February 6, 2023

    The Institute of Photonic Sciences (ICFO)in collaboration with the Vall d'Hebron Research Institute (VHIR) offers PhD-fellowship positions to well-qualified graduate students, who wish to obtain a doctoral degree in any of the research topics covered at ICFO. The positions are offered in the scope of the FLIGHT Program, a MCSA-COFUND doctoral program focused on intersectoral research training in collaboration with Clinical Partners. Our PhD-program brings together top-level training and teaching for young scientists, benefiting from the extensive course offerings of local universities and focused instruction by ICFO professors, in a stimulating, international and interdisciplinary environment. PhD-students have the opportunity to take advantage of our network of excellence, consisting in partners of national and international research institutes and universities.

    Important: Our PhD Fellowship Program welcomes applications from individuals with a degree in a field of medical sciences related to the ICFO research activities. Candidates who fulfil the MSCA mobility requirements (i.e. NOT have resided or carried out their main activity in Spain for more than 12 months during the 3 years prior to the call deadline), are encouraged to apply to the FLIGHT Fellowship program. Recruited Fellows will work to develop a project in collaboration with one of Clinical Partners. Fellows in the Clinical tracks will be embedded in both organisations, undertaking secondments of 6-18 months at the partner during their fellowship.

    Research project in the Clinical track on offer in this call is the following: CT001: New neuro-monitoring tools for theranostics in neuro-critical care (Prof. T. Durduran, PhD, at ICFO | Maria- Antonia Poca, MD, PhD and Juan Sahuquillo, MD, PhD at Vall d’Hebron Institut de Recerca (Barcelona).

    + info

  • Diagnosis and Treatment of Normal-Pressure Hydrocephalus Syndrome | New Publication!

    We have collaborated as guest editors in the special issue on Diagnosis and Treatment of Normal-Pressure hdrocephalus Syndrome This focused issue has been completed and published in the Clinical Neurology section of the Jourrnal of Clinical Medicine (IF: 4.96).

    In this focused issue, ten papers have been published that review many controversial aspects regarding the screening methods, diagnostic tests, and treatment of patients with NPH that are relevant to individualizing treatment and improving outcomes after surgery. Three of the 10 published papers come from the Vall d'Hebron University Hospital's neurosurgery department. One of our major contributions has been a thorough analysis of the many kinds of devices that can be used to shunt patients with NPH. We stress the need of the neurosurgeon being knowledgeable about the variations among commercially available devices and avoiding the usual error of selecting a one-size-fits-all system for this particular patient population. We emphasize the need for the neurosurgeon to be aware of the differences among commercially-available devices and to avoid the common mistake of choosing a one-size-fits-all system for this group of patients. The variables to take into account for selecting the most appropiate CSF device are discussed. We believe that a more rational approach to shunting increases the chances of a positive outcome and increase the quality of life of patients with this syndrome.

    + info

  • Non-invasive diagnostic of benign external hydrocephalus in kids | New UNINN publication!

    Benign external hydrocephalus (BEH) is considered a self-limiting pathology with a good prognosis. However, some children present a pathological intracranial pressure (ICP) characterized by quantitative and qualitative alterations (the so-called B-waves) that can lead to neurological sequelae.

    We recruited eleven patients (median age 16 months, range 7 to 55 months) with BEH and an unfavorable evolution requiring ICP monitoring. Bedside, nocturnal monitoring using near-infrared time-resolved and diffuse correlation spectroscopies synchronized to the clinical monitoring was performed. We were able to detect noninvasively StO2 and BFI variations —with optical techniques in BEH children. This new technique helps in managing children with BEH.

    + info

  • Cochrane Injuries Group

    We are pleased to share the news that one of the members of our Research Unit (J. Sahuquillo, Department of Neurosurgery, Vall d’Hebron University Hospital) has recently joined the Cochrane Injuries group as a Clinical editor. The Cochrane Injuries group is part of the Cochrane Collaboration, an international not-for-profit and independent organisation, dedicated to making up-to-date, accurate information about the effects of healthcare. The work involves preparing, maintaining and promoting systematic reviews for the prevention, treatment and rehabilitation of traumatic injury, including the emergency resuscitation of seriously injured and burned patients.

    + info

  • Becas | SH Medical Group

    SH Medical Group colabora con PIC SmartCampus proporcionando 30 becas para cursos de formación continuada en esta plataforma. Su concesión está sujeta a las bases y directrices de la organización SmartCampus. Las bases pueden modificarse según el curso. Dado que nuestro primer curso de Hidrocefalia ha cerrado ya las inscripciones, cualquier interesado puede optar a estas becas para la próxima edición del curso o de cualquier otro curso que este a punto de iniciarse en los próximos 3 meses. Para más información. Consulta las bases y los requisitos en el blog de PIC SmartCampus.

    + info

  • Secondary Analysis of the RESCUEicp Randomized Clinical Trial | Publicación UNINN

    Our unit collaborated actively in the design and implementation of the multicenter multinational RESCUEicp clinical trial about the use of decompressive craniotomy in the management of patients with raised intracranial pressure which results were published in 2016. The secondary analysis of the RESCUEicp have been published on June 6, 2022 to explore the 24-month outcomes for patients with traumatic intracranial hypertension who receive a decompressive craniectomy. Findings: In this prespecified secondary analysis of a randomized clinical trial, 408 adults received either decompressive craniectomy or standard care. The Extended Glasgow Outcome Scale was used to assess 24-month outcomes in this secondary analysis; surgical patients had sustained reduced mortality but higher rates of vegetative state, severe disability, and moderate disability at 24 months.

    Conclusions and Relevance.At 24 months, patients with surgically treated posttraumatic refractory intracranial hypertension had a sustained reduction in mortality and higher rates of vegetative state, severe disability, and moderate disability. Patients in the surgical group were more likely to improve over time vs patients in the medical group.

    + info

  • Publicación UNINN | Conferencia Consenso Chiari en Adultos | Neurological Sciences

    El servicio de Neurocirugía del Hospital Universitario Vall d'Hebron ha participado en la publicación de las primeras recomendaciones internacionales para el diagnóstico y tratamiento de la malformación de Chiari tipo 1 en el adulto. Las malformaciones de la charnela craneocervical son una de las líneas de investigación traslacional consolidadas de la UNINN.

    Un panel multidisciplinar de expertos elaboraron un documento de consenso. Después de una revisión basada en la evidencia y debates posteriores, se formularon 63 declaraciones agrupadas en 4 dominios (definición y clasificación/planificación/cirugía/siringomielia).El documento de consenso introduce 63 recomendaciones de expertos dirigidas a médicos e investigadores que tratan a adultos con Chiari y siringomielia.

    + info

  • SUR1_GLIA

    Sulfonylurea Receptor 1 in Central Nervous System Injury | Publicación UNINN

    In the last few years, our research unit has focused on the study of Sulfonylurea receptor 1 (SUR1) as a target receptor for the management of postraumatic brain edema. In this focused review Jha et al. update the role of SUR1 in CNS injuries and their treatment.

    + info

  • Conferencia Consenso Chiari en Pacientes pediátricos | Publicación | Neurological Sciences

    El servicio de Neurocirugía del Hospital Universitario Vall d'Hebron ha participado en esta segunda publicación de las recomendaciones internacionales para el Diagnóstico y Tratamiento de la malformación de Chiari tipo 1 en pacientes en edad pediátrica. Las malformaciones de la charnela craneocervical son una de las líneas de investigación traslacional consolidadas de la UNINN.Chiari malformation type 1 (CM1) is a rare condition where agreed classification and treatment are still missing. The goal of this study is to achieve a consensus on the diagnosis and treatment of CM1 in children.

    The consensus document consists of 58 statements (24 on diagnosis, 34 on treatment), serving clinicians and researchers following children with CM1. There is a clear need for establishing an international network and registry and to promote collaborative studies to increase the evidence base and optimize the long-term care of this patient population.

    + info

  • Neurodevelopmental profile in children with benign external hydrocephalus syndrome | Publicación UNINN

    New! The management of children with benign external hydrocephalus (BEH) remains controversial. Most BEH children do well in the long-term, but a substantial number have temporary or permanent psychomotor delays. The study aims to assess the prevalence and pattern of neurodevelopmental delay in a cohort of children with BEH. Results: Eighteen children (43%) presented statistically lower scores in the gross motor and composite motor of the Bayley-III scales compared to their healthy peers. Conclusion: In BEH, it is important to establish a diagnostic algorithm that helps to discriminate BEH patients that have self-limiting delays from those at risk of a persistent delay that should be referred for additional studies and/or interventions that might improve the natural evolution of a disease with high impact on the children and adult’s quality of life.

    + info

  • A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) | Publicación UNINN

    Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place.
    Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present.
    These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

    + info

  • Management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) | Publicación UNINN

    We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination.

    + info

última actualización 14.02.2024