R G Sola

Publications (72)81.91 Total impact

• Article: Response to "Vagus nerve stimulation: Urgent need for the critical reappraisal of clinical effectiveness"

  Eduardo García-Navarrete, Cristina V Torres, Isabel Gallego, Marta Navas, Jesús Pastor, R G Sola
  Seizure 04/2013; · 1.80 Impact Factor
• Article: [Neurophysiological assisted transsulcal approach to a high grade glioma without affect neither motor nor somatosensory function].

  J Pastor, P Pulido-Rivas, R G Sola
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  ABSTRACT: INTRODUCTION. Intraoperative mapping and neuronavigation permitted a safe approach through the rolandic sulcus, minimizing the impact onto the motor or somatosensory functions. Fluorescence-guide resection defines a limit that allows a total resection without exceed the border of the tumor. CASE REPORT. A 39-year-old man who was operated by a tumor placed into the rolandic area. With the patient anesthetized (propofol + remyfentanil), we performed cortical mapping, neuronavigation and fluorescence-guide resection with 5-aminolevulinic acid. Post-resection neurophysiologic assessment showed a minor and highly localized effect onto the somato-sensory system. CONCLUSION. Rolandic area surgery can be safely performed in anesthetized patients when extensive neurophysiological, anatomical and biological assessments are performed.
  Revista de neurologia 04/2013; 56(7):370-4. · 0.65 Impact Factor
• Article: [Contamination of paroxysmal activity in quantitative EEG methods in epileptic patients].

  J Pastor, R G Sola, G J Ortega
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  ABSTRACT: INTRODUCTION. The presence of an acute spike-wave pattern in the recordings of epileptic patients can contaminate the calculated synchronisation values between pairs of electrodes. MATERIALS AND METHODS. We present a simple procedure, involving a numeric simulation of a bivariate electroencephalogram recording with paroxysmal activity, to determine whether or not a method for quantifying synchronisation must be used on any of the recordings that are typically employed in the preoperative evaluation of patients with epilepsy. RESULTS. The information provided by this procedure makes it possible to distinguish between the authentic synchronisation of baseline activity and that produced by paroxysmal activity, such as acute spike-wave patterns. The procedure developed in this study makes it possible to quantify the degree of 'contamination' produced by the synchronisation of the paroxysmal activity on the synchronisation values of the baseline activity. CONCLUSIONS. The issue addressed in this work is of fundamental importance when automatic methods are utilised in the clinical applications of quantitative electroencephalography and can help to prevent diagnostic errors in which synchronisation is used as a marker of the pathology.
  Revista de neurologia 12/2012; 55(12):713-7. · 0.65 Impact Factor
• Article: Long-term results of vagal nerve stimulation for adults with medication-resistant epilepsy who have been on unchanged antiepileptic medication.

  Eduardo García-Navarrete, Cristina V Torres, Isabel Gallego, Marta Navas, Jesús Pastor, R G Sola
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  ABSTRACT: PURPOSE: Several studies suggest that vagal nerve stimulation (VNS) is an effective treatment for medication-resistant epileptic patients, although patients' medication was usually modified during the assessment period. The purpose of this prospective study was to evaluate the long-term effects of VNS, at 18 months of follow-up, on epileptic patients who have been on unchanged antiepileptic medication. METHODS: Forty-three patients underwent a complete epilepsy preoperative evaluation protocol, and were selected for VNS implantation. After surgery, patients were evaluated on a monthly basis, increasing stimulation 0.25mA at each visit, up to 2.5mA. Medication was unchanged for at least 18 months since the stimulation was started. The outcome was analysed in relation to patients' clinical features, stimulation parameters, epilepsy type, magnetic resonance imaging (MRI) results, and history of prior brain surgery. RESULTS: Of the 43 operated patients, 63% had a similar or greater than 50% reduction in their seizure frequency. Differences in the responder rate according to stimulation intensity, age at onset of epilepsy, duration of epilepsy before surgery, previous epilepsy surgery and seizure type, did not reach statistical significance. Most side effects were well tolerated. CONCLUSIONS: 62.8% of our series of 43 medication-resistant epileptic patients experienced a significant long-term seizure reduction after VNS, even in a situation of on unchanged medical therapy. Patient characteristics predictive of VNS responsiveness remain subject to investigation. Controlled studies with larger sample sizes, on VNS for patients with medication-resistant epilepsy on unchanged medication, are necessary to confirm VNS efficacy for drug-resistant epilepsy, and to identify predictive factors.
  Seizure 10/2012; · 1.80 Impact Factor
• Article: [Continuous monitoring of cortical visual evoked potentials by means of subdural electrodes in surgery on the posterior optic pathway. A case report and review of the literature].

  C V Torres, J Pastor, E Rocio, R G Sola
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  ABSTRACT: INTRODUCTION. Intraoperative monitoring of functional language and motor areas is a commonly used technique which makes it possible to minimise the post-operative sequelae and to perform an optimal resection of lesions in these areas. Monitoring of the visual cortex, however, is not usually carried out nowadays. The scarce spatial resolution and its sensitivity to anaesthesia are some of the technical difficulties that reduce its clinical usefulness. The study reports a case of resection of an occipital lesion under general anaesthetic, with intraoperative monitoring of the cortical visual evoked potentials (VEP) by means of subdural electrodes. CASE REPORT. A 50-year-old female who underwent surgery involving the resection of an occipital lesion that was suggestive of radionecrosis. The VEP were monitored by administering flashing light at 4.1 Hz and recording with subdural strip electrodes on the occipital cortex. During the operation, a progressive lowering of the amplitude of the cortical VEP was observed when 50% of the baseline amplitude was exceeded, and thus the resection was finished. The increase in latency was below 10% of the baseline value. The patient recovered well during the post-operative period and her sight did not present any changes with respect to the baseline values. CONCLUSIONS. In our case, monitoring the cortical VEP by cortical recordings produced stable recordings with a good correlation with the post-operative visual function. Cortical recordings performed either directly or by means of subdural electrodes make it possible to achieve adequate spatial resolution and response intensity. Further studies need to be conducted with a greater number of patients in order to obtain decisive conclusions.
  Revista de neurologia 09/2012; 55(6):343-8. · 0.65 Impact Factor
• Article: [Significance of complex analysis of electrical activity in temporal lobe epilepsy: electrocorticography].

  Agostina Palmigiano, Jesús Pastor, Rafael G Sola, Guillermo J Ortega
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  ABSTRACT: Locating and excising epileptogenic zones is the traditional treatment in pharmacoresistant temporal lobe epilepsy. Some patients, however, continue to suffer from attacks even after surgery. Therefore, new hypotheses must be formulated in order to account for the apparent shortcomings of correctly performed surgical procedures. An approach that is not traditional in the field, namely complex networks, is used to attempt to show that modifying the properties of the limbic network can lead to the elimination of the attacks, regardless of the location of the epileptogenic zones. The intraoperative electrocorticographic recordings of 20 patients with pharmacoresistant temporal lobe epilepsy were utilised in the study. An analysis of complex networks was used to study the local synchronisation activity in the lateral and mesial cortex of the temporal lobe and, essentially, the zones with the highest temporal stability were determined. Those cortical zones with higher synchronic activity are associated with a greater temporal stability and when these zones are excised during surgery, the patient no longer suffers any disabling attacks. In contrast, when these zones are not excised, the patient continues to have attacks in the post-operative period. The findings support the hypothesis of the existence of a limbic network, which the lateral and mesial cortices of the temporal lobe are part of, and whose capacity to establish an overall synchronisation is affected when certain zones are removed.
  Revista de neurologia 08/2012; 55(4):207-16. · 0.65 Impact Factor
• Article: [Intracerebral neurenteric cysts in newborn infants].

  Paloma Pulido-Rivas, Andrés López-García, José Jiménez-Heffernan, Rafael G Sola
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  ABSTRACT: Intracranial neurenteric cysts are very infrequent congenital lesions. Within the nervous system, they are most commonly located in the rachis. Another frequent site is the craniocervical junction. Few cases of supratentorial location have been reported. A differential diagnosis is required to distinguish them from other cysts. They are not often diagnosed in the paediatric age. The clinical features they give rise to are due to the mass effect or episodes of chemical meningitis. Magnetic resonance imaging is the best diagnostic method although on many occasions they cannot be distinguished from arachnoid cysts. Treatment consists in surgery with complete resection of the membranes in order to prevent recurrences. We report two cases of infants who, in the last weeks of gestation, presented supratentorial intracerebral cystic lesions that resembled arachnoid cysts. A neonatal magnetic resonance scan confirmed the existence of such supratentorial cysts with septae inside them. After presenting an increase in the cranial perimeter, surgical treatment was undertaken with a neuronavigation-guided craniotomy and debridement of the cysts. The cysts contain mucus and have thick membranes. Pathological study results are consistent with a neurenteric cyst. One of the patients presented complete resolution after the intervention with good cerebral expansion. In the second case, there was persistence of an adjoining arachnoid cyst, in which placement of a cyst-peritoneal shunt was necessary with full resolution. Most intracranial cysts are arachnoid cysts, but there are other cystic lesions that must be treated by surgical means so that they can be completely excised and sent for pathological analyses.
  Revista de neurologia 07/2012; 55(1):26-30. · 0.65 Impact Factor
• Article: [Neurosurgical techniques for the neuromodulation of pain].

  Cristina V Torres, Rafael G Sola
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  ABSTRACT: Neuromodulation for treating pain goes back to the times of the ancient Egyptians, who applied natural electric currents to modulate the painful sensation. Since then, this concept has been developed in parallel with the scientific and technological development, and various forms of neuromodulation with different indications and characteristics have originated. Chronic pain may produce significant disability, which leads to important physical, social and psychological consequences. Peripheral nerve, spinal cord, deep brain and motor cortex stimulation are safe and effective techniques that control pain and improve quality of life in selected patients.
  Revista de neurologia 12/2011; 53(11):677-87. · 0.65 Impact Factor
• Article: [Deep brain stimulation for refractory epilepsy: extrathalamic targets].

  C V Torres, J Pastor, E G Navarrete, R G Sola
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  ABSTRACT: Epilepsy is a neurological disorder that affects 1-2% of the population. The majority of epileptic patients achieve a good seizure control with the current available treatments. However, there is a subgroup of patients that remain severely disable despite the variety of anti-epileptic drugs, the possibility of surgery for resection of the epileptogenic foci in selected patients, and vagal nerve stimulation; various lines of research are being carried out to look for new treatment alternatives. Deep brain stimulation (DBS) of the thalamus has emerged as a therapeutic alternative for patients who remain in-capacitated; the efficacy of this new therapy is subject of several studies, and its effectiveness and safety has not been established yet. There are other targets for deep brain stimulation that may be useful for drug-resistant epilepsy. Experiments with animal models and preliminary human studies have shown encouraging results with DBS on cerebellum, subthalamic nucleus, substantia nigra, hippocampus and cerebral cortex, among others. The purpose of this review is to revisit the studies that have been carried out on these brain nuclei, as targets for DBS for drug-resistant epilepsy. Studies have shown varying degrees of effectiveness, and there is a need for controlled trials to draw any definite conclusions.
  Revista de neurologia 08/2011; 53(3):153-64. · 0.65 Impact Factor
• Article: [Thalamic deep brain stimulation for refractory epilepsy].

  Cristina V Torres, Jesús Pastor, Eduardo G Navarrete, Rafael G Sola
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  ABSTRACT: Epilepsy is a neurological disorder that affects 1-2% of the population. Despite the available treatments (drug therapy, resective surgery, vagus nerve stimulation), there is a significant subgroup of patients that continues to have disabling seizures. The indications of deep brain stimulation are exponentially growing, and there is a wide experience with deep brain stimulation (DBS) for the treatment of abnormal movements. DBS for epilepsy may be a new therapy for the subgroup of patients that remain disabled despite other treatments. Experiments with animal models, and the new advances in our knowledge about the neurophysiological processes that govern the genesis of epilepsy, have led to the selection of various brain targets for stimulation. The thalamus is a fundamental relay centre in the corticothalamic and corticostriatal thalamocortical circuits, and it has been studied with this purpose. Studies on epileptic patients have shown various degrees of effectiveness; however, controlled studies do not permit definitive conclusions about the role of DBS in the treatment of epilepsy. Probably a better patient selection would lead to more decisive conclusions. Further randomised studies are needed to draw reliable conclusions and scientific evidence on the effectiveness of DBS for refractory epilepsy.
  Revista de neurologia 07/2011; 53(2):99-106. · 0.65 Impact Factor
• Article: New insights on culture and calcium signalling in neurons and astrocytes from epileptic patients.

  M F Cano-Abad, I Herrera-Peco, R G Sola, J Pastor, E García-Navarrete, R Carrasco Moro, P Pizzo, A Ruiz-Nuño
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  ABSTRACT: Primary brain cell cultures are a useful tool for understanding the physiopathology of epilepsy and for searching new potential antiepileptic drugs. These cell types are usually prepared from murine species and few human models have been described. The main goal of this study is the establishment of experimental conditions to isolate and culture neurons and astrocytes from human brain and to test its functionality. The tissues came from antiepileptic drug-resistant epileptic patients undergoing surgery. Human neurons and astrocytes were isolated following an enzymatic and mechanical dissociation protocol. Cultures were viable for 3-6 weeks. Cytological characterization was performed by immunocytochemistry using specific antibodies against both neuron (anti-NeuN) and astrocyte (anti-GFAP) protein markers. In order to test their viability and functionality, cells were loaded with the fluorescent calcium probe fura-2 and variations in cytosolic calcium concentrations ([Ca2+]c) were measured by cell imaging. [Ca2+]c increases were evoked upon cell stimulation with high K+ (KCl 75 mM), glutamate (500 μM) or bicuculline (100 μM). Interestingly, spontaneous [Ca2+]c transients were also observed in some neuron-like cells. A novel unreported finding in this study has been the incorporation of human serum that was critical for cell functionality. The setting of these human cultures open the opportunity to new insights on culture and calcium signalling studies on the mechanism(s) of cell resistance to antiepileptic drugs, as well as to studies on plasticity, maturation and possible neurite emission for graft studies.
  International journal of developmental neuroscience: the official journal of the International Society for Developmental Neuroscience 04/2011; 29(2):121-9. · 2.03 Impact Factor
• Article: [Psychogenic non-epileptic seizures in an epilepsy surgery unit].

  Isabel Gallego, Elena Ezquiaga, Daniel Betancor, Rafael G Sola, Jesús Pastor
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  ABSTRACT: The psychogenic non-epileptic seizures (PNES) represent a significant percentage of patients in different units of epilepsy surgery. AIMS. To analyze the characteristics of patients with PNES and compared with epileptic patients, to analyze the early response to the application of placebo and to discuss the multidisciplinary approach to these patients. 408 patients, candidates for epilepsy surgery in the last nine years, were retrospectively evaluated. All patients were studied with scalp electroencephalography, magnetic resonance imaging, interictal single photon emission computed tomography and video-EEG. Patients were ascribed to the following diagnostic groups: epileptics (90.2%), patients with PNES and/or without seizures or signs of epilepsy (6.4%) and patients for whom no seizures were recorded, but showed signs of epilepsy (3.4%). There were no differences between patients with PNES and epileptic respect to age, average frequency, distribution of seizures or drug treatment, but the time of onset was earlier in PNES. Patients with PNES (n = 15) revealed the presence of epilepsy or irritative manifestations in 10 cases. Most (n = 13) were women and only five had a history of mild psychiatric disorders that were not present in the group of patients exclusively with PNES. In four cases was carried out an induction with placebo, which was positive. A multidisciplinary approach is required for the proper evaluation and treatment of patients with PNES.
  Revista de neurologia 04/2011; 52(8):449-56. · 0.65 Impact Factor
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  Available from: um.edu.my

  Article: [Frontal aneurysmal bone cyst. A case report and review of the literature].

  M Navas-Garcia, P Pulido-Rivas, J M Pascual-Garvi, R Manzanares-Soler, R G Sola
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  ABSTRACT: Cranial aneurysmal bone cyst (ABC) is a rare pathological finding that is usually diagnosed in young patients. It is defined as a benign lesion made up of intervillous spaces limited by connective bone tissue septa and osteoclast-type giant cells; these histological characteristics are common to extracranial ABC. Clinically, in most patients, they manifest as cranial tumours which may be painful and vary in size. About 100 cases of cranial ABC have been reported in the literature. We present a literature review of the cases of frontal ABC reported to date, including one that was recently treated in our own service. A 29-year-old female, with no history of traumatic brain injury, who was examined due to the presence of a fixed, painless frontal cranial lesion on the right-hand side. The results of a radiological study revealed the presence of a lytic cranial lesion with well-delimited edges and marginal sclerosis; peripheral and linear contrast enhancement was also observed in the magnetic resonance imaging of the brain. The patient was submitted to a surgical intervention and the entire lesion was removed. There were no incidents in the post-operative period and the definitive pathological diagnosis was cranial ABC. Cranial ABC is a pathological condition with well-defined histological and radiological characteristics, despite the fact that its aetiopathogenesis is still not fully understood. Complete excision of the tumour is considered to be the preferred treatment, which often leads to full recovery of the patient and also offers a good long-term prognosis.
  Revista de neurologia 03/2011; 52(6):349-54. · 0.65 Impact Factor
• Article: Spontaneous acute hemorrhage within a subependymoma of the lateral ventricle: successful emergent surgical removal through a frontal transcortical approach.

  R Carrasco, J M Pascual, M Navas, J Fraga, R Manzanares-Soler, R G Sola
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  ABSTRACT: INTRODUCTION. Subependymomas are benign neoplasms intimately related to the ventricular system which only exceptionally associate hemorrhagic events. We present neuroradiological and pathological evidences of intratumoral hemorrhage within a single case of subependymoma operated on at our institution. Additionally we analyze retrospectively the well-defined reports of similar cases published in the scientific literature. CASE REPORT. A 71-year-old man on anticoagulant therapy presented with abrupt and progressive deterioration of his level of consciousness. Emergent computed tomography and magnetic resonance imaging evidenced signs of acute bleeding within a mass located at the frontal horn of the left lateral ventricle, producing obstructive biventricular hydrocephalus. The lesion was immediately and completely removed through a left frontal transcortical approach. Pathological diagnosis was consistent with subependymoma displaying areas of microhemorrhage. After surgery the patient developed global anterograde and retrograde amnesia. CONCLUSIONS. A spontaneous hemorrhagic event within an asymptomatic lateral ventricle subependymoma can result in a surgical emergence as a consequence of sudden obstruction of cerebrospinal fluid pathways. Prompt and radical surgical removal of the mass, which allows a rapid resolution of hydrocephalus and prevents the risk of rebleeding, may constitute the safest management strategy.
  Neurocirugia (Asturias, Spain) 12/2010; 21(6):478-83. · 0.54 Impact Factor
• Article: [Structure of the arachnoid layer of the human spinal meninges: a barrier that regulates dural sac permeability].

  M A Reina, A Prats-Galino, R G Sola, A Puigdellívol-Sánchez, R Arriazu Navarro, J A De Andrés
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  ABSTRACT: Drugs injected into the epidural space are known to penetrate the subarachnoid space by simple diffusion through the dural sac. We aimed to study the cellular ultrastructure of the arachnoid membrane and the type of intercellular junctions responsible for creating the barrier that regulates the passage of drugs through the dural sac in humans. Fourteen tissue samples of arachnoid membrane were taken from 2 patients during procedures that required opening the lumbar dural sac. The samples were treated with glutaraldehyde, osmium tetroxide, ferrocyanide and acetone, and then embedded in resin. Ultrathin sections were stained with lead citrate for examination by transmission electron microscopy. The arachnoid membrane was 35 to 40 microm thick. The outer surface contained neurothelial cells (dural border cells) along the subdural compartment, while the internal portion was made up of a plane 5 to 8 microm thick with 4 to 5 arachnoid cells overlapping to form a barrier layer. The intercellular spaces on this plane were 0.02 to 0.03 microm wide; the arachnoid cells were bridged by specialized junctions (desmosomes and other tight junctions). Structural features of the arachnoid cells provide a barrier within the human dural sac. They occupy only the internal portion of the arachnoid membrane. Specialized intercellular junctions explain the selective permeability of this membrane.
  Revista espanola de anestesiologia y reanimacion 10/2010; 57(8):486-92.
• Article: [Voltage sources in mesial temporal area induced by etomidate].

  I Herrera-Peco, G J Ortega, V Hernando-Requejo, R G Sola, J Pastor
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  ABSTRACT: It has been recently shown that activation of the EEG by etomidate is a specific and safe technique during the evaluation of patients for epilepsy surgery. To analyze the pathophysiological properties of interictal activity induced by etomidate and compare with the interictal spontaneous activity. We studied 13 patients by video-EEG with foramen ovale electrodes. Etomidate (0.1 mg/kg) was injected to activate the epileptogenic region. The activity of foramen ovale electrodes was adjusted to a monopolar voltage source. Interictal activity mediated by etomidate fits well to a monopolar model, in the same way that the basal interictal activity. The voltage sources distribution recorded during the interictal activity and distribution of voltage sources recorded in presence of etomidate have similar topographical properties. The equivalent charge induced by etomidate was higher than the basal one. The basal and etomidate induced activity have similar electrophysiological properties, suggesting that the same or similar structures are responsible of both. So, etomidate can be used as an specific inductor of EEG activity during presurgical evaluation.
  Revista de neurologia 09/2010; 51(5):263-70. · 0.65 Impact Factor
• Article: [Giant epicranial pseudocyst following disconnection from a ventriculoperitoneal shunt system].

  Rodrigo Carrasco-Moro, Diego Chillón-Medina, José M Pascual-Garvi, Rebeca Conde-Sardón, Marta Navas-García, Rafael G Sola
  Revista de neurologia 02/2010; 50(3):187-8. · 0.65 Impact Factor
• Article: [Changes in cerebral perfusion induced by etomidate in patients with temporal lobe epilepsy].

  I Herrera-Peco, R Wix-Ramos, L Domínguez-Gadea, M L Meilán-Paz, J L Martínez-Chacón, E de Dios, R G Sola, J Pastor
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  ABSTRACT: Epilepsy is one of the major neurological disorders, affecting roughly 0.5-2% of the world's population and approximately 20-25% of patients are resistant to medication. To analyze the response of cerebral perfusion (assessed by SPECT) and bioelectrical activity (measured in scalp and mesial temporal region) to etomidate. We studied 10 patients presurgically evaluated and studied by video-EEG with foramen ovale electrodes (EFO) and SPECT. Etomidate was administered (0.1 mg/kg), followed by (99)mTc-HmPAO during the study in the video-EEG + EFO. The side-effects consisted of myoclonus (n = 7) and moderate pain (n = 2). There had been no significant respiratory or cardiovascular effects. The bioelectrical activity in the scalp consisted in a brief initial rapid activity, followed by a generalized and hypervoltaged delta pattern for several minutes. In the epileptogenic zone, there was a marked increase of interictal activity. Increased cerebral perfusion was observed in all areas studied, especially in temporal region (mesial and lateral) areas and thalamus. In the tail of the non-epileptic hippocampus, we observed the second largest increase in cerebral perfusion, the only region that is different from contralateral area. Activation by etomidate induces a specific and repetitive response in the bioelectrical activity. In addition, cerebral perfusion changes directly related to the epileptogenic region may serve therefore as a diagnostic tool in the near future.
  Revista de neurologia 12/2009; 49(11):561-5. · 0.65 Impact Factor
• Article: [Giant cavernous sinus haemangioma. Case report].

  M Navas, M Pedrosa-Sánchez, P Martínez-Flórez, R Carrasco, J M Pascual, R G Sola
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  ABSTRACT: Intracranial haemangioma is a benign vascular tumor which seldom affects the cavernous sinus region, being it frequently misdiagnosed as a meningioma. A 60-year-old woman presented with a subacute-onset third cranial nerve palsy. A giant extraaxial mass located in the middle cranial fossa which extended into the selar and supraselar areas was diagnosed. It showed homogeneous enhancement after contrast administration. The angiography revealed mild enhancement as well as indirect signs of mass effect, and a tumoral embolization was performed. Surgery and outcome. The tumor was partially removed through a left pterional approach, leaving an intraselar remnant. The patient had an uneventful postoperative course, and did not present new neurological deficits. The haemangioma must be considered in the differential diagnosis of cavernous sinus tumours. This entity represents a neurosurgical challenge, due to the complexity of this anatomical region and the trend of the tumour to bleed during its dissection.
  Neurocirugia (Asturias, Spain) 10/2009; 20(5):461-6. · 0.54 Impact Factor
• Article: [Epidural fat in various diseases: contribution of magnetic resonance imaging and potential implications for neuro axial anesthesia].

  M A Reina, P Pulido, J Castedo, M C Villanueva, A López, J A De Andrés, R G Sola
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  ABSTRACT: Epidural fat is a reservoir of lipophilic substances that cushions the pulsatile movements of the dural sac, protects nerve structures, and facilitates the movement of the dural sac over the periosteum of the spinal canal during flexion and extension. Excessive epidural fat can compress the underlying structures, however, and affect the placement of catheters and the distribution of injected solutions. This review discusses changes in epidural fat related to various diseases and events: lipomatosis, epidural lymphoma, arachnoid cysts, epidural hematoma, meningiomas, angiolipomas, spondylolysis, scoliosis, spinal stenosis, and liposarcoma. Also discussed are the sequencing and protocols for magnetic resonance imaging that enable epidural fat to be observed and distinguished from neighboring structures. The relevance of epidural fat in spinal surgery is considered. Finally, we discuss the possible anesthetic implications of the abnormal deposition of epidural fat, to explain the unexpected complications that can arise during performance of epidural anesthesia.
  Revista espanola de anestesiologia y reanimacion 04/2007; 54(3):173-83.