PDF - Neurocirugía

Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
(O WHVW GH /DVqJXH SRVWRSHUDWRULR FRPR IDFWRU SURQyVWLFR GH ORV SDFLHQWHV
LQWHUYHQLGRVGHKHUQLDGLVFDOOXPEDU
3,JOHVLDV&DVDUUXELRV5$OGD\$Q]ROD35Xt]/ySH]3*yPH]/ySH]-&UX]%pUWROR\5'/REDWR
6HUYLFLRGH1HXURFLUXJtD8QLGDGGH&DOLGDG\8QLGDGGH(SLGHPLRORJtD+RVSLWDOGH2FWXEUH0DGULG
5HVXPHQ
,QWURGXFFLyQ(QORVSDFLHQWHVLQWHUYHQLGRVGHKHUQLD
GLVFDOOXPEDUWHQGUtDJUDQLQWHUpVGLVSRQHUGHXQFUL
WHULR GH H[SORUDFLyQ ItVLFD TXH SRFR WLHPSR GHVSXpV
GH OD LQWHUYHQFLyQ SHUPLWLHUD DQWLFLSDU OD HYROXFLyQ
FOtQLFDDPHGLRSOD]R(OUHVXOWDGRGHOWHVWGH/DVqJXH
WUDVODLQWHUYHQFLyQTXLU~UJLFDGHKHUQLDGLVFDOOXPEDU
GHSHQGHGHODSUHVHQFLDGHUHFLGLYDKHUQLDULD\RGHOD
IRUPDFLyQGH¿EURVLVDOUHGHGRUGHODUDt]QHUYLRVDDIHF
WDGD (VWXGLRV SUHYLRV KDEtDQ GHPRVWUDGR OD UHODFLyQ
HQWUHHOUHVXOWDGRGHOWHVWGH/DVqJXHDORVPHVHVGH
ODLQWHUYHQFLyQTXLU~UJLFD\HOJUDGRGHIXQFLRQDOLGDGD
FRUWRSOD]R
2EMHWLYR(OREMHWLYRGHOHVWXGLRKDVLGRGHWHUPLQDU
HOYDORUSURQyVWLFRGHOUHVXOWDGRGHOWHVWGH/DVqJXHD
ORVPHVHVGHODLQWHUYHQFLyQVREUHODHYROXFLyQFOtQLFD
GHORVSDFLHQWHVDPHGLRSOD]R/DHYROXFLyQFOtQLFDVH
KD HYDOXDGR GH IRUPD JOREDO DWHQGLHQGR D UHVXOWDGRV
IXQFLRQDOHVJUDGRGHIXQFLRQDOLGDGVLWXDFLyQODERUDO\
FDOLGDGGHYLGD\FOtQLFRVUHLQWHUYHQFLyQSRUUHFLGLYD
KHUQLDULDQ~PHURGHUHYLVLRQHV\GHLFRQRJUDItDVUHDOL
]DGDVWUDVODLQWHUYHQFLyQ
3DFLHQWHV\0pWRGRV6HDQDOL]DURQSDFLHQWHVFRQ
KHUQLD GLVFDO OXPEDU VRPHWLGRV D KHPLODPLQHFWRPtD
GHVGHKDVWDFRPLHQ]RVGHOHQHO6HUYLFLRGH
1HXURFLUXJtDGHO+RVSLWDO³GH2FWXEUH´(OWHVWGH
/DVqJXHVHHYDOXyDORVPHVHVGHODLQWHUYHQFLyQ/RV
PpWRGRVSDUDHVWLPDUHOJUDGRGHIXQFLRQDOLGDGIXHURQ
ORV FULWHULRV PRGL¿FDGRV GH 6SDQJIRUW \ OD FDOLGDG GH
YLGDVHJ~QHOFXHVWLRQDULR6)ODDVLJQDFLyQGHUHVXO
WDGRVDORV\PHVHVGHODFLUXJtD
5HVXOWDGRV /RV UHVXOWDGRV GH OD LQYHVWLJDFLyQ KDQ
GHPRVWUDGRHOYDORUSURQyVWLFRGHOUHVXOWDGRGHOWHVWGH
/DVqJXHSRVWTXLU~UJLFRDORVPHVHVHQUHODFLyQFRQ
ODHYROXFLyQFOtQLFDGHORVSDFLHQWHV(OULHVJRGHSUHVHQ
WDUXQHVWDGRIXQFLRQDOPDORDORV\PHVHV\GH
QRWUDEDMDUDFDXVDGHOGRORUDORV\PHVHV
DXPHQWy VLJQL¿FDWLYDPHQWH HQ ORV SDFLHQWHV FRQ XQ
1HXURFLUXJtD5HFLELGR$FHSWDGR
UHVXOWDGRSRVLWLYRGHOWHVW$GHPiVHOUHVXOWDGRGHODQi
OLVLVPXOWLYDULDQWHWUDVDMXVWDUSRUODVGHPiVYDULDEOHV
GHOHVWXGLRUHIRU]yHOYDORUSURQyVWLFRGHOWHVWVREUHHO
HVWDGRIXQFLRQDO\ODVLWXDFLyQODERUDOGHOORVSDFLHQWHV
HQHVWRVSHULRGRVGHWLHPSR
$VLPLVPRVHFRQ¿UPyVXYDORUSURQyVWLFRVREUHORV
GLIHUHQWHVDVSHFWRVGHFDOLGDGGHYLGDDQDOL]DGRVSHU
FHSFLyQGHVDOXGHQJHQHUDOSDSHOIXQFLRQDOLQWHUIHUHQ
FLDGHOGRORUFRQODDFWLYLGDGKDELWXDOVDOXGPHQWDO\
SDSHOVRFLDOGHORVSDFLHQWHVDORVPHVHV\PHVHV
$VLPLVPR VH HQFRQWUy XQD FRUUHODFLyQ HVWDGtVWL
FDPHQWH VLJQL¿FDWLYD HQWUH OD SRVLWLYLGDG GHO WHVW \ OD
IUHFXHQFLD GH UHLQWHUYHQFLyQ TXLU~UJLFD \ HO Q~PHUR
GH YLVLWDV \ SUXHEDV GH LPDJHQ GH FRQWURO VROLFLWDGDV
GXUDQWHHOVHJXLPLHQWR
&RQFOXVLRQHV (O HVWXGLR KD DSRUWDGR PiV LQIRU
PDFLyQ VREUH OD XWLOLGDG GH OD H[SORUDFLyQ GHO WHVW GH
/DVqJXHDORVPHVHVGHODLQWHUYHQFLyQGDGRVXYDORU
FRPRIDFWRUSURQyVWLFRGHODHYROXFLyQFOtQLFDXWLOL]D
FLyQGHUHFXUVRVGLDJQyVWLFRVHWF\IXQFLRQDOFDOLGDG
GH YLGD HVWDGR IXQFLRQDO \ VLWXDFLyQ ODERUDO GH ORV
SDFLHQWHVDPHGLRSOD]R\PHVHV
3$/$%5$6 &/$9( +HUQLD GLVFDO OXPEDU 5HVXOWDGRV
&DOLGDGGHYLGD*UDGRIXQFLRQDO7HVWGH/DVqJXH
/DVqJXH¶VWHVWDVSURJQRVWLFIDFWRUIRUSDWLHQWVXQGHU
JRLQJOXPEDUGLVFVXUJHU\
6XPPDU\
,QWURGXFWLRQ ,Q SDWLHQWV RSHUDWHG IRU KHUQLDWHG
OXPEDUGLVFLWFRXOGEHYHU\XVHIXOWRGHYHORSSK\VLFDO
H[DPLQDWLRQFULWHULDWKDWZRXOGDOORZHDUO\SUHGLFWLRQ
RIPHGLXPRUORQJWHUPFOLQLFDORXWFRPHV7KHUHVXOWRI
WKH/DVqJXHWHVWDIWHUVXUJHU\GHSHQGVRQWKHRFXUUHQFH
RI UHFXUUHQW KHUQLDWHG GLVF DQGRU VFDU IRUPDWLRQ
DURXQGWKHQHUYHURRW3UHYLRXVVWXGLHVKDYHVKRZQWKH
DVVRFLDWLRQEHWZHHQWKHUHVXOWRI/DVqJXHWHVWDVVHVVHG
PRQWKVDIWHUVXUJHU\DQGWKHVKRUWWHUPIXQFWLRQDO
RXWFRPH
Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
(OWHVWGH/DVqJXHSRVWRSHUDWRULRFRPRIDFWRUSURQyVWLFRGHORVSDFLHQWHVLQWHUYHQLGRVGHKHUQLDGLVFDOOXPEDU
2EMHFWLYH 7R GHWHUPLQH WKH SURJQRVWLF YDOXH RI
SRVWRSHUDWLYH /DVqJXH WHVW LQ UHODWLRQ ZLWK PHGLXP
WHUPIXQFWLRQDODQGFOLQLFDORXWFRPHVZKLFKZHUHHVWL
PDWHGE\DQDO\]LQJWKHIXQFWLRQDOJUDGHHPSOR\HPHQW
VWDWXV TXDOLW\ RI OLIH UHRSHUDWLRQ IRU UHFXUUHQW GLVF
KHUQLDWLRQ DQG WKH QXPEHU RI FOLQLFDO UHYLVLRQV DQG
LPDJLQJVWXGLHVQHHGHGGXULQJWKHIROORZXS
3DWLHQWV DQG 0HWKRGV SDWLHQWV ZKR XQGHUZHQW
KHPLODPLQHFWRP\ IRU OXPEDU KHUQLDWHG GLVF EHW
ZHHQ DQG ZHUH VWXGLHG 7KH /DVqJXH VLJQ
ZDV WHVWHG PRQWKV DIWHU VXUJHU\ $ PRGL¿FDWLRQ RI
6SDQJIRUW¶V FULWHULD WR PHDVXUH WKH IXQFWLRQDO JUDGH
DQG WKH LWHP 6KRUWIRUP KHDOWK VXUYH\ 6)
PHWKRG WR PHDVXUH WKH TXDOLW\ RI OLIH ZHUH XVHG WR
TXDQWLI\RXWFRPHVDWDQGPRQWKVDIWHULQLWLDO
VXUJHU\
5HVXOWV7KLVLQYHVWLJDWLRQKDVSURYHGWKHSURJQRV
WLFYDOXHRI/DVqJXHWHVWDVVHVVHGPRQWKVDIWHULQLWLDO
VXUJHU\$VWDWLVWLFDOO\VLJQL¿FDQWFRUUHODWLRQZDVIRXQG
EHWZHHQ D SRVLWLYH VWUDLJKW OHJ UDLVLQJ WHVW DQG D SRRU
IXQFWLRQDOVWDWXVDWDQGPRQWKVDQGWKHULVNGR
QRWUHWXUQWRZRUNEHFDXVHRISHUVLVWHQWSDLQDW
DQG PRQWKV $ VWDWLVWLFDOO\ VLJQL¿FDQW FRUUHODWLRQ
ZDV DOVR IRXQG EHWZHHQ WKH UHVXOW RI WKH WHVW DQG WKH
IUHTXHQF\RIUHRSHUDWLRQIRUUHFXUUHQWGLVFKHUQLDWLRQ
DQGWKHQXPEHURIFOLQLFDOUHYLVLRQVDQGLPDJLQJFRQ
WUROVWXGLHVQHHGHGWKURXJKWKHIROORZXS
$PXOWLYDULDWHDQDO\VLVDGMXVWHGIRURWKHUYDULDEOHV
LQFOXGHGLQWKHVWXG\UHLQIRUFHGWKHSURJQRVWLFYDOXHRI
WKLVFOLQLFDOVLJQRQWKHIXQFWLRQDOVWDWXVDQGWKHSURED
ELOLW\ RI UHWXUQLQJ WR ZRUN DW GLIIHUHQW LQWHUYDOV DIWHU
LQLWLDOVXUJHU\
/LNHZLVH WKH SURJQRVWLF YDOXH RI /DVqJXH WHVW RQ
GLIIHUHQW DVSHFWV RI TXDOLW\ RI OLIH KHDOWK SHUFHSWLRQ
IXQFWLRQDO SHUIRUPDQFHV SRRU VRFLDO LQWHUDFWLRQ DQG
VHYHUHSDLQDQDO\]HGDWDQGPRQWKVDIWHUVXUJHU\
ZHUHDOVRFRQ¿UPHG
&RQFOXVLRQ7KLVVWXG\SURYLGHVDGGLWLRQDOLQIRUPD
WLRQDERXWWKHSUHGLFWLYHYDOXHRIWKHVWUDLJKWOHJUDLVLQJ
WHVWHGPRQWKVDIWHUVXUJHU\RQWKHFOLQLFDOGLDJQRVWLF
UHVRXUFHVFRQVXPSWLRQVXFFHVVLYHRXWSDWLHQWUHYLVLRQV
HWFDQGIXQFWLRQDOTXDOLW\RIOLIHIXQFWLRQDOJUDGHDQG
UHWXUQ WR ZRUN RXWFRPHV DVVHVVHG DQG PRQWKV
DIWHULQLWLDOVXUJHU\
.(<:25'6$XGLW /XPEDU GLVF KHUQLDWLRQ 2XWFRPH
4XDOLW\RIOLIH)XQFWLRQDOJUDGH/DVqJXHWHVW
,QWURGXFFLyQ
(O WHVW GH /DVqJXH HV SUREDEOHPHQWH HO VLJQR FOtQLFR
PiV LPSRUWDQWH SDUD HYDOXDU OD WHQVLyQ QHUYLRVD TXH SUR
GXFH XQD KHUQLDFLyQ GLVFDO GXUDQWH HO HVWLUDPLHQWR GHO
1HXURFLUXJtD
QHUYLR FLiWLFR (QWUH ODV FDUDFWHUtVWLFDV GHO WHVW GHVWDFDQ
VXHOHYDGDVHQVLELOLGDGSDUDGHWHFWDUODLUULWDFLyQGHODUDt]
QHUYLRVD\VXEDMDHVSHFL¿FLGDGHQFXDQWRDGHWHUPLQDUOD
FDXVD TXH RULJLQD HVWD VLWXDFLyQ (O UHVXOWDGR GHO WHVW GH
/DVqJXH WUDV OD LQWHUYHQFLyQ TXLU~UJLFD GH KHUQLD GLVFDO
OXPEDUGHSHQGHSULQFLSDOPHQWHGHODSUHVHQFLDGHUHFLGLYD
KHUQLDULD\RGHODIRUPDFLyQGH¿EURVLVDOUHGHGRUGHODUDt]
QHUYLRVDDIHFWDGD(VWXGLRVSUHYLRVKDEtDQHQFRQWUDGRXQD
DVRFLDFLyQHQWUHHOUHVXOWDGRGHOWHVWWUDVODUHDOL]DFLyQGH
PLFURGLVFHFWRPtD\HOHVWDGRIXQFLRQDOGHORVSDFLHQWHV
/RV UHVXOWDGRV LQGLFDEDQ TXH HQ ORV SDFLHQWHV HQ ORV TXH
SHUVLVWtD XQ WHVW GH /DVqJXH SRVLWLYR D ORV PHVHV GH OD
LQWHUYHQFLyQ WHQtDQ SHRUHV UHVXOWDGRV GH IXQFLRQDOLGDG D
FRUWRSOD]R
(OREMHWLYRGHHVWHHVWXGLRKDVLGRHYDOXDUODUHODFLyQ
HQWUHHOUHVXOWDGRGHOWHVWGH/DVqJXHDORVPHVHVGHOD
LQWHUYHQFLyQ\ODHYROXFLyQFOtQLFDGHORVSDFLHQWHVDPHGLR
SOD]R&RQHVWH¿QVHKDQHVWXGLDGRGLIHUHQWHVDVSHFWRVGHO
UHVXOWDGR GH OD LQWHUYHQFLyQ TXLU~UJLFD HQ SDFLHQWHV FRQ
KHUQLDGLVFDOOXPEDUFRPRVRQODFDOLGDGGHYLGDHOJUDGR
GH IXQFLRQDOLGDG \ OD VLWXDFLyQ ODERUDO GH ORV SDFLHQWHV D
ORV\PHVHVGHODLQWHUYHQFLyQ7DPELpQVHFRQ
VLGHUDURQ ODV UHLQWHUYHQFLRQHV SRU UHFLGLYD KHUQLDULD \ HO
Q~PHURGHUHYLVLRQHV\GHSUXHEDVGLDJQyVWLFDVGHLPDJHQ
UHDOL]DGDVWUDVODLQWHUYHQFLyQ
3DFLHQWHV\PpWRGRV
6H KDQ HVWXGLDGR SDFLHQWHV LQWHUYHQLGRV GH KHUQLD
GLVFDOOXPEDUGHVGHKDVWDFRPLHQ]RVHQHO6HUYL
FLRGH1HXURFLUXJtDGHO+RVSLWDO³GH2FWXEUH´GH0DGULG
/D UHFRJLGD GH GDWRV KD VLGR UHWURVSHFWLYD LQIRUPDFLyQ
FRQWHQLGDHQODKLVWRULDFOtQLFD\SURVSHFWLYDHQFXHVWDVGH
FDOLGDGGHYLGDJUDGRGHIXQFLRQDOLGDG\VLWXDFLyQODERUDO
/RV SDFLHQWHV REMHWR GH HVWXGLR FXPSOtDQ ORV VLJXLHQWHV
FULWHULRVGHLQFOXVLyQDGXOWRV!DxRVFRQGLDJQyVWLFR
GHKHUQLDGLVFDOOXPEDUVRPHWLGRVDKHPLODPLQHFWRPtD6H
HVWXGLDURQ SDFLHQWHV HQ ORV TXH VH KDEtD UHÀHMDGR HO
UHVXOWDGRGHODH[SORUDFLyQGHOWHVWGH/DVqJXHDORVPHVHV
GHODLQWHUYHQFLyQHQODUHYLVLyQGHOSDFLHQWHHQFRQVXOWD\
SDFLHQWHVDORVTXHQRVHKDEtDH[SORUDGR&RQHO¿QGH
KRPRJHQHL]DUODPXHVWUDVHH[FOX\HURQDTXHOORVSDFLHQWHV
TXHKXELHUDQVXIULGRXQDLQWHUYHQFLyQOXPEDUSUHYLDHQHO
PLVPRQLYHO\DTXpOORVFRQLQIHFFLyQHVSLQDORWXPRU(O
UHVXOWDGRGHOWHVWGH/DVqJXHVHFODVL¿FyHQSRVLWLYRƒ
ƒSRVLWLYRƒƒSRVLWLYR!ƒ\QHJDWLYR
6H HVWXGLDURQ GLIHUHQWHV DVSHFWRV GH OD FDOLGDG GHO
SURFHVRTXLU~UJLFRDQDOL]DQGRUHVXOWDGRVGHHYROXFLyQGHO
SDFLHQWH FOtQLFRV UHLQWHUYHQFLyQ SRU UHFLGLYD KHUQLDULD
Q~PHUR GH UHYLVLRQHV HQ FRQVXOWD \ Q~PHUR GH SUXHEDV
GLDJQyVWLFDV GH LPDJHQ 50 UHDOL]DGDV WUDV OD LQWHUYHQ
FLyQ\IXQFLRQDOHVFDOLGDGGHYLGDJUDGRGHIXQFLRQDOL
GDGVLWXDFLyQODERUDO
Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
1HXURFLUXJtD
,JOHVLDV&DVDUUXELRV\FRO
7DEOD
&DUDFWHUtVWLFDVJHQHUDOHV\FOtQLFDVGHORVSDFLHQWHVLQWHUYHQLGRVGHKHUQLDGLVFDOOXPEDUQ 1RWDHQHVWDWDEODVHKDQWHQLGRHQFXHQWDVyORDTXHOORVSDFLHQWHVHQORVTXHVHKDSRGLGRUHFRJHUHOYDORUGHFDGDYDULDEOH
/D FDOLGDG GH YLGD VH GHWHUPLQy DSOLFDQGR HO FXHVWLR
QDULR 6) (O JUDGR GH IXQFLRQDOLGDG VH HVWDEOHFLy
XWLOL]DQGRXQDPRGL¿FDFLyQGHORVFULWHULRVGH6SDQJIRUW
TXHVHDJUXSDURQHQ,\,,H[FHOHQWHV,,,UHJXODUHV\,9
PDORV/DVLWXDFLyQODERUDOGHORVSDFLHQWHVVHDJUXSyHQ
SDFLHQWHVTXHWUDEDMDEDQQRWUDEDMDEDQDFDXVDGHOGRORU\
QRWUDEDMDEDQSRURWUDVFDXVDV(VWRVDVSHFWRVVHUHFRJLH
URQDORV\PHVHVGHODLQWHUYHQFLyQORVFXHVWLR
QDULRVVHHQYLDURQSRUFRUUHR\ODLQIRUPDFLyQVHUHFRJLy
WHOHIyQLFDPHQWH
6HFRPSDUDURQORVUHVXOWDGRVGHOWHVWGH/DVqJXHHQODV
GLVWLQWDVFDWHJRUtDVGHHVWDGRIXQFLRQDOVLWXDFLyQODERUDO
FDOLGDGGHYLGD\HYROXFLyQGHORVSDFLHQWHVFRQODVSUXHEDV
WGH6WXGHQWR8GH0DQQ:KLWQH\6HDMXVWyODHVWLPDFLyQ
GH OD DVRFLDFLyQ HQWUH HO WHVW GH /DVqJXH \ ODV YDULDEOHV
GHUHVXOWDGRHVWDGRIXQFLRQDOVLWXDFLyQODERUDO\FLHUWRV
SDUiPHWURVGHFDOLGDGGHYLGDFRPRVRQODSHUFHSFLyQGH
VDOXGHQJHQHUDOODLQWHUIHUHQFLDGHOGRORUFRQODDFWLYLGDG
KDELWXDO OD IXQFLyQ ItVLFD \ VRFLDO GH ORV SDFLHQWHV FRQ
FDGDXQDGHODVFDUDFWHUtVWLFDVGHORVSDFLHQWHVHGDGVH[R
SHVRFRPRUELOLGDGIXPDGRUWLHPSRWUDQVFXUULGRGHVGHHO
LQLFLRGHORVVtQWRPDVGXUDFLyQHSLVRGLRSUHYLRDODFLUX
JtDWUDWDPLHQWRSVLTXLiWULFRVDQJUDGRHSLGXUDOGXUDQWHOD
LQWHUYHQFLyQ HWF SRU PHGLR GH XQ DQiOLVLV GH UHJUHVLyQ
ORJtVWLFD
5HVXOWDGRV
/DVFDUDFWHUtVWLFDVGHORVSDFLHQWHVGHOHVWXGLRVH
UHÀHMDQHQODWDEOD
/D HGDG PHGLD GH ORV SDFLHQWHV LQWHUYHQLGRV IXH GH
“DxRVGHORVTXHHUDQPXMH
Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
(OWHVWGH/DVqJXHSRVWRSHUDWRULRFRPRIDFWRUSURQyVWLFRGHORVSDFLHQWHVLQWHUYHQLGRVGHKHUQLDGLVFDOOXPEDU
1HXURFLUXJtD
UHV/RVQLYHOHVLQWHUYHQLGRVIXHURQ///
6 \ // \ /6 (O WHVW GH /DVqJXH
SUHRSHUDWRULRIXHSRVLWLYRHQHOGHORVSDFLHQWHV
/RV SDFLHQWHV VH DJUXSDURQ HQ SDFLHQWHV FRQ XQ
UHVXOWDGRGHODPDQLREUDGH/DVqJXHSRVLWLYRQHJDWLYR\
SDFLHQWHVDORVTXHQRVHH[SORUyHQODUHYLVLyQUHDOL]DGDD
ORVPHVHVGHODLQWHUYHQFLyQ
$ ORV PHVHV GH OD LQWHUYHQFLyQ HO GH ORV SDFLHQWHVDORVTXHVHH[SORUyHOWHVWGH/DVqJXHHQFRQVXOWD
SUHVHQWDEDXQUHVXOWDGRQHJDWLYR
(VWDGRIXQFLRQDOGHORVSDFLHQWHVHQUHODFLyQFRQHOUHVXO
WDGRGHOWHVWDORVPHVHVGHODLQWHUYHQFLyQ
(QODYDORUDFLyQGHOHVWDGRIXQFLRQDOGHORVSDFLHQWHVVH
FRQVLGHUyHOJUDGRGHIXQFLRQDOLGDGODVLWXDFLyQODERUDO\
ODFDOLGDGGHYLGDWUDVODLQWHUYHQFLyQTXLU~UJLFD
(OJUDGRGHIXQFLRQDOLGDGDOFDQ]DGRSRUORVSDFLHQWHVD
ORV\PHVHVGHODLQWHUYHQFLyQHQUHODFLyQFRQHO
UHVXOWDGRGHOWHVWGH/DVqJXHVHUHÀHMDHQOD¿JXUD
(Q ORV SDFLHQWHV FRQ WHVW GH /DVqJXH SRVWRSHUDWRULR
SRVLWLYR HO JUDGR GH IXQFLRQDOLGDG IXH PDOR ,9 HQ HO
HO \ HO D ORV \ PHVHV
UHVSHFWLYDPHQWH IUHQWH DO \ HQ ORV
SDFLHQWHVFRQ/DVqJXHQHJDWLYRRHO\
GHORVSDFLHQWHVDORVTXHQRVHH[SORUyHO/DVqJXHDORV
PHVHVGHODLQWHUYHQFLyQ
/DVGLIHUHQFLDVHQFRQWUDGDVHQHODQiOLVLVELYDULDEOHHQ
UHODFLyQFRQHOUHVXOWDGRGHOWHVWIXHURQVLJQL¿FDWLYDVDORV
\PHVHVGHODLQWHUYHQFLyQS\SUHVSHF
WLYDPHQWH
(QHODQiOLVLVPXOWLYDULDEOHVHFRPSUREyTXHHOWHVWGH
/DVqJXHHUDXQDYDULDEOHLQGHSHQGLHQWHFRQYDORUSURQyVWLFR
VREUHHOJUDGRGHIXQFLRQDOLGDGGHORVSDFLHQWHVDORV\
PHVHVGHVSXpVGHDMXVWDUODVGHPiVYDULDEOHVGHOHVWXGLR
/DVLWXDFLyQODERUDOGHORVSDFLHQWHVDORV\
PHVHV GH OD LQWHUYHQFLyQ HQ UHODFLyQ FRQ HO UHVXOWDGR GHO
WHVWGH/DVqJXHTXHGDUHÀHMDGDHQOD¿JXUD
(QORVSDFLHQWHVHQORVTXHSHUVLVWtDXQWHVWGH/DVqJXH
SRVLWLYRDORVPHVHVGHODLQWHUYHQFLyQQRWUDEDMDEDQD
FDXVDGHOGRORUHOHO\HODORV\
PHVHV UHVSHFWLYDPHQWH IUHQWH DO HO \
HO HQ ORV SDFLHQWHV FRQ XQ UHVXOWDGR QHJDWLYR R HO
\HQORVSDFLHQWHVDORVTXHQRVHUHD
OL]yODH[SORUDFLyQ/DVGLIHUHQFLDVIXHURQVLJQL¿FDWLYDVD
ORV\PHVHVGHODLQWHUYHQFLyQSS\
SUHVSHFWLYDPHQWH
(OUHVXOWDGRGHODQiOLVLVPXOWLYDULDEOHSUHVHQWDEDDOWHVW
GH /DVqJXH FRPR IDFWRU SURQyVWLFR LQGHSHQGLHQWH GH OD
VLWXDFLyQODERUDOGHORVSDFLHQWHVDORV\PHVHVGHOD
LQWHUYHQFLyQGHVSXpVGHDMXVWDUSRUWRGDVODVYDULDEOHVGHO
HVWXGLR\DTXHVHPDQWXYRODVLJQL¿FDFLyQ\ODPDJQLWXG
GHODDVRFLDFLyQ
)LJXUD (O JUi¿FR PXHVWUD HO HVWDGR IXQFLRQDO , \ ,,
EXHQRRH[FHOHQWH,,,UHJXODU,9PDORGHORVSDFLHQWHV
DORV\PHVHVGHODLQWHUYHQFLyQFXDQGRHOUHVXO
WDGRGHOWHVWGH/DVqJXHSRVWRSHUDWRULRIXHSRVLWLYR\
QHJDWLYR
)LJXUD (O JUi¿FR SUHVHQWD OD VLWXDFLyQ ODERUDO WUDED
MDQ QR WUDEDMDQ SRU RWUDV FDXVDV QR WUDEDMDQ D FDXVD
GHO GRORU GH ORV SDFLHQWHV D ORV \ PHVHV GH
OD LQWHUYHQFLyQ FXDQGR HO UHVXOWDGR GHO WHVW GH /DVqJXH
SRVWRSHUDWRULRIXHSRVLWLYR\QHJDWLYR
6H SUHVHQWDQ DVSHFWRV GH OD FDOLGDG GH YLGD GH ORV
SDFLHQWHVHQUHODFLyQFRQHOUHVXOWDGRGHOWHVWHQODV¿JXUDV
DH/DSHUFHSFLyQGHVDOXGHQJHQHUDOSDORV
\PHVHVODIXQFLyQItVLFDSDORVPHVHVOD
LQWHUIHUHQFLD GHO GRORU HQ OD DFWLYLGDG KDELWXDO S D
ORV\PHVHVODVDOXGPHQWDOS\SDORV
\PHVHVUHVSHFWLYDPHQWH\HOSDSHOVRFLDOS
DORVPHVHV/RVSDFLHQWHVHQORVTXHSHUVLVWtDXQWHVW
SRVLWLYRDORVPHVHVGHODLQWHUYHQFLyQSUHVHQWDEDQXQRV
YDORUHVSHRUHVGHHVWRVSDUiPHWURVGHFDOLGDGGHYLGD(QHO
DQiOLVLVPXOWLYDULDEOHGHVSXpVGHDMXVWDUSRUODVYDULDEOHV
GHOHVWXGLRVHFRQVHUYyODDVRFLDFLyQGHOWHVWGH/DVqJXH
FRPRIDFWRUSURQyVWLFRHQFXDQWRDODSHUFHSFLyQGHVDOXG
Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
1HXURFLUXJtD
,JOHVLDV&DVDUUXELRV\FRO
D
E
G
F
HQJHQHUDOODIXQFLyQItVLFD\HOGRORUDORVPHVHV/D
DVRFLDFLyQGHOWHVWVHPDQWXYRHQFXDQWRDODVDOXGPHQWDO
GH ORV SDFLHQWHV D ORV \ PHVHV 3HUVLVWLy OD VLJQL¿
FDFLyQ GHO UHVXOWDGR GHO WHVW HQ HO SDSHO VRFLDO D ORV PHVHV
(OJUXSRGHSDFLHQWHVDORVTXHQRVHH[SORUyHQFRQ
VXOWD SUHVHQWDURQ XQD HYROXFLyQ FOtQLFD EXHQD LJXDO R
PHMRUTXHORVSDFLHQWHVFRQUHVXOWDGRQHJDWLYRGLIHUHQFLDV
VLJQL¿FDWLYDV
7DVDGHUHLQWHUYHQFLyQTXLU~UJLFDHQUHODFLyQFRQHOUHVXO
WDGRGHOWHVWDORVPHVHVGHODLQWHUYHQFLyQ
(OGHORVSDFLHQWHVFRQXQUHVXOWDGRSRVLWLYRGHO
WHVWGH/DVqJXHDORVPHVHVWXYLHURQTXHVHUUHLQWHUYH
QLGRV IUHQWH DO GH ORV TXH SUHVHQWDURQ XQ UHVXOWDGR
QHJDWLYRRHOGHORVSDFLHQWHVDORVTXHQRVHH[SORUy
HO/DVqJXHDORVPHVHVGHODLQWHUYHQFLyQ/DVGLIHUHQFLDV
IXHURQVLJQL¿FDWLYDVS
'XUDQWHHOVHJXLPLHQWRGHORVSDFLHQWHVVHHQFRQWUDURQ
GLIHUHQFLDVVLJQL¿FDWLYDVHQUHODFLyQFRQHOQ~PHURPHGLR
GH UHYLVLRQHV HQ FRQVXOWD HQ SDFLHQWHV FRQ UHVXOWDGR
SRVLWLYRYVHQSDFLHQWHVFRQUHVXOWDGRQHJDWLYR\HQ
ORVTXHQRVHH[SORUyHOWHVWS\FRQODVSUXHEDV
GLDJQyVWLFDVGHLPDJHQYV\50SUHD
H
)LJXUD6HPXHVWUDQORVSDUiPHWURVGHFDOLGDGGHYLGD
D SHUFHSFLyQ GH VDOXG HQ JHQHUDO E IXQFLyQ ItVLFD F
LQWHUIHUHQFLDGHOGRORUFRQODDFWLYLGDGKDELWXDOGVDOXG
PHQWDO\HSDSHOVRFLDODORV\PHVHVGHODLQWHU
YHQFLyQ FXDQGR HO UHVXOWDGR GHO WHVW SRVWRSHUDWRULR IXH
SRVLWLYR\QHJDWLYR
OL]DGDVVHJ~QHOUHVXOWDGRGHOWHVWH[SORUDGRDORVPHVHV
GHODLQWHUYHQFLyQSRVLWLYRQHJDWLYRQRH[SORUDGR
'LVFXVLyQ
(QORVSDFLHQWHVRSHUDGRVGHKHUQLDGLVFDOOXPEDUXQ
FULWHULRGHH[SORUDFLyQItVLFDTXHSRFRGHVSXpVGHODLQWHU
Documento descargado de http://www.revistaneurocirugia.com el 26/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
(OWHVWGH/DVqJXHSRVWRSHUDWRULRFRPRIDFWRUSURQyVWLFRGHORVSDFLHQWHVLQWHUYHQLGRVGHKHUQLDGLVFDOOXPEDU
YHQFLyQSURQRVWLTXHODHYROXFLyQFOtQLFDGHORVSDFLHQWHVD
PHGLRSOD]RWLHQHXQDJUDQXWLOLGDG(QHOHVWXGLRGH-|QV
VRQVHKDEtDGHPRVWUDGRODUHODFLyQHQWUHHOUHVXOWDGRGHO
WHVWGH/DVqJXHDORVPHVHVGHODLQWHUYHQFLyQTXLU~UJLFD
\HOJUDGRGHIXQFLRQDOLGDGDFRUWRSOD]RFRPRUHVXOWDGR
GHXQDQiOLVLVELYDULDEOH
(QQXHVWURHVWXGLRVHGHWHUPLQyHOYDORUSURQyVWLFRGHO
UHVXOWDGRGHOWHVWGH/DVqJXHDORVPHVHVGHODLQWHUYHQ
FLyQ VREUH OD HYROXFLyQ FOtQLFD GH ORV SDFLHQWHV D PHGLR
SOD]R
/D H[SORUDFLyQ VH DGHODQWy D ORV PHVHV GH OD LQWHU
YHQFLyQ \D TXH OD PD\RU SDUWH GH OD UHFXSHUDFLyQ GHO
Gp¿FLWQHXUROyJLFRVHWHQGUtDTXHKDEHUSURGXFLGRHQHVWH
PRPHQWR
/D HYROXFLyQ FOtQLFD VH KD HYDOXDGR GH IRUPD JOREDO
DWHQGLHQGRDUHVXOWDGRVIXQFLRQDOHVJUDGRGHIXQFLRQDOL
GDGVLWXDFLyQODERUDO\FDOLGDGGHYLGD\FOtQLFRVUHLQWHU
YHQFLyQSRUUHFLGLYDKHUQLDULDQ~PHURGHUHYLVLRQHV\GH
50UHDOL]DGDVWUDVODLQWHUYHQFLyQ
6HWXYRHQFXHQWDDOJUXSRGHSDFLHQWHVSDFLHQWHV
DORVTXHQRVHKDEtDH[SORUDGRODPDQLREUDGH/DVqJXH\D
TXHSRGUtDVXSRQHUXQVHVJRGHVHOHFFLyQGHODSREODFLyQ
GHHVWXGLR6HHQFRQWUDURQGLIHUHQFLDVVLJQL¿FDWLYDVHQOD
HYROXFLyQFOtQLFDFXDQGRVHFRPSDUDURQFRQORVSDFLHQWHV
TXHSUHVHQWDEDQXQUHVXOWDGRSRVLWLYR3RUORWDQWRODHYR
OXFLyQFOtQLFDGHORVSDFLHQWHVDORVTXHQRVHKDEtDUHDOL
]DGRODH[SORUDFLyQ\ODGHORVSDFLHQWHVFRQXQUHVXOWDGR
QHJDWLYR HUD VLPLODU LJXDO R PHMRU (VWR SRGUtD LQGLFDU
TXHHOHVWDGRySWLPRTXHSUHVHQWDEDQHVWRVSDFLHQWHVHQHO
PRPHQWRGHODUHYLVLyQHQFRQVXOWDFRQGLFLRQyHOTXHQRVH
OHVUHDOL]DUDXQDH[SORUDFLyQWDQULJXURVD
(QWUHODVYHQWDMDVGHOHVWXGLRKDGHVWDFDGRODXWLOLGDGGH
ODUHDOL]DFLyQGHHVWDH[SORUDFLyQ\DTXHHOUHVXOWDGRGHO
WHVWGH/DVqJXHDORVPHVHVGHODLQWHUYHQFLyQGHKHUQLD
GLVFDO PRVWUy XQ YDORU SURQyVWLFR VREUH HO JUDGR GH IXQ
FLRQDOLGDGTXHLEDQDSUHVHQWDUORVSDFLHQWHVDORV\
PHVHV(OULHVJRGHSUHVHQWDUXQHVWDGRIXQFLRQDOPDOR,9
\GHQRWUDEDMDUDFDXVDGHOGRORUDORV\PHVHV
DXPHQWyHQORVSDFLHQWHVFRQXQUHVXOWDGRSRVLWLYRGHOWHVW
$GHPiVHOUHVXOWDGRGHODQiOLVLVPXOWLYDULDQWHWUDVDMXVWDU
SRUODVGHPiVYDULDEOHVGHOHVWXGLRUHIRU]yHOYDORUSURQyV
WLFRGHOWHVWVREUHHOHVWDGRIXQFLRQDO\ODVLWXDFLyQODERUDO
GHOORVSDFLHQWHVHQHVWRVSHULRGRVGHWLHPSR
$VLPLVPR SDUHFLy FRQ¿UPDUVH VX YDORU SURQyVWLFR
VREUHORVGLIHUHQWHVDVSHFWRVGHFDOLGDGGHYLGDDQDOL]DGRV
SHUFHSFLyQ GH VDOXG HQ JHQHUDO SDSHO IXQFLRQDO LQWHUIH
UHQFLDGHOGRORUFRQODDFWLYLGDGKDELWXDOVDOXGPHQWDO\
SDSHOVRFLDOGHORVSDFLHQWHVDORVPHVHV\PHVHV
(QGH¿QLWLYDHOHVWXGLRKDDSRUWDGRPiVLQIRUPDFLyQ
VREUHODXWLOLGDGGHODH[SORUDFLyQGHOWHVWGH/DVqJXHDORV
PHVHVGHODLQWHUYHQFLyQGDGRVXYDORUSURQyVWLFRGHOD
HYROXFLyQFOtQLFDXWLOL]DFLyQGHUHFXUVRVGLDJQyVWLFRVHWF
\IXQFLRQDOFDOLGDGGHYLGDHVWDGRIXQFLRQDO\VLWXDFLyQ
1HXURFLUXJtD
ODERUDOGHORVSDFLHQWHVDPHGLRSOD]R\PHVHV
%LEOLRJUDItD
$OEHUW 7- 0HVD -- .HQQHWK 0' (QJ . 0F
,QWRVK 7& %DOGHUVWRQ 5$ +HDOWK RXWFRPH DVVHVVPHQW
EHIRUHDQGDIWHUOXPEDUODPLQHFWRP\IRUUDGLFXORSDW\6SLQH
$WODV 6- 'H\R 5$ .HOOHU 5% &KDSLQ $0
3DWULFN '/ /RQJ -0 6LQJHU '( 7KH 0DLQH /XPEDU
6SLQH6WXG\3DUW,,6SLQH
&KDUQOH\-2UWKRSDHGLFVLJQVLQWKHGLDJQRVLVRIGLVF
SURWXVLRQZLWKVSHFLDOUHIHUHQFHWWKHVWUDLJKWOHJUDLVLQJWHVW
/DQFHW
'HYLOOp:YDQGHU:LQGW'']DIHUDJLF$%H]HPHU
3%RXWHU/7KHWHVWRI/DVpJXH6\VWHPDWLFUHYLHZRIWKH
DFFXUDF\LQGLDJQRVLQJKHUQLDWHGGLVF6SLQH
-|QVVRQ%6WU|PTYLVW%7KHVWUDLJKWOHJUDLVLQJWHVW
DQGWKHVHYHULW\RIV\PSWRPVLQOXPEDUGLVFKHUQLDWLRQ6SLQH
-|QVVRQ%6WU|PJYLVW%1HXURORJLFVLJQVLQOXPEDU
GLVFKHUQLDWLRQ3UHRSHUDWLYHDI¿FWLRQDQGSRVWRSHUDWLYHUHFR
YHU\LQFDVHV$FWD2UWKRS6FDQG
-|QVVRQ%6WU|PTYLVW%6LJQL¿FDQFHRIDSHUVLVWHQW
SRVLWLYH VWUDLJKW OHJ UDLVLQJ WHVW DIWHU OXPEDU GLVF VXUJHU\ -
1HXURVXUJ6SLQH
0F &XOORFK -$ 3ULQFLSLHV RI 0LFURVXUJHU\ IRU
/XPEDU'LVF'LVHDVH1HZ<RUN5DYHQ3UHVV
6SHQFHU '/ 7KH DQDWRPLFDO EDVLV RI VFLDWLFD VHFRQ
GDU\WRKHUQLDWHGOXPEDUGLVFDUHYLHZ1HXURO5HV
6XSSO6
:DUH -( 'RQDOG &7KH 026LWHP VKRUW IRUP
KHDOWKVXUYH\6)0HG&DUH
:DUH-(.RVLQVNL0.HOOHU6'$LWHP6KRUW
)RUP+HDOWK6XUYH\0HG&DUH
$JUDGHFLPLHQWRVDO'U,JQDFLR,JOHVLDV
(VWHHVWXGLRKDVLGR¿QDQFLDGRPHGLDQWHXQDEHFD),66
QRFRQFHGLGDSRUHO,QVWLWXWRGH6DOXG&DUORV
,,,
,JOHVLDV&DVDUUXELRV 3 $OGD\$Q]ROD 5 5Xt]/ySH]
3 *yPH]/ySH] 3 &UX]%pUWROR - /REDWR 5' (O
WHVW GH /DVqJXH SRVWRSHUDWRULR FRPR IDFWRU SURQyVWLFR
GH ORV SDFLHQWHV LQWHUYHQLGRV GH KHUQLD GLVFDO OXPEDU
1HXURFLUXJtD
&RUUHVSRQGHQFLD SRVWDO 'U ,JOHVLDV &DVDUUXELRV 6HUYLFLR GH
1HXURFLUXJtD 8QLGDG GH &DOLGDG \ 8QLGDG GH (SLGHPLRORJtD
+RVSLWDO³GH2FWXEUH´&DUUHWHUDGH$QGDOXFtD.P
0DGULG