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Vol. 8. Issue 4.
Pages 284-293 (January 1997)
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Vol. 8. Issue 4.
Pages 284-293 (January 1997)
Enfermedad de Creutzfeldt-Jakob en Neurocirugía: una revisión de riesgos y medidas de prevención
Creutzfeldt-Jakob disease in neurosurgery: a review of risks and prevention measures
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J.E. Martínez-Lage, M. Poza
Serv. de Neurocirugía, Hospital Universitario Virgen de la Arrixaca, Murcia
P. Brown*, L. Cervenáková*, A. Ruiz Bremón**, J. de Pedro**
* Laboratory of Central Nervous System Studies, National Institute of Neurological Disorder and Stroke, Bethesda, MD
** Centro de Vigilancia Epidemiológica, Inst. de Salud Carlos IlI, Madrid
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Resumen

De 1988 a 1996 se han publicado al menos 17 casos de enfermedad de Creutzfeldt-Jakob (ECJ) relacionada con la colocación de injertos de duramadre obtenida de cadáveres en el curso de operaciones de Neurocirugía. El conocimiento de las formas de transmisión en el medio neuroquirúrgico, el cambio introducido en los métodos de obtención y esterilización de los injertos de origen humano, y sobre todo el mayor empleo de tejidos autólogos parecen haber puesto fin a una complicación de la neurocirugía: la ECJ yatrógena, terminando así con una pesadilla, de la cual ya solo cabe esperar la aparición de casos esporádicos. Los autores revisan su experiencia personal, así como los casos publicados (y no publicados) conocidos, y los métodos en uso para la erradicación de una enfermedad en la que el neurocirujano ha sido protagonista y, a la vez, vector involuntario. Del mismo modo, los neurocirujanos han contribuido a la investigación de los casos y a detener el desarrollo de esta enfermedad en el medio quirúrgico.

Palabras Clave:
Complicaciones en Neurocirugía
Encefalopatía espongiforme
Enfermedad de Creutzfeldt-Jakob yatrógena
Enfermedades por priones
Infección por virus lentos
Injertos de duramadre
Abstract

From 1988 to 1996 there have been at least 17 reports on Creutzfeldt-Jakob disease (CJD) related to the placement of dura mater grafts of cadaveric origin during the course of neurosurgical procedures. The knowledge of means of transmission in the neurosurgical milieu, the changes introduced in the procurement and sterilization of grafts of human origin, and especially the widespread utilization of autologous tissues in dural repair, seems to have put to an end to this feared neurosurgical complication. Probably, we will see in the future only sporadic and infrequent cases of this entity. The authors review their personal experience, published and unpublished data on iatrogenic CJD cases, and the methods in use for eradication of this disease, in which the neurosurgeons have been involuntary protagonists and vectors. We also note the role played by neurosurgeons in the active investigation of most cases, and in contributing to halt CJD spread in the surgical environment.

Key words:
Complications in Neurosurgery
Dura mater grafts
Iatrogenic Creutzfeldt-Jakob disease
Prion infection
Slow-virus infection
Spongiform encephalopathy

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