{"id":116783,"date":"2014-04-25T00:00:35","date_gmt":"2014-04-24T22:00:35","guid":{"rendered":"https:\/\/dev.institutchiaribcn.com\/%e3%82%a2%e3%83%aa%e3%82%a7%e3%83%97%e3%82%b9%e6%b0%8f%e3%81%ae%e5%a0%b1%e5%91%8a%e6%9b%b8%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e5%9b%9e%e7%ad%94\/"},"modified":"2026-03-27T10:46:32","modified_gmt":"2026-03-27T09:46:32","slug":"%e3%82%a2%e3%83%aa%e3%82%a7%e3%83%97%e3%82%b9%e6%b0%8f%e3%81%ae%e5%a0%b1%e5%91%8a%e6%9b%b8%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e5%9b%9e%e7%ad%94","status":"publish","type":"comunicacion","link":"https:\/\/institutchiaribcn.com\/jp\/%e3%82%a2%e3%83%aa%e3%82%a7%e3%83%97%e3%82%b9%e6%b0%8f%e3%81%ae%e5%a0%b1%e5%91%8a%e6%9b%b8%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e5%9b%9e%e7%ad%94\/","title":{"rendered":"\u30a2\u30ea\u30a7\u30d7\u30b9\u6c0f\u306e\u5831\u544a\u66f8\u306b\u5bfe\u3059\u308b\u56de\u7b54"},"content":{"rendered":"

Published by ICSEB<\/a> at 2012\u5e7412\u67084\u65e5<\/p>\n

El comentario del Dr. Zuev, neurocirujano ruso, en un forum:<\/strong><\/p>\n

(se puede encontrar el comentario original en ruso en el link: https:\/\/www.syringomyelia.ru\/forum\/\u2013\/160\u2014\u2013?limit=10&start=10<\/a>)<\/p>\n

\u0412uenos d\u00edas a todos quien se interesa por ese tema!<\/p>\n

Finalmente hemos podido encontrar unas publicaciones internacionales de los institutos m\u00e9dicos de \u201creferencia\u201d en America y Europa, que desmienten teor\u00edas del origen y patogenia de SACH y SM, de los que est\u00e1 \u201cgritando\u201d el Institut en Barcelona. Noten que los art\u00edculos han sido publicados en las revistas respetables:<\/p>\n

1. \u201cTo date, there are no published reports of an explicit relationship between CM-I and TCS. In a recent study of spinal cord traction in fresh cadavers, caudal tension on the CMD was found to produce less than 1 mm downward movement of the medulla and upper cervical spinal cord and no displacement of the cerebellar tonsils. The authors concluded that caudal fixation of the spinal cord is an implausible cause of CM-I and that SFT is unlikely to reverse tonsillar ectopia\u201d \u2013 Tubbs RS, Loukas M, Shoja MM, Oakes WJ. Observations at the craniocervical junction with simultaneous caudal traction of the spinal cord. Childs Nerv Syst 2007;23:367-9.<\/p>\n

2. This cord traction theory was generally dismissed as an oversimplification<\/p>\n

that did not account for the complex neural as osseus anomalies of Chiari malformation type II and did not explain why nerve roots below the mid-thoracic level coursed normally rather than cephalad as would be expected<\/p>\n

if there was significant downward traction on the CMD \u2013 Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. \u2013 Thomas H. Milhorat et al.- Surgical Neurology 72 (2009) 20\u201335 \u2013 Department of Neurosurgery, The Chiari Institute, Harvey Cushing Institutes of Neuroscience, USA<\/p>\n

3. In patients with large tonsillar herniations extending below the arch of C1, it is our practice to perform a posterior fossa decompression before SFT to avoid the potential risk of exacerbating tonsillar herniation by the<\/p>\n

sudden release of lumbar CSF. \u2013 Association of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. \u2013 Thomas H. Milhorat et al.- Surgical Neurology 72 (2009) 20\u201335 \u2013 Department of Neurosurgery, The Chiari Institute, Harvey Cushing Institutes of Neuroscience, USA<\/p>\n

En el \u00faltimo art\u00edculo hay mucho de inter\u00e9s sobre el tema pero el resumen es el siguiente: LA SECCI\u00d3N DEL FILUM TERMINALE DEBE SER REALIZADA S\u00d3LO EN EL CASO RIGUROSAMENTE INDICADO y no a todos los enfermos con SACH y SM.<\/p>\n

Sr. Zuev hay que puntualizar en su comunicaci\u00f3n algunas consideraciones en relaci\u00f3n a la publicaci\u00f3n de Tubbs, como:<\/p>\n

1. \u201cTubbs intenta con una experimentaci\u00f3n inadecuada replicar a mi art\u00edculo del 2005\u201d<\/p>\n

El art\u00edculo que cita: \u201cTubbs RS, Loukas M, Shoja MM, Oakes WJ. Observations at the craniocervical junction with simultaneous caudal traction of the spinal cord. Childs Nerv Syst 2007;23:367-9.\u201d<\/p>\n

Quiere ser una r\u00e9plica a otro publicado: \u201cRoyo-Salvador MB, Sol\u00e9-Llenas J, Dom\u00e9nech JM, Gonzalez-Adrio R (2005). Results of the section of the filum terminale in 20 patients with syringomyelia scoliosis and Chiari malformation. Acta Neurochir (Wien) 147:515\u2013523.\u201d<\/p>\n

Vease la bibiliograf\u00eda del art\u00edculo de Tubbs:<\/strong><\/p>\n

1. Goldstein F, Kepes JJ (1966) The role of traction in the development of the Arnold-Chiari malformation. An experimental study. J Neuropathol Exp Neurol 25:654\u2013666<\/p>\n

2. Oakes WJ, Tubbs RS (2004) Chiari malformations. In: Winn HR (ed) Youmans neurological surgery, 5th edn. Saunders, Philadel- phia, pp 3347\u20133361<\/p>\n

3. Royo-Salvador MB, Sol\u00e9-Llenas J, Dom\u00e9nech JM, Gonz\u00e1alez- Adrio R (2005) Results of the section of the filum terminale in 20 patients with syringomyelia scoliosis and Chiari malformation. Acta Neurochir (Wien) 147:515\u2013523<\/p>\n

4. Tubbs RS, Salter G, Grabb PA, Oakes WJ (2001) The denticulate ligament: anatomy and functional significance. J Neurosurg 94 (Spine 2):271\u2013275<\/p>\n

5. Tubbs RS, Bui CJ, Rice WC, Loukas M, Naftel RP, Holcombe MP, Oakes WJ (2006) Critical analysis of the Chiari I malformation found in children with lipomyelomeningocele. J Neurosurg (in press).<\/p>\n

En ese art\u00edculo de Tubbs para concluir y dar la respuesta a mi art\u00edculo, cita:<\/strong><\/p>\n

\u201cRoyo-Salvador et al. [3] have described three patients with CIM, two of these with syringomyelia, in whom symptoms were improved in two after transection of the filum terminale. Interestingly, these patients did not have a fatty infiltrated filum terminale, low conus medullaris, and were operated \u201cwithout opening the dural sac.\u201d<\/p>\n

Los autores no se han tomado la molestia de leerse el fundamento te\u00f3rico previo a ese art\u00edculo, que es mi tesis doctoral \u201cAportaci\u00f3n a la etiolog\u00eda de la Siringomielia\u201d de 1992, y tres publicaciones m\u00e1s:<\/p>\n

Royo-Salvador MB. [A new surgical treatment for syringomyelia, scoliosis, Arnold-Chiari malformation, kinking of the brainstem, odontoid recess, idiopathic basilar impression and platybasia]. Rev Neurol. 1997 Apr;25(140):523-30. Spanish.<\/p>\n

Royo-Salvador MB. [Platybasia, basilar groove, odontoid process and kinking of the brainstem: a common etiology with idiopathic syringomyelia, scoliosis and Chiari malformations]. Rev Neurol. 1996 Oct;24(134):1241-50. Spanish.<\/p>\n

Royo-Salvador MB. [Syringomyelia, scoliosis and idiopathic Arnold-Chiari malformations: a common etiology]. Rev Neurol. 1996 Aug;24(132):937-59. Review. Spanish.<\/p>\n

Posiblemente porque los autores solo leen en norteamericano y se han olvidado o desconocen de que su Medicina se la ense\u00f1amos nosotros, puesto que es un producto de la cultura mediterr\u00e1nea.<\/p>\n

En 1975 cuando iniciamos la investigaci\u00f3n de la tracci\u00f3n del sistema nervioso como causa de la siringomielia idiop\u00e1tica y el SACH.I con el Dr. Domenech catedr\u00e1tico de la c\u00e1tedra de Anatom\u00eda y Embriolog\u00eda Humana de la Facultad de Medicina de la Universidad Aut\u00f3noma de Barcelona, descartamos el estudio con cad\u00e1veres, puesto que su comportamiento es diferente al \u201cvivo\u201d: la elasticidad, las compensaciones del conjunto neuro-cr\u00e1neo-vertebral, la inflamaci\u00f3n, la circulaci\u00f3n de los l\u00edquidos intersticiales, del LCR\u2026 De igual forma descartamos la experimentaci\u00f3n animal, ya que siempre se podr\u00eda decir que los hallazgos no son extrapolables al humano por cualquier m\u00ednima raz\u00f3n. De hecho iniciamos una simulaci\u00f3n de la tracci\u00f3n medular con embriones de pollo que no result\u00f3 viable.<\/p>\n

Al final me decid\u00ed por la observaci\u00f3n en los pacientes y demostrar la existencia de una fuerza de tracci\u00f3n medular en pacientes afectos de Siringomielia idiop\u00e1tica, al demostrar estad\u00edsticamente que la posici\u00f3n de su cono medular era m\u00e1s baja que en la poblaci\u00f3n normal, mediante estudios de RM de toda la columna vertebral en 292 pacientes y 50 sin las enfermedades estudiadas (\u201cAportaci\u00f3n a la etiolog\u00eda de la Siringomielia\u201d, 1992, Universidad Aut\u00f3noma de Barcelona, Espa\u00f1a).<\/p>\n

En el art\u00edculo de Tubbs, que lo conocemos desde la fecha de su publicaci\u00f3n, se aplica una fuerza de 75N\/16 lbs y la observaci\u00f3n para la deformaci\u00f3n es \u201csimult\u00e1nea\u201d en la regi\u00f3n cervical, en tronco cerebral y en las am\u00edgdalas cerebelosas: \u201cIn 12 fresh adult cadavers (less than 6 h postmortem), distal tension (75 N\/16 lbs) utilizing a manual tension gauge (Lyman, Middletown, CT, USA) was applied to the conus medullaris with simultaneous observation of the cervical spinal cord, brainstem, and hindbrain (cerebellar tonsils) and their relationship to the foramen magnum (referenced to a metric ruler placed at the foramen magnum after the removal of the posterior arch of the atlas and 2 cm of the midline occiput\u201d.
\nPara valorar una parte inadecuada de \u00e9sta experimentaci\u00f3n cuya conclusi\u00f3n se quiere aplicar a la cl\u00ednica humana, hay que considerar la f\u00f3rmula de la elongaci\u00f3n de un cuerpo f\u00edsico, que es:<\/p>\n

X = A.cosw.t<\/p>\n

(donde X es la elongaci\u00f3n, A el radio, w=2pi\/T (T=periodo) y t=tiempo).<\/p>\n

Para el c\u00e1lculo de la elongaci\u00f3n un factor directamente proporcional es \u201ct\u201d, el tiempo de aplicaci\u00f3n de la fuerza. Si consideramos que un a\u00f1o tiene 31.536.000 segundos y muchos de los pacientes soportan de forma continuada la fuerza de tracci\u00f3n sin ning\u00fan descanso, m\u00e1s de 20-30 a\u00f1os. As\u00ed para obtener la elongaci\u00f3n durante ese per\u00edodo tendr\u00edamos que multiplicar lo observado en un segundo, como la observaci\u00f3n simult\u00e1nea de la publicaci\u00f3n de Tubbs, por 946.080.000 que son los segundos que tienen 30 a\u00f1os.<\/p>\n

En palabras m\u00e1s sencillas, la elongaci\u00f3n del sistema nervioso por una fuerza aplicada a la m\u00e9dula espinal depende tambi\u00e9n del tiempo que se aplica; no es lo mismo la elongaci\u00f3n resultado de aplicar una fuerza durante 1 segundo \u00f3 5 minutos \u00f3 durante 30 a\u00f1os.<\/p>\n

Le sorprende a Tubbs que en mi publicaci\u00f3n no se realice apertura del saco dural para la secci\u00f3n del filum terminale, \u201cand were operated \u201cwithout opening the dural sac\u201d\u201d, eso indica que desconoce datos anat\u00f3micos importantes. En una determinada zona del filum terminale externo es posible seccionar la inserci\u00f3n conjunta del filum terminale \u00f3 tambi\u00e9n llamado ligamento cocc\u00edgeo, y la inserci\u00f3n de la duramadre.
\nEn cuanto a la cita de Milhorat:<\/p>\n

En el a\u00f1o 2004 tuve una reuni\u00f3n personal y profesional con el Dr. Thomas H. Milhorat, en un hospital de Nueva York, donde intercambiamos informaci\u00f3n, opiniones y teor\u00edas en relaci\u00f3n al SACH.I, Siringomielia y Escoliosis idiop\u00e1tica. Es significativo que el hasta entonces palad\u00edn de la craniectom\u00eda suboccipital aplicada al SACH.I por la teor\u00eda de la fosa craneal peque\u00f1a, cambiara su discurso he iniciara la aplicaci\u00f3n de la SFT en el SACH.I. De tal forma que el siguiente art\u00edculo que public\u00f3 tras nuestro encuentro es el que se cita:<\/p>\n

\u201cAssociation of Chiari malformation type I and tethered cord syndrome: preliminary results of sectioning filum terminale. \u2013 Thomas H. Milhorat et al.- Surgical Neurology 72 (2009) 20\u201335\u201d.<\/p>\n

Este art\u00edculo desde hace algunos a\u00f1os figura comentado en nuestra web.<\/a><\/p>\n

Milhorat copi\u00f3 parcialmente mi teor\u00eda sin realizar ning\u00fan estudio cient\u00edfico previo que justificara su cambio de criterio y actuaci\u00f3n, tampoco dijo que la teor\u00eda en la que se basaba ahora era de otro, la hizo suya como hacen frecuentemente algunas personas.<\/p>\n

Al aplicar la SFT en pacientes con el SACH.I, Milhorat comprueba que es \u00fatil en la siringomielia. Pero ignora por completo la aplicaci\u00f3n para la Escoliosis idiop\u00e1tica.
\nMilhorat no se molest\u00f3 en leer mis anteriores publicaciones, ni mi tesis, donde se demuestra lo que m\u00e1s tarde aplico en los art\u00edculos posteriores de la casu\u00edstica operatoria. Posiblemente porque los norteamericanos s\u00f3lo leen en norteamericano. Y no se han enterado que actualmente el idioma espa\u00f1ol ha superado en uso al ingl\u00e9s.<\/p>\n

Milhorat no pudo copiar mi t\u00e9cnica quir\u00fargica m\u00ednimamente invasiva para la SFT, puesto que no se la expliqu\u00e9, y realiz\u00f3 laminectom\u00edas lumbares para la SFT con las consiguientes f\u00edstulas de LCR, que le ha causado m\u00faltiples demandas judiciales a \u00e9l y a su equipo incluido Bolognese.<\/p>\n

Actualmente Milhorat est\u00e1 jubilado y continua su consulta Bolognese, que no ha publicado ni una p\u00e1gina como primer autor en relaci\u00f3n al SACH.I, Siringomielia y Escoliosis idiop\u00e1tica. Sus conocimientos y teor\u00edas es como la de todos los neurocirujanos que no han realizado investigaciones sobre el SACH.I, la Siringomielia y Escoliosis idiop\u00e1tica. Es decir, Bolognese, est\u00e1 donde est\u00e1bamos nosotros hace 37 a\u00f1os.<\/p>\n

\u201cAportaci\u00f3n a la etiolog\u00eda de la siringomielia\u201d. Miguel B. Royo Salvador. 1992. Universidad Aut\u00f3noma de Barcelona.Tesis Doctoral. Con la estad\u00edstica m\u00e1s importante del mundo estudiada por un s\u00f3lo autor, de 292 casos de siringomielias asociadas o no a Chiari I y escoliosis. En forma de 319+55 ap\u00e9ndice=374 p\u00e1ginas de la Tesis doctoral.<\/p>\n

Y las publicaciones posteriores en relaci\u00f3n al tema: Que suman 58 p\u00e1ginas en tres idiomas: espa\u00f1ol, franc\u00e9s e ingl\u00e9s. Suman un total de 423 p\u00e1ginas publicadas. La tesis doctoral aprobada \u201ccum laude\u201d por un tribunal de tesis doctoral de seis catedr\u00e1ticos o especialistas significativos. Y el resto de publicaciones por tribunales de la especialidad m\u00e9dicos y \u00e9ticos de los comit\u00e9s de las diferentes publicaciones.<\/p>\n

1: Royo-Salvador MB, Sole-Llenas J, Domenech JM, Gonzalez-Adrio R. Results of the section of the filum terminale in 20 patients with syringomyelia, scoliosis and Chiari malformation. Acta Neurochir (Wien). 2005 May;147(5):515-23; discussion 523.<\/p>\n

2: Royo-Salvador MB. [On the relationship between Chiari malformations and hydrosyringomyelia]. Rev Neurol. 1999 Aug 16-31;29(4):389-90. Spanish.<\/p>\n

3: Royo Salvador MB. Referring to the posterior fossa cranioectomy and tonsillar resection in order to treat Chiari I malformation with syringomyelia. Acta Neurochir (Wien). 1999;141(9):1020-1.<\/p>\n

4: Royo-Salvador MB. [The etiology of the Chiari I\/syringomyelia complex]. Neurologia. 1999 Oct;14(8):415-8. Spanish.<\/p>\n

5: Royo Salvador MB. [Tonsillectomy as a treatment of Chiari I malformation with syringomyelia]. Neurochirurgie. 1999 Nov;45(4):338-9. French.<\/p>\n

6: Royo-Salvador MB. Relating to classification and etiology of Chiari I malformation. Magn Reson Imaging. 1999 Nov;17(9):1403.<\/p>\n

7: Royo Salvador MB. \u201cPseudo\u201d idiopathic scoliosis in syringomyelia. Eur Spine J. 1999;8(5):421.<\/p>\n

8: Royo-Salvador MB. [Etiology and treatment of Chiari I\/syringomyelia complex]. Rev Neurol. 1999 Jun 16-30;28(12):1218. Spanish.<\/p>\n

9: Royo-Salvador MB. [A new surgical treatment for syringomyelia, scoliosis, Arnold-Chiari malformation, kinking of the brainstem, odontoid recess, idiopathic basilar impression and platybasia]. Rev Neurol. 1997 Apr;25(140):523-30. Spanish.<\/p>\n

10: Royo-Salvador MB. [Platybasia, basilar groove, odontoid process and kinking of the brainstem: a common etiology with idiopathic syringomyelia, scoliosis and Chiari malformations]. Rev Neurol. 1996 Oct;24(134):1241-50. Spanish.<\/p>\n

11: Royo-Salvador MB. [Syringomyelia, scoliosis and idiopathic Arnold-Chiari malformations: a common etiology]. Rev Neurol. 1996 Aug;24(132):937-59. Review. Spanish.<\/p>\n

Que el tipo de publicaci\u00f3n anglosajona de un n\u00famero escaso de p\u00e1ginas por art\u00edculo da la idea err\u00f3nea que es suficiente para entender y aplicar las conclusiones en forma de tratamiento de una teor\u00eda compleja como la que exponemos y contraria a la que est\u00e1 en uso.<\/p>\n

Cuando la publicaci\u00f3n es tan extensa como nuestras dos primeras publicaciones de 22, 9 p\u00e1ginas, y adem\u00e1s en espa\u00f1ol, muchos profesionales no llegan a leer todo el art\u00edculo e incluso si lo leen todo, se hacen una idea vaga y propia de lo que se pretende explicar.<\/p>\n

En ambos casos anteriores la documentaci\u00f3n parcial adquirida, supone para algunos profesionales suficiente como para hacer una teor\u00eda propia, aplicando a su manera las conclusiones e interviniendo a los pacientes sin criterios cient\u00edficos previamente demostrados, con los consiguientes resultados err\u00e1ticos, que acabar\u00e1 en el desprestigio de una teor\u00eda correcta y de la soluci\u00f3n.
\nPor todo lo anterior, unido a la existencia de varios neurocirujanos que aprovech\u00e1ndose de nuestra repercusi\u00f3n medi\u00e1tica dicen hacer lo mismo que nosotros, (por ejemplo ver la imagen de abajo, que no ha tenido ning\u00fan contacto con nosotros), hemos considerado:<\/p>\n

La creaci\u00f3n de la marca registrada Filum System\u00ae, donde se recoge lo fundamental de nuestras investigaciones, que se impartir\u00e1 en la Filum Academy Barcelona\u00ae, dando la acreditaci\u00f3n a los profesionales que realicen el curso de formaci\u00f3n. Desistiendo por ahora en proceder a m\u00e1s publicaciones o participaci\u00f3n en Congresos, excepto las que se realicen para el Filum System\u00ae.<\/p>\n

Traducci\u00f3n de la imagen:<\/strong><\/p>\n

\u201cNosotros nos respaldamos con la experiencia de trabajo de muchos a\u00f1os de los centros Chiari, incluidos los centros l\u00edderes como Institut Chiari en Nueva-York (E.E.U.U.), Tel-Aviv (Israel) y Barcelona (Espa\u00f1a). Nuestro centro mantiene constantemente el contacto con estos centros\u201d.<\/p>\n","protected":false},"featured_media":140034,"template":"","tipos-de-comunicacion":[631],"class_list":["post-116783","comunicacion","type-comunicacion","status-publish","has-post-thumbnail","hentry","tipos-de-comunicacion-noticias"],"yoast_head":"\n\u30a2\u30ea\u30a7\u30d7\u30b9\u6c0f\u5831\u544a\u66f8\u3078\u306e\u533b\u5b66\u56de\u898b\u89e3 | \u30d0\u30eb\u30bb\u30ed\u30ca\u30ad\u30a2\u30ea\u7814\u7a76\u6240<\/title>\n<meta name=\"description\" content=\"ICSEB \u5bf9\u963f\u91cc\u8036\u666e\u65af\u6c0f\u62a5\u544a\u4e66\u4f5c\u5b98\u65b9\u56de\u5e94\uff0c\u8be6\u7ec6\u8bf4\u660e\u5185\u5bb9\u3001\u4f9d\u636e\u53ca\u4e34\u5e8a\u89c1\u89e3\uff0c\u6f84\u6e05\u76f8\u5173\u4e8b\u5b9e\u4e0e\u89c2\u70b9\uff0c\u5e76\u63d0\u4f9b\u4e13\u4e1a\u89e3\u91ca\u3001\u80cc\u666f\u4fe1\u606f\u53ca\u5b8c\u6574\u4e34\u5e8a\u53c2\u8003\u4e0e\u6cbb\u7597\u5efa\u8bae\u3002\" \/>\n<meta name=\"robots\" content=\"index, follow, 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