Research Interests: Cardiology, Surgery, Neurosurgery, Medicine, Internal Medicine, and 15 moreIschemia, Cerebrovascular diseases, Brain Ischemia, Artery, Angiography, Myocardial Infarction, Occlusion, Anastomosis, Middle Cerebral Artery, Internal Carotid Artery, Carotid Artery Stenosis, Revascularization, Hemiparesis, cerebral arteries, and superficial temporal artery
Background Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical complexity of this region. Then, innovative techniques such as the extradural sphenoid ridge approach are suitable for a safe microsurgical... more
Background Paraclinoid aneurysms represent a challenge for neurosurgeons due to the anatomical complexity of this region. Then, innovative techniques such as the extradural sphenoid ridge approach are suitable for a safe microsurgical clipping. Method A description of the surgical technique was made by the senior author, a vascular neurosurgeon experienced with the use of this approach in the management of paraclinoid aneurysms exemplified through a clinical case. Conclusion Microsurgical clipping through an extradural sphenoid ridge keyhole approach for small and midsize paraclinoid aneurysms is an excellent treatment modality with good clinical and surgical results.
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The arachnoid knife is a useful instrument when performing a variety of neurosurgical procedures, for example, while opening the sylvian fissure or basal arachnoid bridges in the pterional approach or during the peripheral delimitation... more
The arachnoid knife is a useful instrument when performing a variety of neurosurgical procedures, for example, while opening the sylvian fissure or basal arachnoid bridges in the pterional approach or during the peripheral delimitation and excision of a cortical AVM. At present, there exists a wide variety of arachnoid knives made from different materials (stainless steel, titanium, or diamond-tipped); however, most of these instruments are expensive and may become dull with continuous use or bad handling. In this article, we report the use and advantages of an arachnoid knife from a simple hypodermic needle. In the last 6 years, we have used this technique to open the arachnoid layer in more than 350 neurosurgical procedures. Furthermore, it can be used to perform sharp arteriotomies during bypass procedures or to open the dura mater over bone structures. To date, no complication arising from this simple technique has been documented. A standard hypodermic needle can be used in the operating room as a practical arachnoid knife. It has the characteristics of being effective, low-cost, and available worldwide.
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Research Interests: Microsurgery, Evolution, Medicine, Hydrocephalus, Complication, and 15 moreHumans, Female, Male, Clinical Sciences, Aged, Middle Aged, Adult, Group, Anosmia, Anterior communicating artery, Mortality rate, Neurologic Examination, glasgow outcome scale, Intracranial aneurysm, and Intraoperative complications
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ABSTRACT Effective treatment of cerebral vasospasm is still a matter of concern in clinical neurosurgery. In refractory cases, the use of intraarterial vasodilators as papaverin or even mechanical angioplasty has been recommended.... more
ABSTRACT Effective treatment of cerebral vasospasm is still a matter of concern in clinical neurosurgery. In refractory cases, the use of intraarterial vasodilators as papaverin or even mechanical angioplasty has been recommended. Experience with intraarterial nimodipine has been seldom reported. From March to November 2004, 23 patients underwent what we define as “chemical angioplasty,” using repeated doses of intraarterial nimodipine for treating refractory vasospasm to other therapeutic modalities. A microcatheter was positioned in the internal carotid artery or the vertebrobasilar system as close as possible to the spastic area. A single 200 mg injection was completed each time until circulation improved or a 1200 mg dose perday was reached. All patients were evaluated using the modified 6-point Rankin scale after the procedure and during neurological follow up. The chemical angioplasty was repeated daily until the vasospasm period was surpassed or there was a failure of the technique and low-density areas (LDA) on the CT scan appeared. The response to this treatment was considered good in seventeen patients (symptomatic vasospasm disappeared with improvement on the Rankin scale), regular in three (symptomatic vasospasm without low-density areas on CT scan), and bad in three (appearance of lowdensity areas on CT scan). It was demonstrated that intraarterial nimodipine decreases the transit time in angiography and improves the cerebral blood volume in the MRI-perfusion sequence without a significant change in the mean transit time. “Chemical” angioplasty with nimodipine can be used repeatedly in some patients with severe vasospasm to prevent the appearance of lowdensity areas on CT scan before mechanical angioplasty is considered.
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Research Interests: Humanities and Medicine
Introduccion. Los aneurismas del tope de la arteria basilar representan cerca del 50% de los aneurismas de la circulacion posterior. En la actualidad a pesar de los avances en el tratamiento endovascular, los indices de recanalizacion... more
Introduccion. Los aneurismas del tope de la arteria basilar representan cerca del 50% de los aneurismas de la circulacion posterior. En la actualidad a pesar de los avances en el tratamiento endovascular, los indices de recanalizacion permanecen altos, con mayor riesgo de resangrado a largo plazo. Material y Metodos. Se realizo un estudio retrospectivo de una base de datos llevada de forma prospectiva de todos los aneurismas de la bifurcacion basilar operados en el Instituto Nacional de Neurologia “Manuel Velasco Suarez” de la Ciudad de Mexico en el periodo de 1997-2019. Se analizo la informacion demogra- fica y los resultados quirurgicos. Ademas, se revisaron los aspectos anatomicos basicos y los principales abordajes empleados para tratar estos aneurismas. Resultados. Los aneurismas del tope de la basilar representaron el 1.73% de un total de 1670 aneurismas operados y el 47.5% de los aneurismas de la circulacion posterior (29 casos). Fueron mas frecuentes en el sexo femenino con una relacion 1.2:1. La edad promedio fue de 49.3 anos (rango 22-70 anos). Solo se operaron pacientes con grado neurologico 1-3 de Hunt y Kosnik. La mayor parte fueron aneurismas menores de 10 mm. El 75.8% (n=22) de los casos se originaron en una bifurcacion en posicion normal. Se observo una asociacion con aneurismas multiples en el 37.9% de los casos. La mayor parte (55.1%) presentaron un domo con direccion superior y el 20% fueronaneurismas grandes o gigantes. El abordaje mas utilizado fue el pterional pretemporal. El indice de oclusion total fue del 82.7%. En el seguimiento a 6 meses, 25 pacientes (86%) tuvieron una puntuacion de 0-2 en la escalamodificada de Rankin. La mortalidad global fue del 6.8%. Los resultados mas pobres se obtuvieron en pacientes con aneurismas gigantes y en aquellos que desarrollaron vasoespasmo sintomatico. Conclusiones. La microcirugia ofrece una opcion viable de tratamiento para aneurismas del tope de la basilar. Cuando se tratan en centros de referencia se obtienen resultados quirurgicos muy aceptables e indices de oclusion mayoral obtenido por terapia endovascular.
Research Interests: Humanities and Medicine
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Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main... more
Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main objective of our series was to evaluate the long-term functional outcome and recurrence in patients with BCM treated with conservative or surgical treatments. Hypothesis: We assessed the hypothesis that surgical and conservative treatments are associated with different functional outcome and re-hemorrhage rate in long-term follow-up. Methods: In this non-randomized, clinical series, we compared the clinical and radiological findings of patients with their first hemorrhage secondary to confirmed BCM, treated in a tertiary neurological center, during a twenty five- year period. Treatment of each patient was selected by the attending physician and consisted of either conservative or surgical evacuation of BCM. The primary end-points were recurrent hemorrhage and functional outcome. Favorable prognosis was defined as modified Rankin scale (mRs) of 0 to 2. Results: From January of 1990 to July of 2015; 99 patients with BCM hemorrhage were treated (59 [59,6%] female; mean age 37± 13 years). 37 patients (37,4%) were surgically treated and 62 (62,6%) received conservative treatment. During the follow-up; 20 patients in the medical group (median time of recurrence: 34,5 months; IQR: 13,75-93) and 4 patients in the surgical group (median time of recurrence: 22 months; IQR: 9-46,5) had a recurrence (OR: 0,255; 95% IC: 0,079-0,817), with a cumulative incidence of 5,1 per 100 years-person and 3,96 per 100 years-person respectively. Because of rebleeding, 11 patients of the conservative group were taken to surgery and 3 of the surgical group were to required re-intervention. At the end of follow-up (median: 51 months; IQR: 19-104) 51 patients remained in the conservative group and 28 (54,9%) had a favorable mRs. 48 patients remained in the surgical group and 27 (56,2%) had a favorable mRs (OR:0,94 95% IC: 0,42-2,09). Conclusion: Despite a significant high recurrent hemorrhage rate was observed in conservative treated patients, we did not found difference in clinical outcome between both groups of patients with BCM.
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Ischemic cerebrovascular disease is an important cause of morbidity and mortality. One common final pathway in neuronal ischemic damage is the uncontrolled influx of calcium into the cell, mediated by voltage dependent channels or... more
Ischemic cerebrovascular disease is an important cause of morbidity and mortality. One common final pathway in neuronal ischemic damage is the uncontrolled influx of calcium into the cell, mediated by voltage dependent channels or activation of the NMDA (N-methyl D-aspartate) receptor. The therapeutic utility of a non-competitive NMDA blocker (MK-801, 2 mg/kg i.p.), to prevent the neuronal ischemic damage in an experimental middle cerebral artery occlusion model has been tested. The drug was administered 10 minutes before (group 3) and one hour after the arterial occlusion (group 4), and the results were compared with a group in which no medicament was utilized (group 2) and a control group (sham operation, group 1). MK-801 reduced significantly the area of infarction in relation to the control group (p < 0.05), mainly if the MK-801 was administered before the occlusion (group 3). These results suggest that MK-801 may be useful for the prevention of the neuronal ischemic damage caused by focal ischemia. However, before recommending its use in humans, all the possible collateral effects must be defined.
Research Interests: Medicine, Ischemia, Pubmed, Animals, Anesthesia, and 5 moreBrain Ischemia, Rats, Time Factors, Occlusion, and NMDA receptor
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Background Even when there is a CT scan classification for the evaluation of subarachnoid haemorrhage (SAH) and clinical outcome (Fisher’s scale), until now, there is not an angiographic scale currently in use that correlates the... more
Background Even when there is a CT scan classification for the evaluation of subarachnoid haemorrhage (SAH) and clinical outcome (Fisher’s scale), until now, there is not an angiographic scale currently in use that correlates the vasospasm extent with the clinical outcome.
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Reported are 15 cases of children who suffered injuries to their posterior fossa and the subsequent formation of hematomas and their treatment by the physicians in the Neurosurgical Department of the Traumatology Hospital "Magdalena de... more
Reported are 15 cases of children who suffered injuries to their posterior fossa and the subsequent formation of hematomas and their treatment by the physicians in the Neurosurgical Department of the Traumatology Hospital "Magdalena de las Salinas". Of the 15 cases, 11 had epidural hematomas (three of them with supratentorial extensions), one was subdural, two were cerebellar and another of the brainstem. Seven were considered acute, five were subacute and three were chronic. During their admittance to the hospital, five of the patients were in a state of coma, another five were sleepy or confused and the remaining five were conscious. Three of the patients were conservatively treated, two of which had sequelae or were moderately handicapped. Twelve of the patients were surgically intervened suboccipitally, eleven of which successfully recovered and one of which died. A history of brain injury, occipital fracture and signs of posterior fossa lesions lead to suspect the presence of posterior fossa hematoma.
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✓ Vascular complications after percutaneous injection procedures for relief of trigeminal neuralgia are varied, ranging from puncture of arterial or venous structures to carotid-cavernous fistulas. The authors present a patient in whom an... more
✓ Vascular complications after percutaneous injection procedures for relief of trigeminal neuralgia are varied, ranging from puncture of arterial or venous structures to carotid-cavernous fistulas. The authors present a patient in whom an external carotid artery fistula occurred after a microcompression procedure for the treatment of a left-sided trigeminal neuralgia. This is believed to be the first case of this complication secondary to a percutaneous injection procedure for relief of facial pain.
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The use of intraoperative fluorescence has proven to be a useful tool in multiple neurosurgical procedures with a potential utility in treating arteriovenous malformations (AVMs). The aim of this study was to characterize dynamic changes... more
The use of intraoperative fluorescence has proven to be a useful tool in multiple neurosurgical procedures with a potential utility in treating arteriovenous malformations (AVMs). The aim of this study was to characterize dynamic changes of an AVM using a microscope-integrated technique at the moment of performing an intraoperative Sodium fluorescein videoangiography (FL-VAG) at each of the resection phases. Our study at the National Institute of Neurology and Neurosurgery-Mexico City, prospectively recruited twelve patients harboring an AVM, using FL-VAG as an ancillary technique for the resection of the lesion. We analyzed the transit time (TT) of fluorescein in arterial feeders (TTa) and draining veins (TTv) during the different stages of resection. To achieve this, we recorded three values of the transit time of fluorescein (TTa, initial TTv, final TTv); when final TTv was markedly slower than initial TTv, we hypothesized that the nidus was devascularized enough and could be safely removed. No mortality or morbidity was related to the use of fluorescein. In most cases, the TT values of arterial feeders and draining veins allowed an easier distinction between them. At advanced stages of resection, the FL-VAG assesses the increase in TTv (venous blood is slower or absent), suggesting that most feeding arteries had been obliterated, indicating the appropriate moment for nidus removal. The optimal dose of fluorescein was a 75 mg bolus followed by and injection of 20 ml of saline solution. This simple technique allows a distinction of normal from abnormal flow in draining vessels, and might aid the surgeon to decide when the nidus can finally be safely removed. This is the first study prospectively evaluating this technique, and proposes an ideal dose for brain AVM surgery, in contrast with doses used in tumor cases.
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Research Interests: Surgery, Neurosurgery, Microsurgery, Treatment Outcome, Medicine, and 15 moreCase Report, Humans, Female, Male, Clinical Sciences, Aged, Middle Aged, Posterior Fossa, Adult, Retrospective Studies, Intracranial Arteriovenous Malformations, Microvascular Decompression, Decompression, Neurosciences, and Neuralgia
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Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant... more
Background: The middle cerebral artery (MCA) is a common site of cerebral aneurysms and 82.6% occur at the bifurcation. When surgery is selected as a therapeutic option, it intends to clip the neck completely because if some remnant occurs, there exists the possibility of regrowth and bleeding in the short- or long-term. Methods: We analyzed one drawback of the fenestrated clips of Yasargil and Sugita types to occlude the neck totally at a specific point formed by the union of the fenestra with the blades, creating a triangular space where the aneurysm can protrude, giving place to a remnant that can lead to a future recurrence and rebleeding. We show two cases of ruptured MCA aneurysms in which a cross-clipping technique occluded a broad base and dysmorphic aneurysm using straight fenestrated clips. Results: In both cases (one using a Yasargil clip and the other with a Sugita clip), a small remnant was visualized when fluorescein videoangiography (FL-VAG) was used. In both cases, t...
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Background: Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the posterior fossa is a slow-growing and extremely rare mass lesion that involves the Purkinje neurons and the granular layer of the cerebellum. It is... more
Background: Lhermitte-Duclos disease (LDD) or dysplastic gangliocytoma of the posterior fossa is a slow-growing and extremely rare mass lesion that involves the Purkinje neurons and the granular layer of the cerebellum. It is characterized by specific neuroradiological features and secondary hydrocephalus. However, documentation of surgical experience is scarce. Case Description: A 54-year-old man with LDD manifesting as progressive headache is presented with vertigo and cerebellar ataxia. Magnetic resonance imaging demonstrated a right cerebellar mass lesion with the characteristic “tiger-striped appearance.” We decided to perform partial resection with reduction of tumor volume improving symptomatology as a result of the mass effect in the posterior fossa. Conclusion: Surgical resection is a good alternative for the management of LDD, especially when neurological compromise exists due to mass effect.
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Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or... more
Background: Anomalies of the middle cerebral artery (MCA) are rare; among the different types of anomalies, the aplastic or twig-like (Ap/T) MCA is extremely rare and has been reported under various names, including aplastic, unfused, or rete type anomaly. The occurrence of a brain aneurysm associated with this anatomic variant is an even rare event, and probably their development and rupture are related to hemodynamic stress of the tinny wall of vessels forming the network. Case Description: We present a 43-year-old male patient with an explosive and persistent right orbitofrontal headache. A computed tomography showed a right frontobasal hematoma with intraventricular disruption. Magnetic resonance angiography showed a right MCA aneurysm and what seems to be a MCA trunk stenosis. Cerebral digital subtraction angiography demonstrated a plexiform arterial network and one aneurysm arising from the network. The patient was successfully treated by surgical clipping to evacuate the hema...
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OBJECTIVE Sylvian fissure (SF) arteriovenous malformations (AVMs) are among the most challenging vascular lesions amenable to neurosurgical treatment and account for 10% of all locations. As radiosurgery and endovascular techniques are... more
OBJECTIVE Sylvian fissure (SF) arteriovenous malformations (AVMs) are among the most challenging vascular lesions amenable to neurosurgical treatment and account for 10% of all locations. As radiosurgery and endovascular techniques are increasingly involved in multimodal management protocols, the role of microsurgery needs to be reassessed as a stand-alone technique. The aim of this study was to show that total excision can be achieved with reasonable levels of morbidity and mortality in a real-world setting from a specialized high-volume center. METHODS Forty-three patients with SF AVMs were identified from a series of 577 AVM patients treated microsurgically over a 22-year period. The mean patient age was 33.07 years (range 15–60 years), and there were 22 male and 21 female patients. The mode of presentation was headache in 51.2%, hemorrhage in 34.9%, seizures in 30.2%, and steal phenomenon in 9.3%. The authors analyzed the anatomical basis and angiographic characteristics of such...
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Research Interests: Humanities and Medicine
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Brainstem cavernous malformations (BSCMs) account for up to 18% of all intracranial cavernous malformations. Due to their complex anatomic location, they represent a significant challenge for neurosurgeons. As such, the identification of... more
Brainstem cavernous malformations (BSCMs) account for up to 18% of all intracranial cavernous malformations. Due to their complex anatomic location, they represent a significant challenge for neurosurgeons. As such, the identification of risk factors associated with negative outcomes is of significant importance. We analyze a series of 50 cases of BSCMs treated surgically in order to identify risk factors for unfavorable outcomes. Patients who underwent surgical resection of BSCM at our institution between 2000 and 2015 were retrospectively reviewed. Univariate and multivariable logistic regression models were used to identify predictors of unfavorable outcomes, defined as those with a modified Rankin score (mRs) of >2. Fifty Latin American patients, with a mean age of 35.85 ± 13.06 years, consisting of 29 females (58%) and 21 males (42%), underwent surgical resection. Mean modified Rankin Scale (mRs) score at admission was 2.6 ± 1.05, and the mean BCSM size was 18.00 ± 7.19 mm. ...
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The results described in this work are part of a larger project. The long term goal of this project is to help physicians predict the hemodynamic changes, and associated risks, caused by different treatment options for brain arteriovenous... more
The results described in this work are part of a larger project. The long term goal of this project is to help physicians predict the hemodynamic changes, and associated risks, caused by different treatment options for brain arteriovenous malformations. First, we need to build a model of the vascular architecture of each specific patient. Our approach to build these models is described in this work. Later we will use the model of the vascular architecture to simulate the velocity and pressure gradients of the blood flowing within the vessels, and the stresses on the blood vessel walls, before and after treatment. We are developing a computer program to describe each blood vessel as a parametric curve, where each point within this curve includes a normal vector that points in the opposite direction of the pressure gradient. The shape of the cross section of the vessel in each point is described as an ellipse. Our program is able to describe the geometry of a blood vessel using as an input a cloud of dots. The program allows us to model any blood vessel, and other tubular structures.
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Research Interests: Cardiology, Medicine, Brain, Humans, Hemodynamics, and 15 moreFemale, Male, Aged, Adult, Blood Flow, Flow Velocity, Cerebral Aneurysms, Cerebral Blood Flow, Blood Flow Velocity, Anterior communicating artery, Brain Diseases, Cerebral Angiography, Cerebral Vasospasm, Carotid Arteries, and Intracranial aneurysm
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The use of intraoperative fluorescence has proven to be a useful tool in multiple neurosurgical procedures with a potential utility in treating arteriovenous malformations (AVMs). The aim of this study was to characterize dynamic changes... more
The use of intraoperative fluorescence has proven to be a useful tool in multiple neurosurgical procedures with a potential utility in treating arteriovenous malformations (AVMs). The aim of this study was to characterize dynamic changes of an AVM using a microscope-integrated technique at the moment of performing an intraoperative Sodium fluorescein videoangiography (FL-VAG) at each of the resection phases. Our study at the National Institute of Neurology and Neurosurgery-Mexico City, prospectively recruited twelve patients harboring an AVM, using FL-VAG as an ancillary technique for the resection of the lesion. We analyzed the transit time (TT) of fluorescein in arterial feeders (TTa) and draining veins (TTv) during the different stages of resection. To achieve this, we recorded three values of the transit time of fluorescein (TTa, initial TTv, final TTv); when final TTv was markedly slower than initial TTv, we hypothesized that the nidus was devascularized enough and could be saf...
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RESUMEN Uno de los síntomas más importantes producidos por el crecimiento de los tumores de la hipófisis es la afec-ción de las vías ópticas. El diagnóstico temprano y la descompresión dependerá el resultado terapéutico. Se analizan 49... more
RESUMEN Uno de los síntomas más importantes producidos por el crecimiento de los tumores de la hipófisis es la afec-ción de las vías ópticas. El diagnóstico temprano y la descompresión dependerá el resultado terapéutico. Se analizan 49 casos tratados quirúrgicamente por vía transcraneal y transesfenoidal, y el efecto del tratamien-to en la función visual; así como, la necesidad de se-guimiento de estos tumores. Palabras clave: tumor de hipófisis, alteración visual, ciru-gía transesfenoidal, transcraneal. ABSTRACT RESULTS OF SURGICAL TREATMENT OF PITUITARY ADENOMAS WITH COMPRESSION OF OPTIC PATHWAY One of the most important symptoms produced by the growth of pituitary adenomas is the optic pathways lesion. From the early diagnosis and the decompres-sion of these structures depend the favorable outcome. Forty nine cases surgically trated by the transcraneal or the transesphenoidal approach are reviewed and the results of both ways compared. The follow up of these cases is stressed. (Arch Neurocien 6(3): 100-107, 2001). culo estimulante y luteinizante) por lo tanto el potencial de secretar hormonas excesivas; y, los no funciona-les carecen de producción hormonal. Los no funcio-nales pueden secretar subunidades alfa o beta (biológicamente inactivas), así mismo pueden contener pequeñas cantidades de células que se tiñen positiva-mente para hormonas adenohipofisiarias 9,10,12,13. La primera gran serie de pacientes con adenomas de hipófisis tratados quirúrgicamente fue de Harvey (1939), Cushing reportando que con el tratamiento combinado con radioterapia el 87% de los pacientes permanecieron asintomáticos después de 5 años de seguimiento, en total 205 pacientes; el 13% tuvo recurrencia; los síntomas de recurrencia reaparecieron a los 3 años en el 70% y alos 5 años en el 95%. La recurrencia es menor en aque-llos con tratamiento combinado de cirugía y radioterapia que en aquellos tratados sólo por cirugía, y con cirugía transcraneal se ha evidenciado mayor recurrencia (30%) que por vía transeptoesfenoidal (TSE) (5%), aunque ésto tal vez se deba a que tumores de mayor tamaño se ope-ran por vía transcraneal (TC) ,4,5,8,10. Dado que la función visual se altera debido a la compresión que ejercen los tumores de la hípófisis sobre el quiasma y los ner-vios ópticos se considero importante evaluar los resul-tados de la cirugía en esta tan trascendente función. Para ello se siguió la siguiente metodología. Hipótesis 1. La regresión de la cápsula tumoral es máxima a los 3 meses posquirúrgicos. 2. Existe mayor deterioro en la función endocrina en pacientes con resección total del adenoma que en aquellos con resección parcial. os adenomas de hipófisis son tumores que se origi-nan de la adenohipófisis. Son tumores benignos que se dividen en funcionales y no funcionales: los fun-cionales son aquellos que contienen inmunorreactividad a hormonas de la adenohipófisis (prolactina, hormona del crecimiento, hormona adrenocorticotrópica, hormonas folí-L
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Introduccion. Los aneurismas del tope de la arteria basilar representan cerca del 50% de los aneurismas de la circulacion posterior. En la actualidad a pesar de los avances en el tratamiento endovascular, los indices de recanalizacion... more
Introduccion. Los aneurismas del tope de la arteria basilar representan cerca del 50% de los aneurismas de la circulacion posterior. En la actualidad a pesar de los avances en el tratamiento endovascular, los indices de recanalizacion permanecen altos, con mayor riesgo de resangrado a largo plazo. Material y Metodos. Se realizo un estudio retrospectivo de una base de datos llevada de forma prospectiva de todos los aneurismas de la bifurcacion basilar operados en el Instituto Nacional de Neurologia “Manuel Velasco Suarez” de la Ciudad de Mexico en el periodo de 1997-2019. Se analizo la informacion demogra- fica y los resultados quirurgicos. Ademas, se revisaron los aspectos anatomicos basicos y los principales abordajes empleados para tratar estos aneurismas. Resultados. Los aneurismas del tope de la basilar representaron el 1.73% de un total de 1670 aneurismas operados y el 47.5% de los aneurismas de la circulacion posterior (29 casos). Fueron mas frecuentes en el sexo femenino con ...
In this paper, is presented the case of a 32-year-old, righ-handed male patient, with a clinical picture characterized by facial pain and diplopia 12 months before admission. The patient was then a worker in the United States of America... more
In this paper, is presented the case of a 32-year-old, righ-handed male patient, with a clinical picture characterized by facial pain and diplopia 12 months before admission. The patient was then a worker in the United States of America and received medical attention there. After performing a CT sean, no definite diagnosis could be established. The patient returned to Mexico E and after 6 months, developed a progressive paralysis of the oculomotor nerve. A new neurological evaluation showed the existence of a tumorallesion on the left cavernous sinus region with perilesional edema. The diagnosis was a meningioma of the lateral wall of the cavernous sinus. The patient underwent surgery through a Dolenc approach with a total resection of the tumor. The histopathological diagnosis was tuberculoma. The patient received treatment with ryfampicin and ethambutol for the next six months. After surgery the patient recovered from the III nerve paralysis and remains asymptomatic after 5 years ...
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Cavernous angiomas,cavernomas or occult vascular malformations, belong to the group of vascular malformations described originally by Mc Cormick. They represent between 5-13% of the total intracranial vascular malformations. Of these,... more
Cavernous angiomas,cavernomas or occult vascular malformations, belong to the group of vascular malformations described originally by Mc Cormick. They represent between 5-13% of the total intracranial vascular malformations. Of these, between 15-35% are located at the brainstem from the mesencephalon to the medulla oblongata. Cavernomas of the brainstem are considered frequently out of surgical treatment due to the apparent complexity to reach them safetly. This fact has induced a phenomena of inapropiate alternatives such the radiosurgery or endovascular therapy. The skull base approaches, have demostrated a great advance in exposure and surgical treatment of cavernomas at this location, regardless of their position in the brainstem. In this paper, we report our experience with 6 patients harboring a brainstem cavernoma that underwent surgical treatment at the National Institute of Neurology and Neurosurgery «Manuel Velasco Suarez» – Mexico City. In all cases the excision of the ca...
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La craneotomia pterional es uno de los abordajes mas comunes dentro de la neurocirugia, tienen inconvenientes tales como la seccion del musculo temporal que ocasiona defectos esteticos importantes. Se realizo un estudio comparativo para... more
La craneotomia pterional es uno de los abordajes mas comunes dentro de la neurocirugia, tienen inconvenientes tales como la seccion del musculo temporal que ocasiona defectos esteticos importantes. Se realizo un estudio comparativo para evaluar las tecnicas de diseccion del musculo temporal en el abordaje pterional y definir cual es la que presenta menor lesion al musculo, asi como a la rama frontotemporal del nervio facial. Las tres tecnicas evaluadas fueron: I. La seccion muscular transversal, II. Diseccion subfacial, y III. Craneotomia osteoplastica. En todos los pacientes se valoro un procedimiento quirurgico unilateral, con evolucion neurologica favorable y participacion voluntaria. Se encontraron los mejores resultados cosmeticos para el grupo 2, con un hundimiento de la fosa temporal de 1.08 mm contra 2.6 mm para los del grupo 1 (p=0.0020) y 2 mm para el grupo 3 ( p=0.033). En ningun caso hubo datos clinicos de lesion a la rama frontotemporal del nervio facial. La electromiog...
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Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main... more
Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main objective of our series was to evaluate the long-term functional outcome and recurrence in patients with BCM treated with conservative or surgical treatments. Hypothesis: We assessed the hypothesis that surgical and conservative treatments are associated with different functional outcome and re-hemorrhage rate in long-term follow-up. Methods: In this non-randomized, clinical series, we compared the clinical and radiological findings of patients with their first hemorrhage secondary to confirmed BCM, treated in a tertiary neurological center, during a twenty five- year period. Treatment of each patient was selected by the attending physician and consisted of either conservative or surgical evacuation of BCM. The primary end-points were recurrent hemorrha...
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Background: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain... more
Background: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state. Case Description: We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM). Conclusion: We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.
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Introduction. Pheochromocytomas (Pheo) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla and from the extra-adrenal autonomic paraganglia, respectively. Only 1–3% of head and neck... more
Introduction. Pheochromocytomas (Pheo) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla and from the extra-adrenal autonomic paraganglia, respectively. Only 1–3% of head and neck PGL (HNPGL) show elevated catecholamines, and at least 30% of Pheo and PGL (PCPG) are associated with genetic syndromes caused by germline mutations in tumor suppressor genes and proto-oncogenes. Clinical Case. A 33-year-old man with a past medical history of resection of an abdominal PGL at the age of eleven underwent a CT scan after a mild traumatic brain injury revealing an incidental brain tumor. The diagnosis of a functioning PGL was made, and further testing was undertaken with a PET-CT with 68Ga-DOTATATE, SPECT-CT 131-MIBG, and genetic testing. Discussion and Conclusion. The usual clinical presentation of functioning PCPG includes paroxistic hypertension, headache, and diaphoresis, sometimes with a suggestive family history in 30–40% of case...
BACKGROUND Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, are present in 1.5%-9% of all intracranial aneurysms. Here we characterize the important microsurgical anatomy of DACAs; describe... more
BACKGROUND Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, are present in 1.5%-9% of all intracranial aneurysms. Here we characterize the important microsurgical anatomy of DACAs; describe the surgical approach to treating these aneurysms with a minimally invasive surgical technique, the mini anterior interhemispheric approach (MAIA); and examine the nuances of aneurysm clipping in this region. METHODS This was a retrospective and descriptive analysis of a series of aneurysm surgeries performed at the National Institute of Neurology and Neurosurgery in Mexico City. Cadaveric dissections were used to demonstrate relevant cerebrovascular anatomy. We analyzed patient demographic data and aneurysm characteristics. Patients' neurologic grade was evaluated using the Hunt and Kosnik (H-K) scale, and surgical outcomes were evaluated using the Glasgow Outcome Scale (GOS). Other variables were analyzed using the χ2 test. RESULTS We analyzed a total of 32 DACA aneurysms (10 nonruptured and 22 ruptured), representing 5.8% of all aneurysms. The study cohort was 64.3% females and 35.7% males. H-K grade II was the most frequent classification (32.4%); 42.8% of patients presented with a Fisher grade IV aneurysm. Aneurysm location was classified as supra-genu, genu, or infra-genu. Eight patients had multiple aneurysms, among which 50% were located at the bifurcation of the middle cerebral artery. CONCLUSIONS Surgical clipping through a MAIA approach is an excellent treatment option for pericallosal artery aneurysms.
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Resumen Introduccion La enfermedad moyamoya (EM) es una arteriopatia oclusiva y progresiva de la circulacion cerebral anterior que puede producir eventos isquemicos o hemorragicos. El objetivo terapeutico es la prevencion de nuevos... more
Resumen Introduccion La enfermedad moyamoya (EM) es una arteriopatia oclusiva y progresiva de la circulacion cerebral anterior que puede producir eventos isquemicos o hemorragicos. El objetivo terapeutico es la prevencion de nuevos eventos a traves de tratamiento medico o cirugia de revascularizacion. Metodos Se estudio a 17 pacientes con EM y sindrome de moyamoya, atendidos de enero de 1989 a diciembre del 2016. Trece pacientes tenian EM definitiva (76%), un paciente EM unilateral (5,2%) y 3 pacientes sindrome de moyamoya (18%). Once pertenecian al sexo femenino y 6 al masculino. Su forma de presentacion fue hemorragia intraparenquimatosa (35,2%), isquemia cerebral (29,4%), hemorragia subaracnoidea (17,6%), crisis convulsivas (11,7%) y un paciente empezo con cefalea sin hemorragia. Resultados En 10 pacientes se realizo una cirugia de revascularizacion (58,8%) y 7 se manejaron medicamente (41,2%). La valoracion neurologica, empleando la escala modificada de Rankin al ingreso y en su ultima consulta, mostro una diferencia significativa (p Conclusiones Si bien nuestra poblacion muestra diferencias con otras series reportadas fuera de Asia, esta es la serie reportada mas numerosa para una poblacion hispana. Nuestros resultados indican que los procedimientos de revascularizacion son utiles para prevenir nuevos eventos vasculares isquemicos o hemorragicos.
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The olfactory function could be examined in 101 of 138 patients with anterior communicating artery aneurysms, whom we treated during a recent 6-year period. Among them, 49 patients underwent surgery by the anterior interhemispheric... more
The olfactory function could be examined in 101 of 138 patients with anterior communicating artery aneurysms, whom we treated during a recent 6-year period. Among them, 49 patients underwent surgery by the anterior interhemispheric approach and 52 underwent surgery by the basal interhemispheric approach. Fifteen patients (31%) exhibited anosmia after surgery by the anterior interhemispheric approach, whereas only one patient (1.9%) exhibited anosmia after surgery by the basal interhemispheric approach. Unilateral dural incision and unilateral brain retraction without elevation of the frontal lobe from the frontal base are important, because frontal lobe depression and elevation during surgery may injure the olfactory nerve.
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OBJECTIVE: Brainstem cavernous malformations (BSCMs) account for up to 18% of all intracranial cavernous malformations. Due to their complex anatomic location, they represent a significant challenge for neuro-surgeons. As such, the... more
OBJECTIVE: Brainstem cavernous malformations (BSCMs) account for up to 18% of all intracranial cavernous malformations. Due to their complex anatomic location, they represent a significant challenge for neuro-surgeons. As such, the identification of risk factors associated with negative outcomes is of significant importance. We analyze a series of 50 cases of BSCMs treated surgically in order to identify risk factors for unfavorable outcomes.-METHODS: Patients who underwent surgical resection of BSCM at our institution between 2000 and 2015 were retrospectively reviewed. Univariate and multivariable logistic regression models were used to identify predictors of unfavorable outcomes, defined as those with a modified Rankin score (mRs) of >2.-RESULTS: Fifty Latin American patients, with a mean age of 35.85 AE 13.06 years, consisting of 29 females (58%) and 21 males (42%), underwent surgical resection. Mean modified Rankin Scale (mRs) score at admission was 2.6 AE 1.05, and the mean BCSM size was 18.00 AE 7.19 mm. The rate of gross total resection was 92%. Overall, 80% of patients showed improved or unchanged clinical status at the last follow-up period; however, only 58% of patients had a favorable outcome with a mean mRs of 2.33 AE 1.136. Multivariable logistic binary regression identified hemor-rhagic recurrence (P [ 0.040), lower cranial nerve deficit (P [ 0.019), and BSCMs >15 mm in diameter (P [ 0.006) as predictive factors for unfavorable surgical outcomes.-CONCLUSION: BSCM size, compromise of lower cranial nerves, and hemorrhagic recurrence before surgery were identified as risk factors associated with unfavorable outcomes of surgically treated BSCMs in this cohort.
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Effect of two different surgical techniques (standard dissection and interfacial approach) over the postoperative functionality of the temporal muscle. The results point that interfacial dissection causes a temporal hollowing and muscle... more
Effect of two different surgical techniques (standard dissection and interfacial approach) over the postoperative functionality of the temporal muscle. The results point that interfacial dissection causes a temporal hollowing and muscle atrophy according the EMG results
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OBJECTIVE: To characterize dynamic changes of arte-riovenous malformation using a microscope-integrated technique at the moment of performing intraoperative fluorescein videoangiography (FL-VAG) at each of the resection phases.-METHODS:... more
OBJECTIVE: To characterize dynamic changes of arte-riovenous malformation using a microscope-integrated technique at the moment of performing intraoperative fluorescein videoangiography (FL-VAG) at each of the resection phases.-METHODS: We prospectively recruited 12 patients with arteriovenous malformations and used FL-VAG as an ancillary technique for resection of the lesion. We analyzed transit time (TT) of FL in arterial feeders (arterial transit time) and draining veins (venous transit time [TTv]) during the different stages of resection. To achieve this, we recorded 3 values of TT of FL (arterial TT, initial TTv, final TTv); when final TTv was markedly slower than initial TTv, we hypothesized that the nidus was devascularized enough and could be safely removed.-RESULTS: No mortality or morbidity was related to use of FL. In most cases, TT values of arterial feeders and draining veins allowed an easier distinction between them. At advanced stages of resection, FL-VAG assessed increase in TTv (venous blood slower or absent), suggesting that most feeding arteries had been obliterated, indicating the appropriate moment for nidus removal. Optimal dose of FL was a 75-mg bolus followed by injection of 20 mL of saline solution.-CONCLUSIONS: FL-VAG allows a distinction of normal from abnormal flow in draining vessels and might help the surgeon to decide when the nidus can be safely removed. This is the first study prospectively evaluating this technique , and it proposes an ideal dose for brain arteriovenous malformation surgery, in contrast to doses used in tumor cases.
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(p = 0.006). Lesion size >18 mm (hazards ratio, HR 3.34, 95% CI 1.54-7.26; p = 0.0001) and ventral location or crossing the brain stem's midpoint (HR 2.5, 95% CI 1.14-5.46; p = 0.022) were associated with a major risk of rebleeding in the... more
(p = 0.006). Lesion size >18 mm (hazards ratio, HR 3.34, 95% CI 1.54-7.26; p = 0.0001) and ventral location or crossing the brain stem's midpoint (HR 2.5, 95% CI 1.14-5.46; p = 0.022) were associated with a major risk of rebleeding in the uni-variate analysis, but only a lesion >18 mm remained statistically significant (HR 2.7, 95% CI 1.2-6.21; p = 0.016) in the multivariate analysis. Conclusion: A lesion size >18 mm was the principal factor associated with hemorrhage recurrence. The overall functional outcome was good. However, significant morbidity was attributable to rebleeding.
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RESUMEN Las fístulas arterio venosas durales (FAVD) del piso anterior del cráneo comprenden un subgrupo de las mal-formaciones arterio venosas durales, muy rara en su presentación y con amplio espectro clínico de síntomas y signos, pero... more
RESUMEN Las fístulas arterio venosas durales (FAVD) del piso anterior del cráneo comprenden un subgrupo de las mal-formaciones arterio venosas durales, muy rara en su presentación y con amplio espectro clínico de síntomas y signos, pero de gran importancia en su diagnóstico temprano y manejo definitivo, por su conocida alta inci-dencia de riesgo de sangrado 1 con complicaciones neu-rológicas severas que deterioran la calidad de vida de los pacientes. La primera FAVD fue descrita en 1963 por Lepoire 2 , y a partir de ella se presentan casos reportes en la literatura y series que no sobrepasan la decena de casos, a la actualidad menos de una centena de casos descritos. Se reviso el caso de un paciente masculino de la 4ta década de la vida con diagnóstico de malforma-ción arterio venosa dural, que no debuta con evento vascular hemorrágico y sometido a cirugía para trata-miento definitivo con excelente resultado. Se analiza el perfil del paciente, historia clínica neurológica, los estu-dios de neuroimagen, diagnósticos diferenciales, manejo quirúrgico definitivo y evolución a 10 meses. Palabras claves: malformación arterio-venosa dural, fís-tula dural, hemorragia, complicaciones neurológicas. ABSTRACT Dural arterio venous fistulas of the anterior portion of the cranial base are infrecuent and have a variated clinical aspectin signs and symptoms. The early diagnosis is very important as in the complete treatment due to the severe damage that might produce. We present the case of a male in the fourth decade diagnoses with AV malfor-mation with good results. Our review is made of diagnostic and therapeutic methods.
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Introduction: Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management aims to prevent new cerebrovascular events through... more
Introduction: Moyamoya disease (MD) is a progressive, occlusive disease of the arteries of
the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management
aims to prevent new cerebrovascular events through surgical revascularisation and/or
pharmacological treatment.
Methods: We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (n = 3),
who were evaluated between January 1989 and December 2016; 11 patients were women and
6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3
had moyamoya syndrome (18%). The condition manifested as intraparenchymal haemorrhage
(in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures
(11.7%), and headache with no associated haemorrhage (one patient).
Results: Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological
treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission
and at the last consultation; mRs scores were significantly lower in the group undergoing surgery
(P < .04). During follow-up, none of the patients undergoing revascularisation experienced
recurrences, whereas 2 patients receiving pharmacological treatment did experience a new
vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were
observed between the treatment outcomes of different revascularisation techniques.
Conclusions: Although our population has different demographic characteristics from those of
other non-Asian populations, ours is the largest published series of Hispanic individuals with
MD. Our results support the use of revascularisation procedures to improve these patients’
neurological status and to prevent new cerebrovascular events.
© 2018 Sociedad Espa˜nola de Neurología. Published by Elsevier España, S.L.U. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
the anterior cerebral circulation that may cause ischaemia or haemorrhage. Patient management
aims to prevent new cerebrovascular events through surgical revascularisation and/or
pharmacological treatment.
Methods: We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (n = 3),
who were evaluated between January 1989 and December 2016; 11 patients were women and
6 were men. Thirteen patients had definitive MD (76%), one had unilateral MD (5.2%), and 3
had moyamoya syndrome (18%). The condition manifested as intraparenchymal haemorrhage
(in 35.2% of patients), brain ischaemia (29.4%), subarachnoid haemorrhage (17.6%), seizures
(11.7%), and headache with no associated haemorrhage (one patient).
Results: Ten patients (58.8%) underwent revascularisation and 7 (41.2%) received pharmacological
treatment. All patients were evaluated with the modified Rankin Scale (mRs) at admission
and at the last consultation; mRs scores were significantly lower in the group undergoing surgery
(P < .04). During follow-up, none of the patients undergoing revascularisation experienced
recurrences, whereas 2 patients receiving pharmacological treatment did experience a new
vascular event (one ischaemic and one haemorrhagic) (P < .05). No significant differences were
observed between the treatment outcomes of different revascularisation techniques.
Conclusions: Although our population has different demographic characteristics from those of
other non-Asian populations, ours is the largest published series of Hispanic individuals with
MD. Our results support the use of revascularisation procedures to improve these patients’
neurological status and to prevent new cerebrovascular events.
© 2018 Sociedad Espa˜nola de Neurología. Published by Elsevier España, S.L.U. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
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Letter to the editor about the effects of covering aneurysms with gauze and the possibility to cause an inflammatory response affecting the optic nerve and its predominance in female patients.
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RESUMEN Los angiomas cavernosos o cavernomas, son una de las malformaciones vasculares descritas originalmente por Mc Cormick. Representan entre un 5-13% de las malformaciones vasculares intracraneales. Antes del advenimiento de la... more
RESUMEN Los angiomas cavernosos o cavernomas, son una de las malformaciones vasculares descritas originalmente por Mc Cormick. Representan entre un 5-13% de las malformaciones vasculares intracraneales. Antes del advenimiento de la tomografía axial computarizada y la imagen por resonancia magnética se conocían también como malformaciones vasculares ocultas. Aún cuando ocurren en practicamente todas las regiones del sistema nervioso central incluyendo la médula espinal, se frecuencia a nivel del tallo cerebral es de un 15-35% de todos los cavernomas. Los cavernomas del tallo cerebral son lesiones que frecuentemente se han descrito como inoperables y por ende han sido tributarias de tratamientos inefectivos tales como la radiocirugía o la terapia endovascular. En este artículo se presenta una serie de 6 pacientes con cavernomas dee tallo tratados a nivel institucional con diversas localizaciones. En conclusión se puede decir que la selección de un abordaje apropiado de acuerdo a su localización y una disección cuidadosa, asegura la extracción del cavernoma con poco o ningún déficit neurológico agregado. Se discuten las estrategias diagnósticas y de manejo quirúrgico y los abordajes más frecuentemente reportados en la literatura para su tratamiento. El abordaje quirúrgico continúa siendo la mejor opción terapeútica definitiva para los cavernomas de tallo cerebral. Palabras clave: cavernomas, tallo cerebral, tratamiento quirúrgico, malformaciones vasculares cerebrales.
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RESUMEN Uno de los síntomas más importantes producidos por el crecimiento de los tumores de la hipófisis es la afec-ción de las vías ópticas. El diagnóstico temprano y la descompresión dependerá el resultado terapéutico. Se analizan 49... more
RESUMEN Uno de los síntomas más importantes producidos por el crecimiento de los tumores de la hipófisis es la afec-ción de las vías ópticas. El diagnóstico temprano y la descompresión dependerá el resultado terapéutico. Se analizan 49 casos tratados quirúrgicamente por vía transcraneal y transesfenoidal, y el efecto del tratamien-to en la función visual; así como, la necesidad de se-guimiento de estos tumores. Palabras clave: tumor de hipófisis, alteración visual, ciru-gía transesfenoidal, transcraneal. ABSTRACT RESULTS OF SURGICAL TREATMENT OF PITUITARY ADENOMAS WITH COMPRESSION OF OPTIC PATHWAY One of the most important symptoms produced by the growth of pituitary adenomas is the optic pathways lesion. From the early diagnosis and the decompres-sion of these structures depend the favorable outcome. Forty nine cases surgically trated by the transcraneal or the transesphenoidal approach are reviewed and the results of both ways compared. The follow up of these cases is stressed. (Arch Neurocien 6(3): 100-107, 2001). culo estimulante y luteinizante) por lo tanto el potencial de secretar hormonas excesivas; y, los no funciona-les carecen de producción hormonal. Los no funcio-nales pueden secretar subunidades alfa o beta (biológicamente inactivas), así mismo pueden contener pequeñas cantidades de células que se tiñen positiva-mente para hormonas adenohipofisiarias 9,10,12,13. La primera gran serie de pacientes con adenomas de hipófisis tratados quirúrgicamente fue de Harvey (1939), Cushing reportando que con el tratamiento combinado con radioterapia el 87% de los pacientes permanecieron asintomáticos después de 5 años de seguimiento, en total 205 pacientes; el 13% tuvo recurrencia; los síntomas de recurrencia reaparecieron a los 3 años en el 70% y alos 5 años en el 95%. La recurrencia es menor en aque-llos con tratamiento combinado de cirugía y radioterapia que en aquellos tratados sólo por cirugía, y con cirugía transcraneal se ha evidenciado mayor recurrencia (30%) que por vía transeptoesfenoidal (TSE) (5%), aunque ésto tal vez se deba a que tumores de mayor tamaño se ope-ran por vía transcraneal (TC) ,4,5,8,10. Dado que la función visual se altera debido a la compresión que ejercen los tumores de la hípófisis sobre el quiasma y los ner-vios ópticos se considero importante evaluar los resul-tados de la cirugía en esta tan trascendente función. Para ello se siguió la siguiente metodología. Hipótesis 1. La regresión de la cápsula tumoral es máxima a los 3 meses posquirúrgicos. 2. Existe mayor deterioro en la función endocrina en pacientes con resección total del adenoma que en aquellos con resección parcial. os adenomas de hipófisis son tumores que se origi-nan de la adenohipófisis. Son tumores benignos que se dividen en funcionales y no funcionales: los fun-cionales son aquellos que contienen inmunorreactividad a hormonas de la adenohipófisis (prolactina, hormona del crecimiento, hormona adrenocorticotrópica, hormonas folí-L
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Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the... more
Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the 73 patients developed ischemic neurological symptoms associated with cerebral vasospasm, which were reversible in all except four patients (5.5%) who demonstrated low-density areas associated with vasospasm on computed tomographic scans. In general, the flow velocities in the middle cerebral arteries began to increase soon after onset of SAH, reaching the maximum between days 8 and 10, subsequently decreasing gradually. There was no signifi cant difference in the highest value and the time course of flow velocities between symptomatic vasospasm and asymptomatic vasospasm patients. Patients with symptomatic vasospasm demon strated two typical time courses of flow velocities: rapid increases in flow velocities that preceded the clinical manifestations of vasospasm (16 patients, 61.5%), and no rapid increases in flow velocities despite the presence of ischemic symptoms (10 patients, 38.5%). In the latter, angiograms demon strated vasospasm in segments distal to those evaluated by TCD examination. These results showed that the degree of cerebral vasospasm cannot be assessed only by the absolute flow velocities. CBF was measured two to 10 (mean 4.7) times within 3 weeks of SAH using the <SUP>133</SUP>Xe intravenous injec tion method. The CBF value remained stable even during the period of major risk of vasospasm. However, the CBF was significantly lower in patients with symptomatic vasospasm on days 8, 9, 10, 13, 14, and 15, when compared with patients without symptomatic vasospasm. Patients who devel oped ischemic neurological symptoms due to vasospasm without increased flow velocity also showed a low CBF value. The combination of serial TCD and CBF measurements, using the former for ear ly detection of vasospasm and the latter for evaluation of cerebral ischemia, is at present the best method for diagnosis of vasospasm.
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We sought to evaluate the long-term functional outcomes and identify the potential risk factors for rebleeding in patients with brain stem cavernous malformations (BCMs) who presented with hemorrhages and were surgically or conservatively... more
We sought to evaluate the long-term functional outcomes and identify the potential risk factors for rebleeding in patients with brain stem cavernous malformations (BCMs) who presented with hemorrhages and were surgically or conservatively treated and prospectively monitored. From January 1990 to July 2015, we included patients with first hemorrhagic episodes secondary to single BCMs. Modified Rankin score (mRS) was used for neurological status assessment. Univariate and multivariate regression statistics were used to identify the risk factors for rebleeding. A total of 99 patients with BCMs hemorrhages were included (59 [59.6%] women, mean age 37± 13 years). As initial treatments, 37 patients (37.4%) underwent surgery and 62 (62.6%) received conservative treatment. The median follow-up was 3.33 years (interquartile range 1.16-7 years; 408.3 patient/years). The rebleeding rate by patient/year was 10% in conservatively treated patients. Deterioration was significantly more frequent in patients with rebleeding (p = 0.0001). At the end of the follow-up, the mRS were favorable in 49 patients (65.3%) without rebleeding, whereas only 8 (33.3%) with rebleeding evolved to favorable outcomes (p = 0.006). Lesion size &gt;18 mm (hazards ratio, HR 3.34, 95% CI 1.54-7.26; p = 0.0001) and ventral location or crossing the brain stem&#39;s midpoint (HR 2.5, 95% CI 1.14-5.46; p = 0.022) were associated with a major risk of rebleeding in the univariate analysis, but only a lesion &gt;18 mm remained statistically significant (HR 2.7, 95% CI 1.2-6.21; p = 0.016) in the multivariate analysis. A lesion size &gt;18 mm was the principal factor associated with hemorrhage recurrence. The overall functional outcome was good. However, significant morbidity was attributable to rebleeding.
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Base de dados : LILACS. Pesquisa : 177103 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos... more
Base de dados : LILACS. Pesquisa : 177103 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos relacionados. Id: 177103. ...
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Research Interests: Surgery, Treatment, Microsurgery, Evolution, Hydrocephalus, and 19 moreComplication, Humans, Toxicity, Sex ratio, Female, Male, Technique, Follow-up studies, Subarachnoid hemorrhage, Clinical Sciences, Aged, Middle Aged, Adult, Group, Neurosciences, Mortality rate, Postoperative Complications, Neurologic Examination, and Neuropsychological Tests
Research Interests: Surgery, Neurosurgery, Humans, Clinical Sciences, Cisterna, and 4 moreCistern, Neurosciences, Arachnoid, and Needles
In this paper, is presented the case of a 32 year old, righhanded male patient, with a clinical picture characterized by facial pain and diplopia 12 months before admission. The patient was then a worker in the United States of America... more
In this paper, is presented the case of a 32 year old, righhanded male patient, with a clinical picture characterized by facial pain and diplopia 12 months before admission. The patient was then a worker in the United States of America and received medical attention there. After performing a CT sean, no definite diagnosis could be established. The patient returned to Mexico and after 6 months, developed a progressive paralysis of the oculomotor nerve. A new neurological evaluation showed the existence of a tumorallesion on the left cavernous sinus region with perilesional edema. The diagnosis was a meningioma of the lateral wall of the cavernous sinus. The patient underwent surgery through a Dolenc approach with a total resection of the tumor. The histopathological diagnosis was tuberculoma. The patient received treatment with ryfampicin and ethambutol for the next six months. After surgery the patient recovered from the III nerve paralysis and remains asymptomatic after 5 years of...
Ischemic cerebrovascular disease is an important cause of morbidity and mortality. One common final pathway in neuronal ischemic damage is the uncontrolled influx of calcium into the cell, mediated by voltage dependent channels or... more
Ischemic cerebrovascular disease is an important cause of morbidity and mortality. One common final pathway in neuronal ischemic damage is the uncontrolled influx of calcium into the cell, mediated by voltage dependent channels or activation of the NMDA (N-methyl D-aspartate) receptor. The therapeutic utility of a non-competitive NMDA blocker (MK-801, 2 mg/kg i.p.), to prevent the neuronal ischemic damage in an experimental middle cerebral artery occlusion model has been tested. The drug was administered 10 minutes before (group 3) and one hour after the arterial occlusion (group 4), and the results were compared with a group in which no medicament was utilized (group 2) and a control group (sham operation, group 1). MK-801 reduced significantly the area of infarction in relation to the control group (p < 0.05), mainly if the MK-801 was administered before the occlusion (group 3). These results suggest that MK-801 may be useful for the prevention of the neuronal ischemic damage c...
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Reported are 15 cases of children who suffered injuries to their posterior fossa and the subsequent formation of hematomas and their treatment by the physicians in the Neurosurgical Department of the Traumatology Hospital "Magdalena... more
Reported are 15 cases of children who suffered injuries to their posterior fossa and the subsequent formation of hematomas and their treatment by the physicians in the Neurosurgical Department of the Traumatology Hospital "Magdalena de las Salinas". Of the 15 cases, 11 had epidural hematomas (three of them with supratentorial extensions), one was subdural, two were cerebellar and another of the brainstem. Seven were considered acute, five were subacute and three were chronic. During their admittance to the hospital, five of the patients were in a state of coma, another five were sleepy or confused and the remaining five were conscious. Three of the patients were conservatively treated, two of which had sequelae or were moderately handicapped. Twelve of the patients were surgically intervened suboccipitally, eleven of which successfully recovered and one of which died. A history of brain injury, occipital fracture and signs of posterior fossa lesions lead to suspect the pre...
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Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The occurrence of unilateral and bilateral moyamoya disease may be associated with intracranial aneurysms. These aneurysms are of two types: major-artery aneurysms and peripheral-artery aneurysms. The former arise at the circle of Willis... more
The occurrence of unilateral and bilateral moyamoya disease may be associated with intracranial aneurysms. These aneurysms are of two types: major-artery aneurysms and peripheral-artery aneurysms. The former arise at the circle of Willis and the latter are located mainly at either the moyamoya vessels or at the choroidal arteries. We analyzed 76 patients with cerebral aneurysms associated with moyamoya disease who were affected unilaterally or bilaterally. Of them, 10 cases were studied by our group and 66have been reported in other studies. The characteristics of the aneurysms were assessed. The frequency of aneurysms associated with moyamoya is 4-fold higher in unilateral than in bilateral moyamoya. Major-artery aneurysms are found mainly in the arterial complex of the anterior communicating artery-anterior cerebral artery in patients with unilateral moyamoya, and in the basilar artery in patients with bilateral moyamoya. When microaneurysms are taken into account, peripheral-artery aneurysms are more frequent than major-artery aneurysms. Our results suggest that aneurysms associated with moyamoya disease have some characteristics that should be taken into consideration when making comparisons with these lesions encountered in the general population.Copyright © 1994 S. Karger AG, Basel