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Nathal E, Degollado-García J, Rodríguez-Rubio HA, Bonilla-Suástegui A, Serrano-Rubio A. Fluorescein videoangiography (FL-VAG) as a predictor of cerebral bypass patency. World Neurosurg X 2024; 23:100287. [PMID: 38516026 PMCID: PMC10955417 DOI: 10.1016/j.wnsx.2024.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Background The fluorescein videoangiography (FL-VAG) has become a valuable adjunct tool in vascular neurosurgery. This work describes using the FL-VAG during bypass surgery and proposes a classification method for evaluating surgical results. Methods We analyzed 26 patients with 50 cerebral bypasses from September 2018 to September 2022. We used a three grades classification method based on the pass of intravenous fluorescein through the anastomosis. Grade 1 represents the synchronous and total filling of the "T" shape ("green T″) formed by the donor and recipient vessel, Grade 2, the asynchronous filling of the anastomosis (incomplete/asynchronous "green T″), and Grade 3, a non-patent anastomosis (absence of "green T″). Results Of the 26 patients, 8 underwent one bypass, 14 underwent double bypass, 2 underwent three bypasses, and 2 underwent four bypasses in two different interventions. The type of bypass was end-to-side anastomosis in 47 (94%) cases, internal maxillary artery to middle cerebral artery bypass with a radial artery graft (IMax-MCA anastomosis) in 2 (4%), and PICA-VA transposition in one (2%). We made 24 (48%) bypasses on the right side and 26 (52%) on the left side. After the initial surgery, thirty-nine (78%) bypasses were considered as Grade 1, 5 (10%) as Grade 2, and 6 (12%) as Grade 3. After intraoperative bypass patency assessment (IBPA), 45 (90%) of the bypasses were considered Grade 1 and remained patent on CTA. Conclusions Using FL-VAG and a three-tier classification method is a reliable tool to predict bypass patency. It is safe, low-risk, and available worldwide.
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Affiliation(s)
- Edgar Nathal
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City USA
| | - Javier Degollado-García
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City USA
| | - Héctor A. Rodríguez-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City USA
| | - Alfredo Bonilla-Suástegui
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City USA
| | - Alejandro Serrano-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City USA
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Nathal E, Serrano-Rubio A, Gutiérrez-Ávila O, Tovar-Romero L, López-Rodríguez R. Prototype of Low-Cost Microvascular Clips for Laboratory Use. World Neurosurg 2024; 184:213-218. [PMID: 38310952 DOI: 10.1016/j.wneu.2024.01.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Vascular neurosurgical procedures require temporary or permanent surgical clips to treat cerebral aneurysms, arteriovenous malformations, or bypass surgery. In this scenario, surgical clips should have specific characteristics such as high-quality material, proper design, closing force, and biocompatibility. Due to these characteristics, the price of these clips does not allow their availability at the experimental surgery laboratory worldwide. METHODS We describe here the technique for manufacturing handcrafted clips of low cost, using dental stainless steel or titanium wire of 0.18 mm, 0.20 mm, or 0.22 mm in diameter. We must complete six steps to obtain the clip using our hands and small electrician needle nose pliers for wire molding. RESULTS These clips have a closing force of 30-60 gr/cm2 (depending on the wire diameter). They can be used in the experimental surgery laboratory to clip arteries or veins during vascular microsurgery procedures. Also, they can be used as temporary clips with confidence in low-flow bypass (v.gr. superficial temporal artery to middle cerebral artery or occipital artery to posterior inferior cerebellar artery anastomoses). CONCLUSIONS Making practical low-cost clips for use in laboratory procedures or during low-flow anastomosis as temporary clips is possible. The main advantages are the low cost and the worldwide availability of the basic materials. The main disadvantage is the learning curve to get the ability to master the manufacturing of these clips.
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Affiliation(s)
- Edgar Nathal
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", UNAM, Mexico City, Mexico.
| | - Alejandro Serrano-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", UNAM, Mexico City, Mexico
| | - Oscar Gutiérrez-Ávila
- Deparment of Neurosurgery, Hospital Civil de Guadalajara Fray Antonio Alcalde, Universidad de Guadalajara, Mexico City, Mexico
| | - Leoncio Tovar-Romero
- Deparment of Neurosurgery, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Rodrigo López-Rodríguez
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", UNAM, Mexico City, Mexico
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Serrano-Rubio A, López-Rodríguez R, Riley-Moguel AE, Benavides-Burbano CA, Nuñez-Lupaca JN, Becerril-Mejía A, Villalobos-Diaz R, Nathal E. Bone anatomic variations of the parasellar region and its technical implications in para clinoid and posterior communicating segment aneurysms microsurgical clipping - Technical note. Surg Neurol Int 2024; 15:81. [PMID: 38628540 PMCID: PMC11021104 DOI: 10.25259/sni_75_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 04/19/2024] Open
Abstract
Background Microsurgical treatment of paraclinoid aneurysms is a complex task that generally requires anterior clinoid process (ACP) removal to obtain adequate surgical exposure. This procedure poses a considerable technical difficulty due to the association of the ACP to critical neurovascular structures. Furthermore, anatomical variations in the parasellar region, such as the caroticoclinoid foramen (CCF) or an interclinoid bridge (ICB), may impose additional challenges and increase surgical complications. The present study aims to briefly review some anatomic variations in the parasellar region and describe a step-by-step surgical technique for a hybrid anterior clinoidectomy based on the senior author's experience. Methods We present two cases with bone variations on the parasellar region in patients with a paraclinoid aneurysm and another with a posterior communicating segment aneurysm treated by microsurgical clipping at our hospital. Results We focused on safely dealing with these variations during surgery, without further complications, and with good postoperative results. Patients were discharged with no significant deficit. Postoperative control, computed tomography angiography showed complete exclusion of aneurysms. Conclusion Although anatomical variations in the parasellar region can complicate surgical clipping of these aneurysms, it is essential to ensure the best possible surgical outcome to conduct thorough preoperative and radiological evaluations.
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Affiliation(s)
- Alejandro Serrano-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Rodrigo López-Rodríguez
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Ambar Elizabeth Riley-Moguel
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Camilo Armando Benavides-Burbano
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Janeth N. Nuñez-Lupaca
- National University Jorge Basadre Grohmann, Professional School of Human Medicine, Tacna, Peru
| | - Alejandro Becerril-Mejía
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Rodolfo Villalobos-Diaz
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
| | - Edgar Nathal
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Tlalpan, Mexico
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Nathal E, Serrano-Rubio A, Benavides-Burbano CA, Rodríguez-Rubio HA. Paraclinoid aneurysms clipping through an extradural sphenoid ridge keyhole approach. Acta Neurochir (Wien) 2023; 165:2837-2841. [PMID: 37676506 PMCID: PMC10541827 DOI: 10.1007/s00701-023-05760-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
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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Affiliation(s)
- Edgar Nathal
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Universidad Nacional Autonoma de México (UNAM), Insurgentes Sur 3877, Tlalpan, Mexico City, 14263 Mexico
| | - Alejandro Serrano-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Universidad Nacional Autonoma de México (UNAM), Insurgentes Sur 3877, Tlalpan, Mexico City, 14263 Mexico
| | - Camilo Armando Benavides-Burbano
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Universidad Nacional Autonoma de México (UNAM), Insurgentes Sur 3877, Tlalpan, Mexico City, 14263 Mexico
| | - Héctor A. Rodríguez-Rubio
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Universidad Nacional Autonoma de México (UNAM), Insurgentes Sur 3877, Tlalpan, Mexico City, 14263 Mexico
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Degollado-García J, Rodríguez-Rubio HA, Bonilla-Suastegui A, Serrano-Rubio A, Nicolas-Cruz CF, Nathal E. Limitation of fenestrated clips during clipping of middle cerebral artery aneurysm: Technical note. Surg Neurol Int 2023; 14:204. [PMID: 37404494 PMCID: PMC10316142 DOI: 10.25259/sni_374_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/27/2023] [Indexed: 07/06/2023] Open
Abstract
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, the small remnant was clipped with a 3 mm straight miniclip. Conclusion We should be aware of this drawback when clipping aneurysms using fenestrated clips to ensure a complete obliteration of the aneurysm's neck.
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Affiliation(s)
| | | | | | | | | | - Edgar Nathal
- Corresponding author: Edgar Nathal, Department of Vascular Neurosurgery, National Institute of Neurology and Neurosurgery ‘Manuel Velasco Suárez’, Mexico City, Mexico.
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Revuelta-Gutiérrez R, Serrano-Rubio A, López-Rodríguez R, Rodríguez-Rubio HA, Bonilla-Suastegui A, Lara CS, Nathal E. Lhermitte-Duclos disease: A rare case of cerebellar tumor with successful surgical treatment. Surg Neurol Int 2023; 14:185. [PMID: 37292412 PMCID: PMC10246376 DOI: 10.25259/sni_302_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
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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Affiliation(s)
- Rogelio Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Alejandro Serrano-Rubio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Rodrigo López-Rodríguez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Héctor A. Rodríguez-Rubio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Alfredo Bonilla-Suastegui
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Citlaltepetl Salinas Lara
- Department of Neuropathology, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Edgar Nathal
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
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Casas-Martínez MR, Rodríguez-Rubio HA, Bonilla-Suastegui A, López-Rodríguez R, Serrano-Rubio A, Montes-Aguilar OJ, Alvarez-Betancourt L, Morgado-Vazquez JS. Citrobacter koseri: A rare cause of an epidural spinal abscess. Surg Neurol Int 2023; 14:83. [PMID: 37025517 PMCID: PMC10070251 DOI: 10.25259/sni_147_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
Background Citrobacter koseri, a Gram-negative organism, rarely causes an epidural spinal abscess. Case Description A 50-year-old male presented with mild paraparesis attributed to an magnetic resonance (MR)-documented spinal epidural abscess (SEA) at the T10-level. Following surgical debridement, cultures grew C. koseri, a rare Gram-negative organism. The abscess was subsequently managed with a prolonged course of antibiotics resulting in complete symptom and MR-documented radiological resolution. Conclusion A 50-year-old male presented with a T10 SEA attributed to a rare Gram-negative organism, C. koseri. The abscess was appropriately managed with surgical decompression/debridement, followed by prolonged antibiotic therapy.
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Affiliation(s)
- Martín R. Casas-Martínez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
- Corresponding author: Martín R. Casas-Martínez, Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | | | | | - Rodrigo López-Rodríguez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Alejandro Serrano-Rubio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Oscar Josue Montes-Aguilar
- Mexico City Spine Clinic, “Dr. Manuel Dufoo Olvera,” Mexican Social Security Institute, Mexico City, Mexico
| | - Leonardo Alvarez-Betancourt
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Jonathan Samuel Morgado-Vazquez
- Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
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Serrano-Rubio A, Ferrufino-Mejia BR, Balcázar-Padrón JC, Rodríguez-Rubio HA, Nathal E. Ruptured aneurysm associated with a twig-like middle cerebral artery: An illustrative case report. Surg Neurol Int 2022; 13:456. [PMID: 36324980 PMCID: PMC9610211 DOI: 10.25259/sni_678_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
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 hematoma and to prevent further intracranial hemorrhages. Conclusion: The Ap/T-MCA may be associated with hemodynamic stress with a significant effect through the tinny wall of the vessels causing hemorrhage or leading to the formation and rupture of cerebral aneurysms. Based on a correct diagnosis of the anomaly, treatment can be completed successfully through different standard methods.
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Nathal E, Serrano-Rubio A, Monroy-Sosa A, Gutiérrez-Ávila O, Vázquez-Gregorio R, Degollado-García J, Lee Á. Operative considerations and surgical treatment of sylvian fissure arteriovenous malformations: a 20-year experience. Neurosurg Focus 2022; 53:E10. [DOI: 10.3171/2022.4.focus22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
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 lesions.
RESULTS
In the preoperative period, 83.7% of the patients had a modified Rankin Scale (mRS) score of 0–2, and 16.3% had an mRS score of 3–5. After a 12-month follow-up, 95.3% of patients had an mRS score of 0–2, and 4.7% had a score of 3–6. The difference between pre- and postoperative scores was not statistically significant. SF AVMs have several particular features: 1) They produce angiographic steal of the anterior cerebral artery. 2) The nidus is fed by only one of the main trunks of the middle cerebral artery (MCA). 3) Participation of deep perforators is uncommon. 4) They have two or more early draining veins showing their fistulous nature. 5) Preoperative embolization and radiosurgery have a low rate of permanent cure.
CONCLUSIONS
These AVMs represent a surgical challenge due to their proximity to critical structures such as the MCA, insula, internal capsule, and speech and memory functions in the dominant hemisphere. Essential key points are the wide opening of the SF and proper differentiation between feeders and normal vessels. Although this location can seem daunting, SF AVMs carry no additional surgical risk if adequately managed.
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Affiliation(s)
- Edgar Nathal
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
| | - Alejandro Serrano-Rubio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
| | - Alejandro Monroy-Sosa
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
- Department of Neurosurgery, Hospital General de Tláhuac, ISSSTE, Mexico City; and
| | - Oscar Gutiérrez-Ávila
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
| | - Rafael Vázquez-Gregorio
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
| | - Javier Degollado-García
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez,” Mexico City
| | - Ángel Lee
- Hospital Ángeles del Pedregal, Mexico City, Mexico
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Nathal E, Serrano-Rubio A, Maciel E, Arauz A. Moyamoya disease in Mexico: our experience. Neurologia (Engl Ed) 2021; 36:603-610. [PMID: 34654535 DOI: 10.1016/j.nrleng.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/13/2018] [Indexed: 10/23/2022] Open
Abstract
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. MATERIALS AND METHODS We studied a series of 17 patients with MD (n = 14) or moyamoya syndrome (MS; 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 MS (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 (1 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.
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Affiliation(s)
- E Nathal
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico.
| | - A Serrano-Rubio
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - E Maciel
- Escuela de Medicina, Instituto Tecnológico de Monterrey Campus Guadalajara, Guadalajara, Mexico
| | - A Arauz
- Departamento de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudadde México, Mexico
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Nathal E, Serrano-Rubio A, Maciel E, Arauz A. Moyamoya disease in Mexico: Our experience. Neurologia 2018; 36:S0213-4853(18)30179-8. [PMID: 30076039 DOI: 10.1016/j.nrl.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/06/2018] [Accepted: 05/13/2018] [Indexed: 10/28/2022] Open
Abstract
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.
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Affiliation(s)
- E Nathal
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México.
| | - A Serrano-Rubio
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - E Maciel
- Escuela de Medicina, Instituto Tecnológico de Monterrey Campus Guadalajara, Guadalajara, México
| | - A Arauz
- Departamento de Neurología Vascular, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
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