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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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Degollado-García J, Casas-Martínez MR, Mejia BRF, Balcázar-Padrón JC, Rodríguez-Rubio HA, Nathal E. Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report. J Cerebrovasc Endovasc Neurosurg 2024; 26:51-57. [PMID: 37997040 PMCID: PMC10995475 DOI: 10.7461/jcen.2023.e2022.11.003] [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: 11/03/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 12/06/2023] Open
Abstract
Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.
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Affiliation(s)
- Javier Degollado-García
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Martin R. Casas-Martínez
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Bill Roy Ferrufino Mejia
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Héctor A. Rodríguez-Rubio
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Edgar Nathal
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
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Ferrufino-Mejia R, Rodríguez-Rubio HA, López-Rodríguez R, Espinoza-Montaño CT, Puentes-Rosero S, Sanchez-Toache K, Ferrufino-Mejia A. Surgical Treatment of Falcotentorial Meningioma: An Illustrative Case Report and Literature Review. Cureus 2024; 16:e55581. [PMID: 38576702 PMCID: PMC10994400 DOI: 10.7759/cureus.55581] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Falcotentorial meningiomas are rare tumors, representing only 2-3% of all intracranial meningiomas. These tumors can grow rapidly, leading to severe neurological complications. They grow at the junction of the tentorium cerebelli and the falx cerebri, in close proximity to the great vein of Galen. The surgical approach depends on several factors, such as the tumor's size, the patency of the straight sinus, and its location, either above or below the tentorium. Complete removal of the tumor in this area is difficult due to its deep location near major neurovascular structures. Various surgical approaches can be employed to remove these tumors, and the decision on which approach to use should be based on its advantages and disadvantages.
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Affiliation(s)
- Roy Ferrufino-Mejia
- Neurosurgery, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
- Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, MEX
| | - Héctor A Rodríguez-Rubio
- Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, MEX
| | - Rodrigo López-Rodríguez
- Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, MEX
| | | | - Santiago Puentes-Rosero
- Neurosurgery, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
| | - Kevin Sanchez-Toache
- Neurosurgery, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
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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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Breda-Yepes M, Rodríguez-Hernández LA, Gómez-Figueroa E, Mondragón-Soto MG, Arellano-Flores G, Hernández-Hernández A, Rodríguez-Rubio HA, Martínez P, Reyes-Moreno I, Álvaro-Heredia JA, Gutiérrez Aceves GA, Villanueva-Castro E, Sangrador-Deitos MV, Alonso-Vanegas M, Guerrero-Juárez V, González-Aguilar A. Relative cerebral blood volume as response predictor in the treatment of recurrent glioblastoma with anti-angiogenic therapy. Clin Neurol Neurosurg 2023; 233:107904. [PMID: 37499302 DOI: 10.1016/j.clineuro.2023.107904] [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: 06/11/2023] [Revised: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Glioblastoma is one of the most common brain tumors in adult populations, usually carrying a poor prognosis. While several studies have researched the impact of anti-angiogenic therapies, especially anti-VEFG treatments in glioblastoma, few have attempted to assess its progress using imaging studies. PURPOSE We attempted to analyze whether relative cerebral blood volume (rCBV) from dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) could predict response in patients with glioblastoma undergoing Bevacizumab (BVZ) treatment. METHODS We performed a retrospective study evaluating patients with recurrent glioblastoma receiving anti-angiogenic therapy with BVZ between 2012 and 2017 in our institution. Patients were scheduled for routine MRIs at baseline and first-month follow-up visits. Studies were processed for DSC-MRI, cT1, and FLAIR images, from which relative cerebral blood volume measurements were obtained. We assessed patient response using the Response Assessment in Neuro-Oncology (RANO) working group criteria and overall survival. RESULTS 40 patients were included in the study and were classified as Bevacizumab responders and non-responders. The average rCBV before treatment was 4.5 for both groups, and average rCBV was 2.5 for responders and 5.4 for non-responders. ROC curve set a cutoff point of 3.7 for rCBV predictive of response to BVZ. Cox Multivariate analysis only showed rCBV as a predictive factor of OS. CONCLUSION A statistically significant difference was found in rCBV between patients who responded and those who did not respond to BVZ treatment. rCBV may be a low-cost and effective marker to assess response to Bevacizumab treatment in GBM.
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Affiliation(s)
- Michele Breda-Yepes
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | | | | | | | | | | | - Pablo Martínez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | - Juan A Álvaro-Heredia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | | | | | - Mario Alonso-Vanegas
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | - Alberto González-Aguilar
- The American British Cowdray (ABC) Medical Center, Mexico City, Mexico; Department of Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico; Emergency Department, National Institute of Neurology and Neurosurgery, Mexico.
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Rubio AS, Rodríguez-Rubio HA, López-Rodríguez R, Bonilla-Suastegui A, Piñón-Jiménez F, Contreras-Vázquez OR, Revuelta-Gutiérrez R. Microvascular decompression for hemifacial spasm: Complications after 292 procedures without neurophysiological monitoring. Surg Neurol Int 2023; 14:343. [PMID: 37810311 PMCID: PMC10559543 DOI: 10.25259/sni_578_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: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hemifacial spasm (HFS) is characterized by involuntary, progressive, and intermittent spasms in the upper and lower facial muscles. Due to the high success rate, microvascular decompression (MVD) is the treatment of choice, and intraoperative neuromonitoring (INM) is considered useful for achieving safe surgery. Still, most centers do not have this technology. Methods We analyzed 294 patients with HFS treated with MVD without INM. We only included patients with a neurovascular etiology while excluding other causes, such as tumors. As part of the postoperative evaluation, we assessed preoperative magnetic resonance imaging and pure-tone audiometry. Results The main complication was peripheral facial paralysis in 50 patients, followed by hypoacusis in 22 patients and deafness in 17 patients, associated with a failed surgical outcome (P = 0.0002). The anterior inferior cerebellar artery (AICA) was an offending vessel, and the involvement of more than one vessel was significantly associated with the development of facial nerve palsy (P = 0.01). AICA was also associated with hearing impairment (P = 0.04). Over 90% of immediate complications improve in the follow-up (6 months), and one patient did not show a cure for initial HFS. Conclusion MVD is the method with the highest long-term cure rates for treating HFS; however, we must inquire into the multiple factors of the patient and the surgeon to predict surgical outcomes. INM is not a must during MVD for HFS. We recommend its use depending on the availability and mainly on the surgeon's skills, for surgeons.
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Affiliation(s)
| | | | | | | | | | | | - R. Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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7
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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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Rodríguez-Rubio HA, López-Rodríguez R, Ramos-Escalante J, Bonilla-Suastegui A, Balcázar-Padrón JC, Rodríguez-Hernández LA, Nicolas-Cruz CF, Piñón-Jiménez F, Siller Uvalle MA, Arritola-Uriarte A, Leal-Galvan A, Ferrufino-Mejia BR. Risk Factors Associated With Neurological and Extra-Neurological Complications and Mortality in Patients With Stroke. Cureus 2023; 15:e40706. [PMID: 37485158 PMCID: PMC10359178 DOI: 10.7759/cureus.40706] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Understanding when and how systemic complications can occur after an acute stroke is crucial. It is important to identify patients who are at higher risk for these complications. Early and effective treatment based on this knowledge can significantly improve patient outcomes. The objective of this study was to identify the risk factors associated with neurological and extra-neurological complications and mortality in stroke patients treated at a secondary care hospital. Methods Of a total of 170 patients diagnosed with hemorrhagic/ischemic stroke and transient cerebral ischemia at a secondary care hospital in Mexico, the records of 125 were reviewed and of these, 86 were included in the study. The study group comprised 86 adult patients (> 18 years of age) diagnosed with ischemic or hemorrhagic stroke or transient cerebral ischemia. Their demographics, clinical characteristics, in-hospital complications, and mortality were retrospectively analyzed. Results Of the 86 patients examined, 34.9% experienced complications, regardless of the type of stroke. The most significant factor associated with mortality and complications during hospitalization in patients with stroke was previous diseases. Other factors that were linked to higher mortality were pre-existing medical conditions. The most common neurological complication among patients with stroke during hospitalization was intracranial hypertension (3.5%). As for extra-neurological complications, pressure ulcers and nosocomial pneumonia had an occurrence rate of 4.7%. Conclusions The main neurological complication during hospitalization of patients with stroke was intracranial hypertension, while the extra neurological complications were pressure ulcers and nosocomial pneumonia.
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Affiliation(s)
- Héctor A Rodríguez-Rubio
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
- Neurology, Hospital General de Tampico "Dr. Carlos Canseco", Tampico, MEX
| | - Rodrigo López-Rodríguez
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Jonathan Ramos-Escalante
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Alfredo Bonilla-Suastegui
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Juan Carlos Balcázar-Padrón
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Luis A Rodríguez-Hernández
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Carlos F Nicolas-Cruz
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Fernando Piñón-Jiménez
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Miguel Angel Siller Uvalle
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | - Aleida Arritola-Uriarte
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
| | | | - Bill R Ferrufino-Mejia
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX
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Ferrufino-Mejia BR, Rodríguez-Rubio HA, López-Rodríguez R, Bonilla Suastegui A, Rodríguez-Florido MA, Hernandez-Gonzalez F, Ferrufino-Mejia A. Spontaneous Intracranial Hemorrhage Associated With an Intracranial Meningioma. Cureus 2023; 15:e40472. [PMID: 37456393 PMCID: PMC10349642 DOI: 10.7759/cureus.40472] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Spontaneous intracranial hemorrhage associated with an intracranial meningioma is rare, with a reported incidence of below 2.4% of all meningiomas. Such cases are described with a cause subdural with intratumoral hemorrhage, which is a challenge for patients and healthcare professionals because it can occur spontaneously without other pathological antecedents. We describe the case of a 55-year-old woman with subdural hemorrhage over the frontoparietal region of the right hemisphere associated with a meningioma, generating a mass effect and shifting the third ventricle and lateral ventricle. Therefore, urgent surgical treatment was decided. A tumor lesion was found with apoplexy, soft consistency, and violaceous color with abundant vascularity in the lesion's center, suggesting a probable angiomatous meningioma. The histopathological evaluation confirmed meningothelial hemorrhagic meningioma grade I, according to the World Health Organization grading. This article discusses the causes, risk factors, diagnosis, and surgical treatment for hemorrhage associated with intracranial meningioma.
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Affiliation(s)
- Bill R Ferrufino-Mejia
- Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
- Neurosurgery, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
| | - Héctor A Rodríguez-Rubio
- Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | - Rodrigo López-Rodríguez
- Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | - Alfredo Bonilla Suastegui
- Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | - Marco A Rodríguez-Florido
- Pathology, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
| | - Flavio Hernandez-Gonzalez
- Neurosurgery, Mexican Institute of Social Security (IMSS) XXI Century National Medical Center, Mexico City, MEX
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10
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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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11
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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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