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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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2
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Rodríguez-Hernández LA, Navarro-Bonnet J, Ortiz-Plata A, Gonzalez-Mosqueda JP, Martinez-Arellano P, Calva-González M, Sangrador-Deitos MV, Mondragón-Soto MG, Lopez Mena D, Portocarrero-Ortiz L. Immunohistochemical Expression of Ki-67, Dopamine D1 and Dopamine D2 Receptors in Meningiomas in a Tertiary Institution in Mexico. Cureus 2023; 15:e39826. [PMID: 37397644 PMCID: PMC10314723 DOI: 10.7759/cureus.39826] [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] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Meningiomas (MNGs) are the most common intracranial tumors found in the adult population. While most intracranial MNGs may be surgically removed, a subset of patients remains ineligible for conventional treatment. This is either because of a lack of surgical access or due to atypical, anaplastic or invasive characteristics of the tumors. These patients may benefit from targeted therapies that focus on cell receptor expression. The aim of this study was to assess dopamine receptor (DR) and Ki-67 expression in the MGNs of patients treated with surgery in the Instituto Nacional de Neurología y Neurocirugía, Mexico. Materials and methods This study analyzed 23 patients with confirmed MNG diagnoses (10 female and 13 male (mean age: 44.5 years)) who had undergone surgical resection between 2010 and 2014 at our institution. In the collected samples, we performed analyses for Ki-67, Dopamine 1 and Dopamine 2 receptors' expression. Results For the markers Ki-67, DR-D1 and DR-D2, the mean percentual expressions were 18.9%, 23.02% and 8.33%. No significant correlation was found between the expressions of these receptors and the studied MNG characteristics. The expression index of Ki-67 showed a significant relation with mean age (p = 0.03) and prolactin levels (p = 0.02). Conclusions Samples showed varied expressions of the studied receptors. Despite the difference in expressions between the markers, more studies are needed to confirm the findings. In contrast to previous studies, we could not find any relationship between D2-R and tumor characteristics.
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Affiliation(s)
- Luis A Rodríguez-Hernández
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Jorge Navarro-Bonnet
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
| | - Alma Ortiz-Plata
- Neuropathology, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
| | - Juan P Gonzalez-Mosqueda
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
| | - Pablo Martinez-Arellano
- Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
| | - Metztli Calva-González
- Psychiatry, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Marcos V Sangrador-Deitos
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Michel G Mondragón-Soto
- Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
- General Surgery, Centro Medico ABC, Mexico City, MEX
| | - Diego Lopez Mena
- Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, MEX
| | - Lesly Portocarrero-Ortiz
- Neuroendocrinology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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3
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Calva-González M, Villanueva-Solórzano PL, Crail-Meléndez ED, Loya-Murguia KM, Dehesa Hernandez IA, Robles-Ramirez F, Rodríguez-Hernández LA, Mondragón-Soto MG, Flores-Vázquez JG, Portocarrero-Ortiz LA. Neuropsychiatric Effects in Patients With Invasive Prolactinomas Treated With Cabergoline. Cureus 2023; 15:e39869. [PMID: 37404423 PMCID: PMC10315068 DOI: 10.7759/cureus.39869] [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] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Background and objective Invasive prolactinoma accounts for 1-5% of all prolactinomas. Its mass and compromise of the diencephalon and frontal and temporal lobes may result in a range of neuropsychiatric symptoms that are often missed during initial evaluations. Cabergoline is a dopaminergic agonist used as the first-line treatment for these patients; however, its effect on neuropsychiatric symptoms in this particular setting remains unexplored. In this study, our primary objective was to describe the epidemiology of neuropsychiatric comorbidities in Mexican patients with invasive prolactinomas. The secondary aim of the study was to describe how these comorbidities are modified by treatment with cabergoline, through follow-up with standardized clinical scales. Methods This was a retrospective analytic study. Data were pulled from clinical records and evaluations of patients at baseline and at six-month follow-ups. Results A total of 10 patients were included in the study. None of them had any prior psychiatric diagnosis. At the initial evaluation, 70% were diagnosed with depression or anxiety. During follow-up, two patients developed neuropsychiatric symptoms; there was a significant reduction in tumor size but no difference was found in clinimetric scores for neuropsychiatric comorbidities. Conclusions Patients with giant prolactinomas may present with several neuropsychiatric symptoms throughout the course of their disease. Although there are several mechanisms involved, it is important to keep in mind that cabergoline may interfere with the dopaminergic pathways involved. This study was underpowered to determine the association but can serve as a pilot for further research on this topic.
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Affiliation(s)
- Metztli Calva-González
- Psychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | | | - Edgar D Crail-Meléndez
- Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | - Kennya M Loya-Murguia
- Neuropsychiatry, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | | | - Fernando Robles-Ramirez
- Neuroradiology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
| | | | - Michel G Mondragón-Soto
- Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
- General Surgery, Centro Medico ABC, Mexico City, MEX
| | | | - Lesly A Portocarrero-Ortiz
- Neuroendocrinology, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, MEX
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4
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Eguiluz-Melendez A, Rodríguez-Hernández LA, López-Molina A, Sangrador-Deitos MV, Mondragón-Soto MG, Gómez-Amador JL, Guinto-Nishimura G. Obstructive hydrocephalus due to posterior fossa tumors in adults: a comparative analysis of three surgical techniques. World Neurosurg 2023:S1878-8750(23)00471-0. [PMID: 37054951 DOI: 10.1016/j.wneu.2023.03.147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE The main treatments for hydrocephalus (HC) due to posterior fossa tumors (PFT) comprise tumor resection with or without an external ventricular drain (TR +/- EVD), ventriculoperitoneal shunt (VPS), and endoscopic third ventriculostomy (ETV). Although preoperative cerebrospinal fluid (CSF) diversion by either technique improves clinical outcomes, there is scarce evidence comparing its efficacy. Therefore, our aim was to restrospectively evaluate each treatment modality. METHODS Fifty-five patients were analyzed in a single center in Mexico City. Treatments were classified as successful (HC resolution with a single surgical event) or failed, and compared with a chi-square test. Kaplan-Meier curves and Log Rank tests were conducted. A Cox proportional hazard model was used to determine relevant covariates predicting outcomes. RESULTS The mean age was 36.3 years, 43.4% were men, and 50.9% presented with uncompensated intracranial hypertension. Mean tumor volume was 33.4 cc and extent of resection was 90.85%. TR +/- EVD was successful in 58.82%, VPS in 100%, and ETV in 76.19% (p=0.014). The mean follow-up was 15.12 months. Log-rank test found statistically significant differences between treatment modalities' survival curves (p=0.016) favoring the VPS group. Postoperative surgical site hematoma was a significant covariate in the Cox model (HR 17 [2.301-81.872], p=0.004). CONCLUSION This study favored the VPS as the most reliable treatment of HC due to PFT in adult population, however, several factors influence clinical outcomes. We proposed an algorithm based upon ours and other authors' findings to facilitate the decision-making process in this pathology.
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Affiliation(s)
- Aldo Eguiluz-Melendez
- Neurosurgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Alberto López-Molina
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
| | | | - Michel G Mondragón-Soto
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
| | - Juan L Gómez-Amador
- Neurosurgery Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
| | - Gerardo Guinto-Nishimura
- Neurosurgery department. Instituto Nacional de Neurología y Neurocirugía, MVS. Address: Insurgentes Sur 3877 Col. La Fama 14269, Mexico City, Mexico
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5
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Villalobos-Díaz R, Ortiz-Llamas LA, Rodríguez-Hernández LA, Flores-Vázquez JG, Calva-González M, Sangrador-Deitos MV, Mondragón-Soto MG, Uribe-Pacheco R, Villanueva Castro E, Barrera-Tello MA. Characteristics and Long-Term Outcome of Cerebellar Strokes in a Single Health Care Facility in Mexico. Cureus 2022; 14:e28993. [PMID: 36259000 PMCID: PMC9573303 DOI: 10.7759/cureus.28993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to analyze and discuss the clinical characteristics, long-term outcome, and prognostic factors of cerebellar strokes treated in a single health care facility in Mexico. Methods We retrospectively reviewed the medical records of adult patients admitted to our hospital with diagnosis of cerebellar ischemic and hemorrhagic stroke between 2018 and 2020. Baseline data included sociodemographic and radiological variables, treatment (surgical versus conservative), and Glasgow Coma Scale on arrival (GCSOA). The final neurological outcome was evaluated with the Glasgow Outcome Scale (GOS) six months after hospital discharge. Results Ten patients (seven male and three female) with a mean age of 57.9 ± 9.3 years were included, six with cerebellar ischemic infarction and four with cerebellar hemorrhage. Out of the 10 patients, four underwent surgery (suboccipital decompressive craniectomy {SDC} ± ventriculostomy). The outcome was favorable in four cases (40%) and unfavorable in six (60%). Patients who underwent surgical treatment fared worse with all four cases associating poor outcome. The comparison between good and poor outcome groups showed significant differences in the presence of obstructive hydrocephalus (one versus six, p = 0.05) and poorer GCSOA (6.16 ± 1.72 versus 12.5 ± 3.6, p = 0.05), associating poorer outcome. Conclusion There is still controversy regarding the appropriate management of cerebellar strokes. The presence of obstructive hydrocephalus and poorer GCSOA are associated to worse outcomes.
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6
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Altuve-Quiroz J, Fernández-Reynoso C, Mondragón-Soto MG, Juárez-Ramírez JI. The Role of Biochemical and Respiratory Markers in the Mortality of Patients With SARS-CoV-2 Infection in a Mexican Population. Cureus 2022; 14:e26249. [PMID: 35898355 PMCID: PMC9308479 DOI: 10.7759/cureus.26249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The SARS-CoV-2 pandemic has challenged the traditional perspectives of health care. The objective of our study was to analyze the association of different hematological biomarkers and respiratory assistance with the disease's severity and mortality in COVID-19. Materials and methods: A single reference center, cross-sectional, retrospective, descriptive and analytical, observational study was carried out on 362 SARS-CoV-2 positive adults from April to October 2020. Results: The mean age of the population was 55.92±13.12 years. A distribution by gender of n=227 (63.0%) men and n=135 women (37.0%) was found. Mortality occurred in 14% of the studied population. Comorbidities associated were hypertension n=128 (35.0%) and diabetes n=112 (31.0%). Of the 362 patients, 64 required advanced ventilatory support when taken to the intensive care unit, of these 39 (60.9%) died and only 25 (39.1%) survived (p<0.0001). On the other hand, biochemical indicators such as CRP, D-dimer, DHL, lymphocytes, leukocytes, neutrophils, and the neutrophil/lymphocyte ratio, showed a significant difference (p<0.0001) at admission and during the stay in the intensive care unit. Conclusions: Patients who required ventilatory assistance showed an increased risk of mortality, as did those who were admitted to the intensive care unit. Higher mortality was associated with higher values of CRP, DHL, D-dimer, neutrophil/lymphocytes ratio, total leukocytes, and lower lymphocytes.
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7
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Mondragón-Soto MG, Villanueva-Castro E, Tovar-Romero LA, Aragón-Arreola JF, Sangrador-Deitos MV, Cano-Velázquez G, Villanueva-Solórzano PL, Gómez-Amador JL. Magnetic resonance imaging finding of coexistence of bilateral paraclinoid aneurysms in a patient with a nonfunctioning macroadenoma, simultaneous resection, and clipping: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21720. [PMID: 36273858 PMCID: PMC9379769 DOI: 10.3171/case21720] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Unruptured incidental intracranial aneurysm can coexist with pituitary adenoma, however, the occurrence is extremely rare. Timely diagnosis of asymptomatic intracranial aneurysms with pituitary adenoma may lead to planning a tailored surgical strategy to deal with both pathologies simultaneously. A case of a patient who underwent transcranial resection of a pituitary adenoma with clipping of two mirror aneurysms is reported.
OBSERVATIONS
A 55-year-old female presented with deterioration of visual acuity that progressed over 1 year, as well as presence of right eyelid ptosis. Magnetic resonance imaging of the head showed the presence of an intrasellar pituitary macroadenoma. Bilateral paraclinoid aneurysms were documented to be in contact with the pituitary tumor. The patient underwent surgery with simultaneous aneurysm clipping and tumor resection through a standard pterional approach with intradural clinoidectomy. The aneurysms were successfully clipped after the tumoral debulking. After clipping, the pseudocapsule was fully resected.
LESSONS
Various treatment options are available. Although endovascular securing of the aneurysms prior to the tumor resection would be ideal, in cases in which this resource is not readily available at all times, the surgeon must be prepared to solve pathologies with an elevated level of complexity.
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Affiliation(s)
- Michel G. Mondragón-Soto
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Leoncio A. Tovar-Romero
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Jorge F. Aragón-Arreola
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Marcos V. Sangrador-Deitos
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Gerardo Cano-Velázquez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Pedro L. Villanueva-Solórzano
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
| | - Juan L. Gómez-Amador
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía “Dr. Manuel Velasco Suárez,” Mexico City, Mexico
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8
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Díaz-Bello S, Hernández-Hernández A, Guinto-Nishimura GY, Mondragón-Soto MG, Lem-Carrillo M, González-Aguilar A, Calleja-Castillo JM, Leyva-Rendón A, León-Ortiz P, Chávez-Piña CM, Pando-Tarín GA, Mejía-Pérez SI, Taboada-Barajas J, Zavala-Álvarez ED, Soto-Hernández JL, Cárdenas G, Gómez-Amador JL. Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center. Neurosurg Focus 2020; 49:E4. [PMID: 33260129 DOI: 10.3171/2020.9.focus20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications. METHODS The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: "Neurosurgery," "COVID-19/SARS-CoV-2," "reconversion/modification," "practice," "academy," and "teaching." Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel. RESULTS According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology. CONCLUSIONS The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.
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Affiliation(s)
- Sergio Díaz-Bello
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alan Hernández-Hernández
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Michel G Mondragón-Soto
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Monica Lem-Carrillo
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alberto González-Aguilar
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Juan M Calleja-Castillo
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Adolfo Leyva-Rendón
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Pablo León-Ortiz
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Carmen M Chávez-Piña
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Gustavo A Pando-Tarín
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Sonia I Mejía-Pérez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,5Medical Education
| | - Jesús Taboada-Barajas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,6Neuroradiology, and
| | - Elsa D Zavala-Álvarez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - José L Soto-Hernández
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Graciela Cárdenas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Juan L Gómez-Amador
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
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9
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Nicolás-Cruz CF, Mondragón-Soto MG, Calderón JRA, Melo-Guzmán G. Manejo bimodal de aneurismas asociados a malformaciones arteriovenosas cerebrales. Reporte de caso y breve revisión de la literatura. CIR CIR 2020; 88:79-83. [PMID: 33284274 DOI: 10.24875/ciru.20000429] [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] [Indexed: 11/17/2022]
Abstract
La patogénesis de los aneurismas intracraneales asociados a malformaciones arteriovenosas cerebrales no es bien entendida y es aún objeto de discusión. Las decisiones sobre cuándo y cómo tratar los aneurismas intracraneales de estas características siempre han sido un reto terapéutico tanto para neurocirujanos vasculares como para terapistas endovasculares neurológicos. Reportamos el caso de una paciente de 51 años con aneurismas múltiples asociados a una malformación arteriovenosa, así como su manejo neuroquirúrgico, con un análisis comparativo con lo publicado en la literatura médica y científica en los últimos 10 años. The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; the decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular neurosurgeons and endovascular neurological therapists. We report the case of a 51-year-old patient with multiple aneurysms associated with arteriovenous malformation, as well as her neurosurgical management, with a comparative analysis what has been published in the medical and scientific literature in the last 10 years.
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Affiliation(s)
- Carlos F Nicolás-Cruz
- Servicio de Cirugía General, Instituto Mexicano del Seguro Social (IMSS). Ciudad de México, México
| | - Michel G Mondragón-Soto
- Servicio de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez. Ciudad de México, México
| | - José R Aguilar Calderón
- Servicio de Neurocirugía, Hospital Central Sur de Alta Especialidad, Petróleos Mexicanos (PEMEX). Ciudad de México, México
| | - Gustavo Melo-Guzmán
- Unidad de Terapia Endovascular Neurológica, Servicio de Neurocirugía, Hospital Juárez de México, Secretaría de Salud. Ciudad de México, México
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Moreno-Jiménez S, Martínez-Vaca N, Pérez-Aguilar B, Gómez-Calva B, Díaz-Chávez JJ, Mondragón-Soto MG. Usefulness and safety from stereotactic biopsy in posterior fossa lesions in adult patients. CIR CIR 2019; 87:554-558. [PMID: 31448801 DOI: 10.24875/ciru.19000717] [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] [Indexed: 11/17/2022]
Abstract
Background Stereotactic biopsy has been reported as a useful and safety procedure in pediatric patients. In adult patients exist more controversy because a greater number of diagnostic options. Objective To demonstrate its usefulness and safety in adult patients with posterior fossa pathology. Method From 2006-2014, 23 patients were operated from posterior fossa. Variables: age, gender, state, pre- and postoperative diagnosis, stereotactic device, location and complications. Results 52.2% females and 47.8% males. The location was ponto-mesencephalic 43.5%, cerebellum 39.1%, bulbar 13% and pineal region 4.3%. The preoperative diagnosis was brainstem glioma 78.2%, lymphoma 8.7%, and meningioma, metastasis and abscess 4.3% each one. In 73.9% Zamorano-Dujovni device was used and in 26.1% the CRW. The definitive diagnosis was pilocytic astrocytoma 17.4%, diffuse astrocytoma 13%, inflammatory response 13%, anaplastic astrocytoma 8.7%, gliosis 8.7%, glioblastoma, neuroectodermic primitive tumor, germinoma, pineocytoma and cryptococcosis 4.3% each one. In 17.4% there was no diagnosis. The preoperative diagnosis was concordant in 43.5%. One transient deficit and one pin displacement 4.3% were present. 91.4% without complications. Conclusions It is a useful, necessary and safety procedure in adult patients.
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Affiliation(s)
- Sergio Moreno-Jiménez
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México.,Clínica de Radiocirugía, Centro Neurológico del Centro Médico ABC. Ciudad de México, México
| | - Néstor Martínez-Vaca
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
| | | | - Brenda Gómez-Calva
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
| | - Jorge J Díaz-Chávez
- Unidad de Radiocirugía, Instituto Nacional de Neurología y Neurocirugía. Ciudad de México, México
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