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Uribe-Pacheco R, Sangrador-Deitos MV, Guinto-Nishimura GY, Villalonga JF, Baldoncini M, Elizalde RL, Campero A. Semi-sitting position and retrosigmoid approach for a large petroclival meningioma resection: 3-dimensional operative video. Surg Neurol Int 2024; 15:476. [PMID: 39777175 PMCID: PMC11705163 DOI: 10.25259/sni_911_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 11/23/2024] [Indexed: 01/11/2025] Open
Abstract
Background Petroclival meningiomas are still a neurosurgical challenge due to their proximity to cranial nerves and cerebral vasculature along the surgical corridor. The usual extension of large petroclival meningiomas is along the posterior fossa, frequently compromising and displacing adjunct cranial nerves such as the sixth and seventh-eight cranial nerve complex with brainstem compression, causing progressive neurological deficit and severe headache. The goal of sizeable petroclival meningioma surgery treatment is a maximal resection with preservation of neurological function. Several surgical approaches to the petroclival region have been described, and decisions depend on the valuable hearing, tumor origin, and lesion extension. Alongside, the semi-sitting position is a simple and feasible adaptation for several posterior fossa interventions, reducing venous hemorrhage and preventing venous air embolism. Case Description Hereby, we present the case of a 39-year-old female patient with progressive intermittent headache and right-sided hemiparesis secondary to a large petroclival meningioma. After a careful case study, surgical treatment was performed employing a retrosigmoid approach, aiming for the safest and maximal resection possible. Conclusion The retrosigmoid is an auditory sparing procedure that, with a semi-sitting position, provides direct visualization of the posterior fossa lateral triangles and the tumor and its dural implantation site with no blood and surgical view comprised of debris. This surgical video illustrates anatomical nuances and critical aspects of the retrosigmoid approach and semi-sitting position as safe and adequate access to complete resection and a favorable long-term clinical outcome. The patient consented to the procedure and the publication of his/her image.
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Pailler JI, Villalonga JF, Ries-Centeno T, Saenz A, Baldoncini M, Pipolo DO, Cárdenas Ruiz-Valdepeñas E, Kaen A, Hirtler L, Roytowski D, Solari D, Cervio A, Campero A. Clinical Applicability of the Sellar Barrier Concept in Patients with Pituitary Apoplexy: Is It Possible? LIFE (BASEL, SWITZERLAND) 2023; 13:life13010158. [PMID: 36676107 PMCID: PMC9861876 DOI: 10.3390/life13010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.
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del Pont FM, Villalonga JF, Sáenz A, Caffaratti G, Alcorta SC, Cervio A. Pseudoaneurysm following Surgical Resection of Craniopharyngioma: What Is the Best Management? INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1729462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractCraniopharyngiomas are benign tumors of the sellar and parasellar region for which surgical resection remains the treatment of choice. There are many publications on the most frequent postoperative complications, but few reports on subclinical lesions affecting the arteries of the circle of Willis, despite their high morbidity and mortality rate. Trauma-induced aneurysms are infrequent, representing less than 1% of intracranial aneurysms. Iatrogenic intracranial pseudoaneurysms are a subtype of surgically induced aneurysms developed as a result of direct injury to the arterial wall or after dissection of tumors adherent to the vessel adventitia. The natural history of these lesions is not well known because their incidence is extremely low. We report two cases of postoperative aneurysms of the internal carotid artery after craniopharyngioma resection and a brief review on the management of such lesions.
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Marcó Del Pont F, Ries Centeno T, Villalonga JF, Giovannini SJM, Caffaratti G, Lorefice E, Cervio A. Results in the treatment of intracranial hemangiopericytomas. Case series. Neurocirugia (Astur) 2020; 32:62-68. [PMID: 32473774 DOI: 10.1016/j.neucir.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intracranial hemangiopericytoma (HPC) is a rare central nervous system tumor characterized by its low incidence, high rate of local recurrence and risk of metastasis. The main objectives of this paper are two: to show the results in the treatment of HPC in our institution in the last 20years and to make a review of the literature on this topic. METHODS Retrospective review that includes patients diagnosed with intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) that have undergone surgery from 1997 to 2017. It includes patients that had nuclear expression of STAT-6 (detected by immunohistochemistry) and gradeII/III histopathological diagnosis (defined by the World Health Organization in 2016). We collected demographic data, tumor characteristics, treatment and survival of these patients. RESULTS A total of 19 patients fulfilled inclusion criteria. The median follow up was 96 months (12-230). The mortality rate was 21% (n=4). 57.9% of patients presented at least one tumor recurrence (n=11) (recurrences of 6%, 67% y 90% at 1, 5 and 10years). Five patients presented extracranial metastasis. Patients with tumors <6cm had greater survival (P<.05). CONCLUSIONS A series of patients undergoing SFT/HPC were presented according to the new WHO criteria. Size is a predictor of survival. Currently there are no validated criteria for surgical resection in this pathology. A classification with surgical guidance would be useful.
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Ries T, Villalonga JF, Giovaninni S, Cervio A. [Tumor-to-tumor: a wolf in sheep's clothing]. Rev Neurol 2019; 69:42-43. [PMID: 31236912 DOI: 10.33588/rn.6901.2019131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Caffaratti G, Villalonga JF, Katz D, Cervio A. Carcinoma pituitario: ¿es demasiado tarde? Rev Neurol 2019; 69:262-263. [DOI: 10.33588/rn.6906.2019130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Villalonga JF, Alessandro L, Farez MF, Mormandi R, Cervio A, Alcorta SC, Muggeri A. The role of surgery in primary central nervous system lymphomas. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:139-144. [DOI: 10.1590/0004-282x20180002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/09/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection. Methods A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015. Results Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016. Conclusions In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.
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Cervio A, Villalonga JF, Mormandi R, Alcorta SC, Sevlever G, Salvat J. Surgical treatment of cerebellar hemangioblastomas. Surg Neurol Int 2017; 8:163. [PMID: 28840067 PMCID: PMC5551294 DOI: 10.4103/sni.sni_490_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/21/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemangioblastomas (HBL) are uncommon tumors of the central nervous system (CNS), corresponding to 1-2.5% of all intracranial tumors. They can present sporadically or in patients with von Hippel-Lindau (VHL) disease and are most often located in the cerebellum, brainstem, and spinal cord. VHL disease is a multiple neoplasia syndrome inherited in an autosomal dominant fashion and caused by a VHL suppressor gene deletion. We present our experience in the management of patients with cerebellar HBL. METHODS Thirty consecutive patients with cerebellar HBL were included in this study. Hospital charts, radiological images, and operative records were reviewed. Modified Rankin scores were used to evaluate the clinical course. RESULTS Thirty patients diagnosed with cerebellar HBL were operated. Complete total resection was achieved in 93% of the cases. Postoperatively, 83% of the patients showed good functional recovery. CONCLUSIONS HBL of the cerebellum should be resected when symptomatic or when the tumor (or a tumor-associated cyst) shows signs of enlargement. Surgical intent should seek en bloc resection to minimize intraoperative bleeding. Patients with HBLs must be tested for VHL gene mutations, and in confirmed cases, relatives should be offered genetic counseling.
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Blanco SB, Segura EL, Cura EN, Chuit R, Tulián L, Flores I, Garbarino G, Villalonga JF, Gürtler RE. Congenital transmission of Trypanosoma cruzi: an operational outline for detecting and treating infected infants in north-western Argentina. Trop Med Int Health 2000; 5:293-301. [PMID: 10810029 DOI: 10.1046/j.1365-3156.2000.00548.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We designed a set of procedures for first-line local health services to detect and treat the congenital transmission of Trypanosoma cruzi at a province-wide scale, and field-tested the programme in the province of Tucumán, northwestern Argentina, from 1992 to 1994. The programme consists of routine screening of pregnant women for seroreactivity to T. cruzi, serological and parasitological follow-up of the newborn at least twice during the first year of age, treatment of the infected infants, and evaluation of the outcome. 927 (5.5%) of 16 842 pregnant women were seroreactive to T. cruzi by indirect haemagglutination assay and ELISA. Twenty-one (6.7%) of 315 newborns to seroreactive mothers were diagnosed as infected with T. cruzi parasites microhaematocrit concentration before 30 days of age. Five newborns who initially tested negative had a T. cruzi infection detected by microhaematocrit and/or serological techniques at 3 or 6 months of age. Thus, congenital infection was diagnosed in 26 (7.1%) infants born to seroreactive women and residing in houses free of triatomine bugs. Four of 6 infants born to seroreactive mothers died during the first year of age and had some evidence of T. cruzi infection; one of the deaths was attributed to T. cruzi based on clinical evidence. After specific treatment with nifurtimox or benznidazole, 30 of 32 infants remained parasitologically and serologically negative. This study shows the feasibility of controlling the incidence of congenitally acquired T. cruzi infections at a province-wide scale by means of a specific screening programme at first-line health services level.
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Ruíz de Valladares R, Rosini de Castagnaro N, Komaid JA, Raya JM, Puga Mendilaharzu H, González R, Villalonga JF. [Isolation of influenza virus in Tucuman--1976]. REVISTA LATINOAMERICANA DE MICROBIOLOGIA 1979; 21:207-10. [PMID: 550224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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de Nader OR, Villalonga JF, Schliserman M, Mingo Y, Buabse E, de Ruiz Holgado AP. [Shigellosis in Tucumán]. REVISTA DE LA ASOCIACION ARGENTINA DE MICROBIOLOGIA 1975; 7:108-10. [PMID: 790480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In 731 diarrhea cases studied from January 1971 to June 1973 in Tucumán a significant increase of shigellosis in eutrophic children was observed. The frequency of Shigella isolations, considering all the enteropathogens found, were: 15,5 %; 13 % and 21,3 % in 1971, 1972 and 1973, respectively (Table 1). All the strains of Shigella isolated belonged to the Shigella flexneri B or Shigella sonnei D groups, being the percentage for the former 78 % in 1971; 93 % in 1972 and 77 % in 1973 (Table 2). The age distribution of patients with shigellosis is shown in Table 3, the 87,7 % occurring within the first 3 years of life. S. flexneri B and S. sonnei D strains showed similar sensitivity to nalidixic acid, cephalosporines, chloramphenicol and trimethoprim plus sulfametoxazol; S. flexneri B was more susceptible to rifampicin, although this antibiotic was not used for therapeutics. A different sensitivity to kanamicin was observed being S. flexneri B, less susceptible than S. sonnei D, (Table 4). Fifty five percent of the cases showed clinical improvement after 48 h. of starting antibiotic treatment; 80 % after 72 h. and only 20 % required 96 or more for significant recovery. Although the number of patients with some degree of malnutrition was small, 7 out of the 8 cases studied required 72 h. or more for recovery.
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Miguel de Nader OR, Villalonga JF, Mingo Y. [Incidence and prevalence of Salmonella in diarrheic processes]. REVISTA LATINOAMERICANA DE MICROBIOLOGIA 1973; 15:71-4. [PMID: 4519946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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De Nader OR, Villalonga JF, Massi A, Delgado MP, Mingo Y, De Jara EN. [Study of susceptibility to diphtheria and carrier detection]. REVISTA LATINOAMERICANA DE MICROBIOLOGIA 1971; 13:237-44. [PMID: 5291971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Villalonga JF, De Nader OR, Massi AG, Mingo Y, De Jara EN, Buabsey E, Hernández P. [Bacteriological study of diphtheria patients and their contacts]. REVISTA LATINOAMERICANA DE MICROBIOLOGIA 1971; 13:189-93. [PMID: 5290796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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De Ruiz Holgado AP, Villalonga JF, Moreno E, De Nader OM, De Molina SB, Hernández P, Mingo Y. [Contribution to the study of acute diarrhea in infants in Tucuman]. BOLETIN DE LA OFICINA SANITARIA PANAMERICANA. PAN AMERICAN SANITARY BUREAU 1967; 63:373-81. [PMID: 4230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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