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Domínguez VR, Pérez-López C, Sánchez CV, Contreras CU, Guerrero AI, Abenza Abildúa MJ. Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE21667. [PMID: 35855010 PMCID: PMC9274291 DOI: 10.3171/case21667] [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: 11/24/2021] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Strongyloidiasis is an underdiagnosed and preventable life-threatening disease caused by infection with the helminth Strongyloides stercoralis. Chronic asymptomatic infection can be sustained for decades, and immunosuppression can lead to disseminated infection, with a mortality rate of 70%–100%. In the neurosurgical population, corticosteroids are the most consistent cause of hyperinfection. OBSERVATIONS The authors present the case of a 33-year-old woman of Paraguayan origin who was diagnosed with sphenoid planum meningioma and treated with a high dose of corticosteroids on the basis of the diagnosis. She underwent surgery, and pathological anatomy reflected grade I meningioma. After the surgery, she started with a history of dyspnea, productive cough, fever, and urticarial rash. Later, she presented with intestinal pseudo-obstruction and bacterial meningitis with hydrocephalus. Serology was positive for Strongyloides (enzyme-linked immunosorbent assay), and she was diagnosed with hyperinfection syndrome. Ivermectin 200 µg/kg daily was established. LESSONS It may be of interest to rule out a chronic Strongyloides infection in patients from risk areas (immigrants or those returning from recent trips) before starting treatment with corticosteroids.
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Affiliation(s)
| | - Carlos Pérez-López
- Departments of Neurosurgery and
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
| | | | | | | | - María José Abenza Abildúa
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
- Department of Neurology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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García Feijoo P, Carceller F, Isla Guerrero A, Sáez-Alegre M, Gandía González ML. Beyond Classic Anastomoses Training Models: Overview of Aneurysm Creation in Rodent Vessel Model. Front Surg 2022; 9:884675. [PMID: 35521434 PMCID: PMC9062134 DOI: 10.3389/fsurg.2022.884675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Nowadays, due to the decline in the number of microsurgical clippings for cerebral aneurysms and revascularization procedures, young neurosurgeons have fewer opportunities to participate and train on this type of surgery. Vascular neurosurgery is a demanding subspecialty that requires skills that can only be acquired with technical experience. This background pushes the new generations to be ready for such challenging cases by training hard on different available models, such as synthetic tubes, chicken wings, or placenta vessels. Although many training models for vascular neurosurgery have been described worldwide, one of the best is the rodent vessels model. It offers pulsation, coagulation, and real blood flow conditions in a physiologic atmosphere that mimics perfectly the intracranial human vessels environment, especially in terms of size. However, the current differences in governmental different regulations about the use of living animals in medical experimentation and the social awareness, as well as the lack of financial support, cause more difficulties for neurosurgeons to start with that kind of training. In this review, we describe the tools and techniques as basic steps for vascular microsurgery training by using rodent models, that provide an accurate copy of brain vessels environment under stable conditions. The initial three classical known microanastomoses for neurosurgeons are end-to-end, end-to-side, and side-to-side, but in literature, there have been described other more complex exercises for training and investigation, such as aneurysm models. Although there is still little data available, we aim to summarize and discuss aneurysm's training models and reviewed the current literature on the subject and its applications, including a detailed description of the techniques.
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Rodríguez Domínguez V, Gandía González ML, García Feijoo P, Sáez Alegre M, Vivancos Sánchez C, Pérez López C, Isla Guerrero A. Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view? Neurocirugia (Astur : Engl Ed) 2021; 33:284-292. [PMID: 34799283 DOI: 10.1016/j.neucie.2021.11.002] [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] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. MATERIALS AND METHODS A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). RESULTS Significant differences were observed in the postoperative improvement of the Nurick scale (p = 0.008) and mJOA (p = 0.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. CONCLUSIONS Laminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.
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Rodríguez Domínguez V, Gandía González ML, García Feijoo P, Sáez Alegre M, Vivancos Sánchez C, Pérez López C, Isla Guerrero A. Tratamiento de la mielopatía cervical mediante abordaje posterior: laminoplastia vs. laminectomía con fijación posterior. ¿Existen diferencias desde el punto de vista clínico y radiológico? Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sáez-Alegre M, García-Feijoo P, Millán P, Vivancos Sánchez C, Rodríguez Domínguez V, García Nerín J, Isla Guerrero A, Gandía-González ML. Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option? Front Neurol 2021; 12:632036. [PMID: 33692744 PMCID: PMC7937865 DOI: 10.3389/fneur.2021.632036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/21/2020] [Accepted: 01/22/2021] [Indexed: 01/01/2023] Open
Abstract
SARS-CoV2 infection can lead to a prothrombotic state. Large vessel occlusion, as well as malignant cerebral stroke have been described in COVID-19 patients. In the following months, given the increase in COVID-19 cases, an increase in malignant cerebral SARS-CoV2 associated strokes are expected. The baseline situation of the patients as well as the risk of evolution to a serious disease due to the virus, depict a unique scenario. Decompressive craniectomy is a life-saving procedure indicated in patients who suffer a malignant cerebral stroke; however, it is unclear whether the same eligibility criteria should be used for patients with COVID-19. To our knowledge seven cases of decompressive craniectomy and malignant cerebral stroke have been described to date. We report on a 39-year-old female with no major risk factors for cerebrovascular disease, apart from oral contraception, and mild COVID-19 symptoms who suffered from left hemispheric syndrome. The patient underwent endovascular treatment with stenting and afterward decompressive craniectomy due to a worsening neurological status with unilateral unreactive mydriasis. We present the case and provide a comprehensive review of the available literature related to the surgical treatment for COVID-19 associated malignant strokes, to establish whether the same eligibility criteria for non-COVID-19 associated strokes should be used. Eight patients, including our case, were surgically managed due to malignant cerebral stroke. Seven of these patients received decompressive craniectomy, and six of them met the eligibility criteria of the current stroke guidelines. The mortality rate was 33%, similar to that described in non-COVID-19 cases. Two patients had a left middle cerebral artery (MCA) and both survived after decompressive craniectomy. Our results support that decompressive craniectomy, using the current stroke guidelines, should be considered an effective life-saving treatment for COVID-19-related malignant cerebral strokes.
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Affiliation(s)
| | | | - Pablo Millán
- Department of Intensive Care Medicine, Hospital La Paz Madrid, Madrid, Spain
| | | | | | - Jorge García Nerín
- Department of Intensive Care Medicine, Hospital La Paz Madrid, Madrid, Spain
| | | | - María Luisa Gandía-González
- Department of Neurosurgery, Hospital La Paz Madrid, Madrid, Spain.,Hospital La Paz Institute for Health Research, Madrid, Spain.,CranioSPain Research Group, Institute for Neuroscience and Sciences of the Movement, Autonomous University of Madrid, Madrid, Spain
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Pérez-López C, Álvarez-Escolá C, Isla Guerrero A. Therapeutic approach to non-functioning pituitary adenomas. Med Clin (Barc) 2021; 156:284-289. [PMID: 33454125 DOI: 10.1016/j.medcli.2020.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/07/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/22/2022]
Abstract
The treatment of non-functioning pituitary adenomas raises two questions: when should they be treated and what role does each available treatment play. We review the usefulness of the different treatments and propose a therapeutic scheme based on the existing literature. Active treatment of pituitary adenomas should be performed when they produce symptoms, have contact with the optic tract, or have grown on imaging tests. The treatment is surgical, using radiotherapy for cases with significant non-removable postsurgical tumour remnants and for those in which histopathology studies show aggressive features. Medical treatment is reserved for situations in which surgical and radiotherapy treatments have been exhausted. The most advisable surgical treatment is endoscopic, although experienced neurosurgeons achieve results with microsurgery that are only slightly inferior.
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Affiliation(s)
- Carlos Pérez-López
- Servicio de Neurocirugía. Hospital Universitario La Paz, Madrid, España.
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Sáez-Alegre M, Pérez López C, Giner García J, Junnior Palpán Flores A, García Feijoo P, Vivancos Sánchez C, Isla Guerrero A. Epidural Lipomatosis and Syringomyelia in Adulthood: Case Report and Literature Review. World Neurosurg 2019; 129:341-344. [DOI: 10.1016/j.wneu.2019.06.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Isla Guerrero A, Mansilla Fernández B, Hernández Garcia B, Gómez de la Riva Á, Gandía González ML, Isla Paredes E. Resultados quirúrgicos de fracturas cervicales traumáticas en pacientes con espondilitis anquilosante. Neurocirugia (Astur) 2018; 29:116-121. [DOI: 10.1016/j.neucir.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 09/20/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022]
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Mansilla Fernández B, Isla Guerrero A, Giner García J, Royo Orejas A. Tractografía en fenómeno de Kernohan: presentación de un caso de hematoma subdural agudo. Rev Neurol 2015. [DOI: 10.33588/rn.6006.2014502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gómez de la Riva Á, Isla Guerrero A, García Grande A. La eritropoyetina como factor de protección de la radioterapia sobre células del sistema nervioso central. Estudio in vitro. Rev Neurol 2014. [DOI: 10.33588/rn.5805.2013211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hernández García BJ, Isla Guerrero A, Castaño A, Alvarez Ruiz F, Gómez de la Riva A. [Tumours of the upper cervical spine]. Neurocirugia (Astur) 2013; 24:250-61. [PMID: 23896559 DOI: 10.1016/j.neucir.2013.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/30/2013] [Accepted: 06/09/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vertebral tumours arising in the upper cervical spine are rare. We present our experience in managing these neoplasms. MATERIAL AND METHODS We retrospectively reviewed the case histories of patients treated at our institution between January 2000 and June 2011. RESULTS There were 9 patients with tumours in C1-C2-C3: 2metastases, 3chordomas, 2plasmocytomas, 1chondrosarcoma and 1osteochondroma. All patients complained of neck pain at the time of diagnosis. Three patients underwent an anterior and posterior approach, 3 an exclusively posterior approach and 3 an exclusively anterior surgical approach. Tumour resection was intralesional in 7 cases. Chemo-radiotherapy was used as adjuvant therapy in patients with malignant tumours. CONCLUSIONS Vertebral tumours in the upper cervical spine are usually malignant. Achieving en bloc resection is particularly challenging and is technically unfeasible in many cases. This worsens the prognosis and makes adjuvant treatment very important.
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Avellaneda Fernández A, Isla Guerrero A, Izquierdo Martínez M, Amado Vázquez ME, Barrón Fernández J, Chesa i Octavio E, De la Cruz Labrado J, Escribano Silva M, Fernández de Gamboa Fernández de Araoz M, García-Ramos R, García Ribes M, Gómez C, Insausti Valdivia J, Navarro Valbuena R, Ramón JR. Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskelet Disord 2009; 10 Suppl 1:S1. [PMID: 20018097 PMCID: PMC2796052 DOI: 10.1186/1471-2474-10-s1-s1] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chiari disease (or malformation) is in general a congenital condition characterized by an anatomic defect of the base of the skull, in which the cerebellum and brain stem herniate through the foramen magnum into the cervical spinal canal. The onset of Chiari syndrome symptoms usually occurs in the second or third decade (age 25 to 45 years). Symptoms may vary between periods of exacerbation and remission. The diagnosis of Chiari type I malformation in patients with or without symptoms is established with neuroimaging techniques. The most effective therapy for patients with Chiari type I malformation/syringomyelia is surgical decompression of the foramen magnum, however there are non-surgical therapy to relieve neuropathic pain: either pharmacological and non-pharmacological. Pharmacological therapy use drugs that act on different components of pain. Non-pharmacological therapies are primarily based on spinal or peripheral electrical stimulation. It is important to determine the needs of the patients in terms of health-care, social, educational, occupational, and relationship issues, in addition to those derived from information aspects, particularly at onset of symptoms. Currently, there is no consensus among the specialists regarding the etiology of the disease or how to approach, monitor, follow-up, and treat the condition. It is necessary that the physicians involved in the care of people with this condition comprehensively approach the management and follow-up of the patients, and that they organize interdisciplinary teams including all the professionals that can help to increase the quality of life of patients.
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Affiliation(s)
- Alfredo Avellaneda Fernández
- Carlos III Health Institute. Sinesio Delgado n. 6 (pavilion 12), 28029, Madrid, Spain
- Spanish Society of Primary Care. c/ Narváez, 15 1º Izda 28009, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Carmen Gómez
- Spanish Society of Medical-Physical Rehabilitation of Madrid, Spain
| | | | | | - José R Ramón
- Carlos III Health Institute. Sinesio Delgado n. 6 (pavilion 12), 28029, Madrid, Spain
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Pérez López C, Isla Guerrero A, Álvarez F, Budke M, Fernández Miranda JC, Paz JF, Pérez Álvarez M. Actualización en el tratamiento de la neurocisticercosis. Rev Neurol 2003. [DOI: 10.33588/rn.3609.2003033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pérez López C, Isla Guerrero A, Gómez Sierra A, Budke M, Álvarez Ruiz F, Sarmiento Martínez MÁ. Réplica. Cavernomatosis múltiple. Diagnóstico diferencial por eco-gradiente. Rev Neurol 2003. [DOI: 10.33588/rn.3605.2003001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Budke M, Isla Guerrero A, Pérez López C, Pérez Álvarez M, García Grande A, Bello MJ, Rey J. Estudio comparativo en el tratamiento de los gliomas de alto grado. Rev Neurol 2003. [DOI: 10.33588/rn.3710.2003014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pérez López C, Durán MDP, Isla Guerrero A, Álvarez F. Derivación de líquido cefalorraquídeo y embarazo. Rev Neurol 2003. [DOI: 10.33588/rn.3609.2002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Isla Guerrero A, Budke M, Cacicedo Egües L, García Grande A, Vázquez Rodríguez I, de Miguel Campo E, Pérez Álvarez M. Efecto protector de la hormona de crecimiento en cultivos de células del sistema nervioso central. Rev Neurol 2002. [DOI: 10.33588/rn.3403.2001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pérez López C, Isla Guerrero A, Gómez Sierra A, Budke M, Álvarez Ruiz F, Sarmiento Martínez MÁ. Tratamiento de la cavernomatosis cerebral múltiple. Rev Neurol 2002. [DOI: 10.33588/rn.3505.2002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Isla Guerrero A, Frutos R, Álvarez F, Pérez Álvarez M. Hernia discal L1-L2 extruida en paciente de edad avanzada. Rev Neurol 2000. [DOI: 10.33588/rn.3004.99420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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