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García-Pérez D, Panero I, Paredes I. Positive outcome after endoscopic treatment of a symptomatic convexity arachnoid cyst in an elderly. Br J Neurosurg 2024; 38:540-541. [PMID: 33464128 DOI: 10.1080/02688697.2021.1872774] [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: 08/07/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Cerebral convexity arachnoid cysts (ACs) only represent around 10-14% of the cysts. Symptomatic ACs in the elderly are rare. We present a 66-year-old woman with headache and a focal epileptic seizure. Imaging revealed a left parietal AC. Conservative management chosen but the patient's neurological condition worsened, and an endoscopic fenestration was then performed. Postoperatively, her symptoms completely resolved and MRI image showed significant shrinkage of the AC.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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2
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Moreno Gómez LM, García-Pérez D, González-León PJ, Munarriz PM, Castaño-León AM. Pathogenesis of spinal intramedullary lipomas: two case reports. J Med Case Rep 2023; 17:317. [PMID: 37488574 PMCID: PMC10367250 DOI: 10.1186/s13256-023-04048-z] [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: 07/12/2021] [Accepted: 06/19/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Spinal lipomas not associated with dysraphism are rare and have an unknown natural history. In this report, we describe two cases; they showed recurrence during long-term follow-up, which makes us doubt a benign malformative etiology. CASE REPORTS Two patients, a 19-year-old South American woman and a 14-year-old boy with spinal lipomas, underwent surgical resection. The lipomas were not associated with dysraphism and were located in the cervicothoracic and craniocervical junctions. In both cases, we decided to operate due to clinical progression; the former had a progressive natural course, and the latter experienced clinical worsening after recurrence from previous surgeries. The surgery took place with the assistance of neurophysiological monitoring and intraoperative ultrasound; a partial resection and medullary decompression were done, following the more recent recommendations. DISCUSSION The natural history of these lesions is currently unknown due to their rarity and the heterogeneity in the long-term follow-up of previously reported cases. Although previous reports describe good outcomes after surgical resection, long follow-ups, especially in young subjects, may show differences in these outcomes with progression and recurrence. We contribute to this last piece of evidence by describing two more cases of progression and recurrence. LESSONS Long-term close follow-up should be done in young subjects with spinal lipomas, as they are more prone to an aggressive course. Metabolism and hormonal changes may be behind this progression. Reoperation must be considered if neurological decline is detected.
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Affiliation(s)
- Luis Miguel Moreno Gómez
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain.
| | - Daniel García-Pérez
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Pedro Juan González-León
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Pablo M Munarriz
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
| | - Ana María Castaño-León
- Neurosurgery Department, University Hospital "12 de Octubre", Avda de Córdoba, s/n, 28041, Madrid, Spain
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García-Pérez D, García-Posadas G, San-Juan R, Brañas P, Panero-Pérez I, Delgado-Fernández J, Paredes I. A prospective study to identify preoperative serum parameters for spinal implant infection detected by sonication fluid culture. Eur Spine J 2023; 32:1818-1829. [PMID: 36897428 DOI: 10.1007/s00586-023-07628-1] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/03/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Low-virulent microorganisms identified on pedicle screws by sonication fluid culture (SFC) are an important cause of implant loosening. While sonication of explanted material improves the detection rate, the risk of contamination exists and no standardized diagnostic criteria for chronic low-grade spinal implant-related infection (CLGSII) are stablished. Besides, the role of serum C-reactive protein (CRP) and procalcitonin (PCT) in CLGSII has not been adequately investigated. METHODS Blood samples were collected prior to implant removal. To increase sensitivity, the explanted screws were sonicated and processed separately. Patients exhibiting at least one positive SFC were classified in the infection group (loose criteria). To increase specificity, the strict criteria only considered multiple positive SFC (≥ 3 implants and/or ≥ 50% of explanted devices) as meaningful for CLGSII. Factors which might promote implant infection were also recorded. RESULTS Thirty-six patients and 200 screws were included. Among them, 18 (50%) patients had any positive SFCs (loose criteria), whereas 11 (31%) patients fulfilled the strict criteria for CLGSII. Higher serum protein level was the most accurate marker for the preoperative detection of CLGSSI, exhibiting an area under the curve of 0.702 (loose criteria) and 0.819 (strict criteria) for the diagnosis of CLGSII. CRP only exhibited a modest accuracy, whereas PCT was not a reliable biomarker. Patient history (spinal trauma, ICU hospitalization and/or previous wound-related complications) increased the likelihood of CLGSII. CONCLUSION Markers of systemic inflammation (serum protein level) and patient history should be employed to stratify preoperative risk of CLGSII and decide the best treatment strategy.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain.
- Department of Neurosurgery, Complejo Universitario Hospital Albacete, Calle Hermanos Falcó 37, 02008, Albacete, Spain.
| | - Guillermo García-Posadas
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Patricia Brañas
- Department of Clinical Microbiology, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Irene Panero-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Juan Delgado-Fernández
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain
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Castaño-Leon AM, Gómez PA, Paredes I, Munarriz PM, Panero I, Eiriz C, García-Pérez D, Lagares A. Surgery for acute subdural hematoma: the value of pre-emptive decompressive craniectomy by propensity score analysis. J Neurosurg Sci 2023; 67:83-92. [PMID: 32972116 DOI: 10.23736/s0390-5616.20.05034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute subdural hematomas (ASDH) are found frequently following traumatic brain injury (TBI) and they are considered the most lethal type of mass lesions. The decision to perform a procedure to evacuate ASDH and the approach, either via craniotomy or decompressive craniectomy (DC), remains controversial. METHODS We reviewed a prospectively collected series of 343 moderate to severe TBI patients in whom ASDH was the main lesion (ASDH volumes ≥10 cc). Patients with early comfort measures (early mortality prediction >50% and not ICP monitored), bilateral ASDH or the presence of another intracranial hematoma with volumes exceeding two times the volume of the ASDH were excluded. Among them, 112 were managed conservatively, 65 underwent ASDH evacuation by craniotomy and 166 by DC (103 pre-emptive DC, 63 obligatory DC). We calculated the average treatment effect by propensity score (PS) analysis using the following covariates: age, year, hypoxia, shock, pupils, major extracranial injury, motor score, midline shift, ASDH volume, swelling, intraventricular and subarachnoid hemorrhage presence. Then, multivariable binary regression and ordinal logistic regression analysis were performed to estimate associations between predictors and mortality and 12 months-GOS respectively. The patients' inverse probability weights were included as an independent variable in both regression models. RESULTS The main variables associated with outcome were year, age, falls from patient´s own height, hypoxia, early deterioration, pupillary abnormalities, basal cistern effacement, compliance to ICP monitoring guidelines and type of surgical approach (craniotomy and pre-emptive DC). CONCLUSIONS According to sliding dichotomy analysis, we found that patients in the intermediate or worst bands of unfavorable outcome prognosis seemed to achieve better than expected outcome if they underwent pre-emptive DC rather than craniotomy.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain -
| | - Pedro A Gómez
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Carla Eiriz
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, i+12-CIBERESP Research Institute, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Castaño-Leon AM, Sánchez Carabias C, Hilario A, Ramos A, Navarro-Main B, Paredes I, Munarriz PM, Panero I, Eiriz Fernández C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Garcia Posadas G, Gomez PA, Lagares A. Serum assessment of traumatic axonal injury: the correlation of GFAP, t-Tau, UCH-L1, and NfL levels with diffusion tensor imaging metrics and its prognosis utility. J Neurosurg 2023; 138:454-464. [PMID: 35901687 DOI: 10.3171/2022.5.jns22638] [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: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Diagnosis of traumatic axonal injury (TAI) is challenging because of its underestimation by conventional MRI and the technical requirements associated with the processing of diffusion tensor imaging (DTI). Serum biomarkers seem to be able to identify patients with abnormal CT scanning findings, but their potential role to assess TAI has seldomly been explored. METHODS Patients with all severities of traumatic brain injury (TBI) were prospectively included in this study between 2016 and 2021. They underwent blood extraction within 24 hours after injury and imaging assessment, including DTI. Serum concentrations of glial fibrillary acidic protein, total microtubule-associated protein (t-Tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NfL) were measured using an ultrasensitive Simoa multiplex assay panel, a digital form of enzyme-linked immunosorbent assay. The Glasgow Outcome Scale-Extended score was determined at 6 months after TBI. The relationships between biomarker concentrations, volumetric analysis of corpus callosum (CC) lesions, and fractional anisotropy (FA) were analyzed by nonparametric tests. The prognostic utility of the biomarker was determined by calculating the C-statistic and an ordinal regression analysis. RESULTS A total of 87 patients were included. Concentrations of all biomarkers were significantly higher for patients compared with controls. Although the concentration of the biomarkers was affected by the presence of mass lesions, FA of the CC was an independent factor influencing levels of UCH-L1 and NfL, which positioned these two biomarkers as better surrogates of TAI. Biomarkers also performed well in determining patients who would have had unfavorable outcome. NfL and the FA of the CC are independent complementary factors related to outcome. CONCLUSIONS UCH-L1 and NfL seem to be the biomarkers more specific to detect TAI. The concentration of NfL combined with the FA of the CC might help predict long-term outcome.
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Affiliation(s)
- Ana M Castaño-Leon
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | | | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Blanca Navarro-Main
- 4Department of Psychiatry, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid; and
| | - Igor Paredes
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pablo M Munarriz
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Irene Panero
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Carla Eiriz Fernández
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Daniel García-Pérez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Luis Miguel Moreno-Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Olga Esteban-Sinovas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Guillermo Garcia Posadas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pedro A Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Alfonso Lagares
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid.,5Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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García-Pérez D, Panero I, Lagares A, Gómez PA, Alén JF, Paredes I. Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center. Neurocirugia (Astur : Engl Ed) 2023; 34:12-21. [PMID: 36623889 DOI: 10.1016/j.neucie.2022.11.004] [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] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature. METHODS Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients. RESULTS Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD. CONCLUSIONS Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Pedro Antonio Gómez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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Galiana Á, Ruiz S, Alén JF, Gómez Grande A, Panero I, Vega D, García-Pérez D, Gutiérrez E, Romero C, Lagares A, Tabuenca MJ, Paredes I. Effects of cranioplasty in cerebral blood perfusion using quantification with 99m-Tc HMPAO SPECT-CT. J Neuroimaging 2023; 33:174-183. [PMID: 36251614 DOI: 10.1111/jon.13058] [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: 04/26/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Syndrome of the trephined or sinking skin flap syndrome is an underdiagnosed condition of craniectomized patients that usually improves after cranioplasty. Among the pathophysiological theories proposed, the changes of cerebral blood perfusion (CBP) caused by cranial defects might have a role in the neurological deficiencies observed. We aim to assess the regional cortex changes in CBP after cranioplasty with Technetium 99m hexamethylpropylene-amine oxime (99mTc-HMPAO) SPECT-CT. METHODS Twenty-eight craniectomized patients subject to cranioplasty were studied with 99mTc-HMPAO SPECT-CT in three different times, before cranioplasty, a week, and 3 months after. The images were processed with quantification software comparing CBP of 24 cortical areas with a reference area, and with a database of controls. A mixed effects model and T-Student were used. RESULTS CBP increased significantly in both hemispheres after cranioplasty, either using ratio (β = .019, p-value = .030 first postsurgical SPECT-CT and β = .021, p-value = .015 in the second study, vs. presurgical) or Z-score (β = .220, p-value = .026 and β = .279, p-value = .005, respectively). Nine areas of the damaged side had a significant lower CBP ratio and Z-score than the undamaged. Posterior cingulate showed an increased CBP ratio (p-value = .034) and Z-score (p-value = .028) in the first postsurgical SPECT-CT. These posterior cingulate changes represent a 4.83% increase in ratio and 91.04% in Z-Score (p-value = .035 and .040, respectively). CONCLUSION CBP changes significantly in specific cortical areas after cranioplasty. Posterior cingulate changes might explain some improvements in attention impairments. SPECT-CT could be a useful tool to assess CBP changes in these patients and might be helpful in their clinical management.
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Affiliation(s)
- Álvaro Galiana
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sebastián Ruiz
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J F Alén
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Neurosurgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Adolfo Gómez Grande
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Panero
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Diana Vega
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Gutiérrez
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Romero
- Instituto de Investigación del Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital 12 de Octubre (i+12), Madrid, Spain.,Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María José Tabuenca
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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García-Pérez D, Abarca J, González-López P, Nieto J, Lagares A, Paredes I. A Frontal Route to Middle and Posterior Cranial Fossa: Quantitative Study for the Lateral Transorbital Endoscopic Approach and Comparison with the Subtemporal Approach. World Neurosurg 2022; 167:e236-e250. [PMID: 35944860 DOI: 10.1016/j.wneu.2022.07.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous sinus and the Meckel's cave. METHODS The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF. RESULTS Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw. CONCLUSIONS LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Javier Abarca
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Pablo González-López
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Juan Nieto
- Department of Neurosurgery, University General Hospital of Alicante, Alicante, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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9
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Castaño-Leon AM, Paredes I, Lagares A, Gomez PA, González-Leon P, Perez-Nuñez A, Jiménez-Roldán L, Delgado-Fernández J, Eiriz Fernández C, García-Pérez D, Moreno-Gómez LM, Esteban-Sinovas O, Delgado-López PD, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez-Carmona M, Arteaga-Romero F, González-Pombo M, F Alén J, Gil-Simoes R, Torres CV, Navas-García M, Blasco García de Andoain G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-González M, Menéndez-Cortezón B, Rodríguez-Botana B, Pérez-Alfayate R, Fernández-García C, Ferrández-Pujante B, Vargas-Jiménez AC, Cotúa C, de la Lama A, Calero Félix L, Ruiz-Juretschke F, García-Leal R, Valera-Melé M, Casitas Hernando V, Rivero B, Orduna-Martínez J, Casado Pellejero J, Fustero De Miguel D, Díaz Molina J, Moles Herbera J, Castelló-Ruiz MJ, Gomar-Alba M, García-Pérez F, Hernández-García BJ, Villaseñor-Ledezma JJ, Otero-Rodríguez Á, Ailagas de Las Heras JJ, Gonçalves-Estella J, Sousa-Casasnovas P, Pascual-Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruiz A, Calvo M, Miranda-Lloret P, Rodríguez-Cadarso M, Antón J, Roca Barber A, Quiroz-Tejada A, Carbayo-Lozano G, Bermúdez G, Paternain Martin C, De la Fuente Villa P, Fidalgo De la Rosa M, Sistiaga-Gracia ÍL, Zabalo G. Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study. BMJ Open 2022; 12:e061208. [PMID: 35977759 PMCID: PMC9388715 DOI: 10.1136/bmjopen-2022-061208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN This was an observational retrospective study. SETTINGS A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.
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Affiliation(s)
- Ana M Castaño-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gomez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pedro González-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Moreno-Gómez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ariel Kaen
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | - Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - José F Alén
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas-García
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Natalia Frade-Porto
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Miguel Gelabert-González
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Beatriz Menéndez-Cortezón
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Brais Rodríguez-Botana
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Carlos Cotúa
- Neurosurgery Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Adolfo de la Lama
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | - Lourdes Calero Félix
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | | | - Roberto García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Marc Valera-Melé
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Belén Rivero
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Jorge Díaz Molina
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Moles Herbera
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria J Castelló-Ruiz
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Mario Gomar-Alba
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Fernando García-Pérez
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | | | | | - Álvaro Otero-Rodríguez
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Pablo Sousa-Casasnovas
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Daniel Arandia Guzmán
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Andoni García Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Luis Torres Carretero
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Alejandra Garrido Ruiz
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Marta Calvo
- Neurosurgery Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Miranda-Lloret
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Joan Antón
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Amparo Roca Barber
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Arnold Quiroz-Tejada
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Garazi Bermúdez
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | - Gorka Zabalo
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
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García-Pérez D, Lopez-Garcia A, Reñones P, Alvarez-Galvan M, Campos-Martin J. Influence of nickel loading on the hydroisomerization of n-dodecane with nickel-tungsten oxide-alumina supported catalysts. Molecular Catalysis 2022. [DOI: 10.1016/j.mcat.2022.112556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Castaño-Leon AM, Gomez PA, Jimenez-Roldan L, Paredes I, Munarriz PM, Perez IP, Eiriz Fernandez C, García-Pérez D, Moreno Gomez LM, Sinovas OE, Posadas GG, Lagares A. Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury: Extension of the Recommendations and the Effect on Outcome by Propensity Score Matching. Neurosurgery 2022; 91:437-449. [DOI: 10.1227/neu.0000000000002044] [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] [Received: 08/30/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
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García-Pérez D, García-Posadas G, Paredes I, Jiménez-Roldán L. Racemose fourth ventricle neurocysticercosis excision through telovelar approach and hydrodissection. World Neurosurg 2022; 165:91. [PMID: 35717015 DOI: 10.1016/j.wneu.2022.06.043] [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: 04/03/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
Intraventricular neurocysticercosis (NCC) is associated with more severe complications and a worse overall outcome.1,8 Fourth ventricle NCC (FVNCC) often presents with CSF obstruction and hydrocephalus, by means of direct mechanical occlusion of ventricular outlets by the cysts or due to an ependymal inflammatory response. Unfortunately, there is little consensus on the optimal management for FVNCC. If possible, surgical removal of cysticerci rather than medical therapy and/or shunt surgery is recommended.9 Endoscopic removal of cysts is described to be an effective treatment modality.5 However, endoscopic removal of inflamed or adherent ventricular cysticerci is associated with increased risk of complications.7 Although microdissection through a posterior fossa telovelar approach is a valid method for FVNCC,2,4 scarce reports describe the therapeutic decision-making and provide a surgical video of adherent FVNCC cyst resection. This operative video shows a 40-year-old female born in Honduras who presented with progressive headache. Computerized tomography revealed ventriculomegaly and transependymal flow. Magnetic resonance imaging (MRI) demonstrated obstructive hydrocephalus secondary to a multiloculated cystic mass within the fourth ventricle. According to the diagnostic criteria, probable racemose FVNCC was suspected.3 MRI raised suspicion that the cysts could be densely adherent to surrounding structures,6 precluding endoscopic removal. We performed a combined microscopic and endoscopic approach, which permitted removal of the cysts through a telovelar approach and hydrodissection technique without damaging nearby structures, and treatment of the associated hydrocephalus through an endoscopic third ventriculostomy (ETV), allowing complete resolution of symptoms and avoidance of CSF shunting.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041.
| | - Guillermo García-Posadas
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid, Spain 28041
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García-Pérez D, Panero I, Munarriz PM, Jimenez-Roldán L, Lagares A, Alén JA. Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging. Neurocirugia (Astur : Engl Ed) 2022; 33:141-148. [PMID: 35526945 DOI: 10.1016/j.neucie.2020.12.005] [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] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. METHODS We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. RESULTS Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. CONCLUSIONS This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Luis Jimenez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - José A Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
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García-Pérez D, Panero I, Lagares A, Gómez PA, Alén JF, Paredes I. Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.12.001] [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: 10/19/2022]
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Paredes I, Castaño Leon AM, Lagares A, Jimenez Roldan L, Perez-Nuñez A, González-Leon P, Delgado-Fernandez J, Eiriz C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Delgado-López P, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez Carmona M, Arteaga Romero F, Gonzalez Pombo M, Alén JF, Gil-Simoes R, Torres CV, Navas Garcia M, Blasco G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-Gonzalez M, Menendez Cortezon B, Rodriguez Botana B, Pérez-Alfayate R, Fernandez Garcia C, Ferrandez Pujante B, Vargas-Jiménez A, Cotúa C, de la Lama A, Calero L, Ruiz-Juretschke F, Garcia Leal R, Valera Mele M, Casitas Hernando V, Rivero Martín B, Orduna J, Casado Pellejero J, Fustero De Miguel D, Diaz-Molina J, Moles Herbera J, Castello Ruiz MJ, Gomar Alba M, Garcia Perez F, Hernandez Garcia BJ, Villaseñor Ledezma J, Otero Rodríguez Á, Ailagas JJ, Goncalves-Estella J, Sousa Casasnovas P, Pascual Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruíz PA, Calvo M, Miranda-Lloret P, Rodriguez-Cadarso Suarez-Vence M, Anotn Oltra J, Roca Barber A, Quiroz Tejada A, Carbayo Lozano G, Bermudez Vilar G, Paternain Martin C, Dela FuenteVilla P, Fidalgo De la Rosa M, Sistiaga García ÍL, Zabalo San Juan G. Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain. BMJ Open 2021; 11:e053983. [PMID: 34893486 PMCID: PMC9065769 DOI: 10.1136/bmjopen-2021-053983] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. SETTINGS The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. PARTICIPANTS This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. INTERVENTIONS An exploratory factorial analysis was performed to select the most relevant variables of the sample. PRIMARY AND SECONDARY OUTCOME MEASURES Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. RESULTS Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. CONCLUSIONS Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality. TRIAL REGISTRATION NUMBER CEIM 20/217.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Jimenez Roldan
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pedro González-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Carla Eiriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Ariel Kaen
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Ordóñez Carmona
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Gonzalez Pombo
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | - José F Alén
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas Garcia
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Blasco
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Natalia Frade-Porto
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Adrian Martin Segura
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Miguel Gelabert-Gonzalez
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Beatriz Menendez Cortezon
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Brais Rodriguez Botana
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Rebeca Pérez-Alfayate
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Andres Vargas-Jiménez
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Cotúa
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Fernando Ruiz-Juretschke
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Roberto Garcia Leal
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Marc Valera Mele
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Vicente Casitas Hernando
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Belén Rivero Martín
- Department of Neurosurgery, Hospital Universitario del Niño Jesús, Madrid, Spain
| | - Javier Orduna
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Juan Casado Pellejero
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Jorge Diaz-Molina
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Jesus Moles Herbera
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Mario Gomar Alba
- Department of Neurosurgery, Hospital Universitario Torrecardenas, Almería, Spain
| | | | | | - Javier Villaseñor Ledezma
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Álvaro Otero Rodríguez
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Juan José Ailagas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Jesús Goncalves-Estella
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Pablo Sousa Casasnovas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Daniel Pascual Argente
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Laura Ruiz Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Daniel Arandia Guzmán
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Andoni García Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Luis Torres Carretero
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Marta Calvo
- Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Castilla-La Mancha, Spain
| | - Pablo Miranda-Lloret
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Joan Anotn Oltra
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Amparo Roca Barber
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Arnold Quiroz Tejada
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Garazi Bermudez Vilar
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | | | | | | | - Gorka Zabalo San Juan
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
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Moreno-Gómez LM, Esteban-Sinovas O, García-Pérez D, García-Posadas G, Delgado-Fernández J, Paredes I. Case Report: SARS-CoV-2 Infection-Are We Redeemed? A Report of Candida Spondylodiscitis as a Late Complication. Front Med (Lausanne) 2021; 8:751101. [PMID: 34901064 PMCID: PMC8664247 DOI: 10.3389/fmed.2021.751101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background: We describe a case of candida spondylodiscitis secondary to coronavirus disease (COVID-19). Case report: A 47-year-old man diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) required prolonged admission to the intensive care unit (ICU). Four months later, he was diagnosed with thoracic candida spondylodiscitis. Medical management was insufficient, so he eventually underwent surgery. Discussions: Fungal infections seem to be more likely in patients with COVID-19, but it is unknown whether they are directly attributed to COVID-19 or other surrounding factors. Regardless of the answer, the diagnosis is complicated, and the mortality rate is high. Lessons: COVID-19 is posing a challenge to the society, and new and unexpected diseases that had once disappeared have risen again. It is our duty to suspect them and to treat them in the most effective way possible.
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17
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Munarriz PM, Navarro-Main B, Alén JF, Jiménez-Roldán L, Castaño-Leon AM, Moreno-Gómez LM, Paredes I, García-Pérez D, Panero I, Eiriz C, Esteban-Sinovas O, Bárcena E, Gómez PA, Lagares A. The influence of aneurysm morphology on the volume of hemorrhage after rupture. J Neurosurg 2021; 136:1015-1023. [PMID: 34534958 DOI: 10.3171/2021.3.jns21293] [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: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient's age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient's age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient's age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.
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Affiliation(s)
- Pablo M Munarriz
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre.,2Universidad Complutense de Madrid
| | | | - Jose F Alén
- 2Universidad Complutense de Madrid.,3Department of Neurosurgery, Hospital Universitario La Princesa; and
| | | | | | | | - Igor Paredes
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre
| | | | - Irene Panero
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre
| | - Carla Eiriz
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre
| | | | - Eduardo Bárcena
- 4Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pedro A Gómez
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre
| | - Alfonso Lagares
- 1Department of Neurosurgery, Hospital Universitario 12 de Octubre.,2Universidad Complutense de Madrid
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18
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García-Pérez D, Panero-Pérez I, Eiriz Fernández C, Moreno-Gomez LM, Esteban-Sinovas O, Navarro-Main B, Gómez López PA, Castaño-León AM, Lagares A. Densitometric analysis of brain computed tomography as a new prognostic factor in patients with acute subdural hematoma. J Neurosurg 2021; 134:1940-1950. [DOI: 10.3171/2020.4.jns193445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Acute subdural hematoma (ASDH) is a major cause of mortality and morbidity after traumatic brain injury (TBI). Surgical evacuation is the mainstay of treatment in patients with altered neurological status or significant mass effect. Nevertheless, concerns regarding surgical indication still persist. Given that clinicians often make therapeutic decisions on the basis of their prognosis assessment, to accurately evaluate the prognosis is of great significance. Unfortunately, there is a lack of specific and reliable prognostic models. In addition, the interdependence of certain well-known predictive variables usually employed to guide surgical decision-making in ASDH has been proven. Because gray matter and white matter are highly susceptible to secondary insults during the early phase after TBI, the authors aimed to assess the extent of these secondary insults with a brain parenchyma densitometric quantitative CT analysis and to evaluate its prognostic capacity.
METHODS
The authors performed a retrospective analysis among their prospectively collected cohort of patients with moderate to severe TBI. Patients with surgically evacuated, isolated, unilateral ASDH admitted between 2010 and 2017 were selected. Thirty-nine patients were included. For each patient, brain parenchyma density in Hounsfield units (HUs) was measured in 10 selected slices from the supratentorial region. In each slice, different regions of interest (ROIs), including and excluding the cortical parenchyma, were defined. The injured hemisphere, the contralateral hemisphere, and the absolute differences between them were analyzed. The outcome was evaluated using the Glasgow Outcome Scale–Extended at 1 year after TBI.
RESULTS
Fifteen patients (38.5%) had a favorable outcome. Collected demographic, clinical, and radiographic data did not show significant differences between favorable and unfavorable outcomes. In contrast, the densitometric analysis demonstrated that greater absolute differences between both hemispheres were associated with poor outcome. These differences were detected along the supratentorial region, but were greater at the high convexity level. Moreover, these HU differences were far more marked at the cortical parenchyma. It was also detected that these differences were more prone to ischemic and/or edematous insults than to hyperemic changes. Age was significantly correlated with the side-to-side HU differences in patients with unfavorable outcome.
CONCLUSIONS
The densitometric analysis is a promising prognostic tool in patients diagnosed with ASDH. The supplementary prognostic information provided by the densitometric analysis should be evaluated in future studies.
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19
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García-Pérez D, Alvarez-Galvan M, Capel-Sanchez M, Blanco-Brieva G, Morales-delaRosa S, Campos-Martin J, Fierro J. Influence of bimetallic characteristics on the performance of MoCoP and MoFeP catalysts for methyl laurate hydrodeoxygenation. Catal Today 2021. [DOI: 10.1016/j.cattod.2020.09.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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García-Pérez D, Parra-Serrano J, Panero I, Moreno LM, Campollo J, Alén JF. Transient cortical blindness secondary to contrast-induced encephalopathy following diagnostic cerebral angiography: report of 2 cases. Acta Neurol Belg 2021; 121:585-589. [PMID: 33123949 DOI: 10.1007/s13760-020-01532-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Javier Parra-Serrano
- Department of Neurology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Irene Panero
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Jorge Campollo
- Division of Neuroradiology, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital, 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
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21
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García-Pérez D, Panero I, Munarriz PM, Jimenez-Roldán L, Lagares A, Alén JA. Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00008-7. [PMID: 33716014 DOI: 10.1016/j.neucir.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. METHODS We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. RESULTS Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. CONCLUSIONS This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Luis Jimenez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - José A Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
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22
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García-Pérez D, Ruiz-Ortiz M, Panero I, Eiriz C, Moreno LM, García-Reyne A, García A, Martín-Medina P, Salvador-Álvarez E, Hernández-Lain A, Serrano A, Gil-Etayo FJ, Castaño-León AM, Paredes I, Pérez-Núñez Á. Snorting the Brain Away: Cerebral Damage as an Extension of Cocaine-Induced Midline Destructive Lesions. J Neuropathol Exp Neurol 2021; 79:1365-1369. [PMID: 33146379 DOI: 10.1093/jnen/nlaa097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/14/2022] Open
Abstract
Cocaine consumption is associated with a variety of clinical manifestations. Though cocaine intranasal inhalation always determines nasal mucosal damages, extensive septum perforations, and midline destructions-known as cocaine-induced midline destructive lesions (CIMDL)-affect only a limited fraction of patients. CIMDL is viewed as a cocaine-associated autoimmune phenomenon in which the presence of atypical anti-neutrophil cytoplasmic antibody (ANCA) promotes and/or defines the disease phenotype. A 51-year-old man presented with an intracranial tumor-like lesion by its space-occupying effect. CT also revealed the destruction of the nasal septum and skull base. A diagnosis of CIMDL was made in light of the patient's history as well as findings of the physical and endoscopic examinations, imaging studies, and laboratory testing. There was no evidence of other pathologies. Histopathological results from cerebral biopsy led us to consider the intracranial pathology as an extension of the CIMDL. CIMDL is the result of a necrotizing inflammatory tissue response triggered by cocaine abuse in a subset of predisposed patients. The reported case is the first CIMDL consistent with brain extension mimicking a tumor-like lesion. While the presence of atypical ANCA seems to promote and/or define the disease phenotype, the specific role of these and other circulating autoantibodies needs further investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Antonio Serrano
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
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23
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Gargini R, Segura-Collar B, Herránz B, García-Escudero V, Romero-Bravo A, Núñez FJ, García-Pérez D, Gutiérrez-Guamán J, Ayuso-Sacido A, Seoane J, Pérez-Núñez A, Sepúlveda-Sánchez JM, Hernández-Laín A, Castro MG, García-Escudero R, Ávila J, Sánchez-Gómez P. The IDH-TAU-EGFR triad defines the neovascular landscape of diffuse gliomas. Sci Transl Med 2021; 12:12/527/eaax1501. [PMID: 31969485 DOI: 10.1126/scitranslmed.aax1501] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/06/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
Gliomas that express the mutated isoforms of isocitrate dehydrogenase 1/2 (IDH1/2) have better prognosis than wild-type (wt) IDH1/2 gliomas. However, how these mutant (mut) proteins affect the tumor microenvironment is still a pending question. Here, we describe that the transcription of microtubule-associated protein TAU (MAPT), a gene that has been classically associated with neurodegenerative diseases, is epigenetically controlled by the balance between wt and mut IDH1/2 in mouse and human gliomas. In IDH1/2 mut tumors, we found high expression of TAU that decreased with tumor progression. Furthermore, MAPT was almost absent from tumors with epidermal growth factor receptor (EGFR) mutations, whereas its trancription negatively correlated with overall survival in gliomas carrying wt or amplified (amp) EGFR We demonstrated that the overexpression of TAU, through the stabilization of microtubules, impaired the mesenchymal/pericyte-like transformation of glioma cells by blocking EGFR, nuclear factor kappa-light-chain-enhancer of activated B (NF-κB) and the transcriptional coactivator with PDZ-binding motif (TAZ). Our data also showed that mut EGFR induced a constitutive activation of this pathway, which was no longer sensitive to TAU. By inhibiting the transdifferentiation capacity of EGFRamp/wt tumor cells, TAU protein inhibited angiogenesis and favored vascular normalization, decreasing glioma aggressiveness and increasing their sensitivity to chemotherapy.
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Affiliation(s)
- Ricardo Gargini
- Centro de Biología Molecular "Severo Ochoa" (CSIC-UAM), Madrid 28049, Spain.,Neurooncology Unit, Instituto de Salud Carlos III-UFIEC, Madrid 28220, Spain
| | - Berta Segura-Collar
- Neurooncology Unit, Instituto de Salud Carlos III-UFIEC, Madrid 28220, Spain
| | - Beatriz Herránz
- Neurooncology Unit, Instituto de Salud Carlos III-UFIEC, Madrid 28220, Spain.,Facultad de Medicina de la Universidad Francisco de Vitoria, Madrid 28223, Spain
| | - Vega García-Escudero
- Centro de Biología Molecular "Severo Ochoa" (CSIC-UAM), Madrid 28049, Spain.,Dto. de Anatomía, Histología y Neurociencia, Facultad de Medicina de la Universidad Autónoma, Madrid 28029, Spain
| | - Andrés Romero-Bravo
- Neurooncology Unit, Instituto de Salud Carlos III-UFIEC, Madrid 28220, Spain
| | - Felipe J Núñez
- Department of Neurosurgery/Department of Cell & Developmental Biology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Daniel García-Pérez
- Dto. Neurocirugía, Hospital 12 de Octubre, Univ. Complutense, Madrid 28041, Spain
| | | | - Angel Ayuso-Sacido
- Fundación de Investigación HM Hospitales, HM Hospitales, Madrid 28015, Spain.,Facultad de Medicina (IMMA), Universidad San Pablo-CEU, Madrid 28925, Spain.,IMDEA Nanoscience, Madrid 28049, Spain
| | - Joan Seoane
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona 08035, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid 28029, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona 08010, Spain
| | - Angel Pérez-Núñez
- Dto. Neurocirugía, Hospital 12 de Octubre, Univ. Complutense, Madrid 28041, Spain
| | | | | | - María G Castro
- Department of Neurosurgery/Department of Cell & Developmental Biology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Ramón García-Escudero
- Instituto de Investigaciones Biomédicas I+12, Hosp. 12 de Octubre, Madrid 28041, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), ISCIII, Madrid 28029, Spain.,Unidad de Oncología Molecular, CIEMAT, Madrid 28040, Spain
| | - Jesús Ávila
- Centro de Biología Molecular "Severo Ochoa" (CSIC-UAM), Madrid 28049, Spain. .,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), ISCIII, Madrid 28029, Spain
| | - Pilar Sánchez-Gómez
- Neurooncology Unit, Instituto de Salud Carlos III-UFIEC, Madrid 28220, Spain.
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24
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Munarriz PM, Bárcena E, Alén JF, Castaño-Leon AM, Paredes I, Moreno-Gómez LM, García-Pérez D, Jiménez-Roldán L, Gómez PA, Lagares A. Reliability and accuracy assessment of morphometric measurements obtained with software for three-dimensional reconstruction of brain aneurysms relative to cerebral angiography measures. Interv Neuroradiol 2020; 27:191-199. [PMID: 32996346 DOI: 10.1177/1591019920961588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the reliability and accuracy of morphological measurements of software employed to three-dimensionally reconstruct aneurysms and vessels (VMTKlab, version 1.6.1,) with computed tomography angiography (CTA) as the source of images. Agreement with measurements from three-dimensional digital subtraction angiography (3 D-DSA) was evaluated. METHODS We evaluated 40 patients presenting with aneurysmal subarachnoid hemorrhage (aSAH). We analyzed four main variables of the aneurysm morphology: absolute height (size), neck (maximum neck width), perpendicular height, and maximum width. The CTA images were uploaded to the software and then segmented to reconstruct the aneurysm. This new method was compared to the current gold standard-3D reconstruction of pretreatment cerebral angiography. We used intraclass correlation coefficient (ICC) and Bland-Altman plot analyses to evaluate the agreement between these methods. RESULTS The ICCs obtained for absolute height, neck, perpendicular height, and maximum width were 0.85, 0.57, 0.85, and 0.89, respectively. This implied good agreement except for the neck of the aneurysm (moderate agreement). Bland-Altman plots are presented for the four indexes. The average of the differences was not significant in terms of absolute height, perpendicular height, and maximum width indicating good agreement. However, it was significant for the neck of the aneurysm. CONCLUSIONS We report good agreement between the values generated using VMTKlab and cerebral angiography for three of the four main variables. Discrepancies in neck diameter are not surprising and its underestimation with a traditional delineation from cerebral angiography has been reported before.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo Bárcena
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose F Alén
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Department of Neurosurgery, Hospital Universitario La Princesa, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Miguel Moreno-Gómez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gómez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación i±12, Madrid, Spain.,Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
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25
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García-Pérez D, Fraile J, Panadero E. Learning strategies and self-regulation in context: how higher education students approach different courses, assessments, and challenges. Eur J Psychol Educ 2020. [DOI: 10.1007/s10212-020-00488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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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26
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García-Pérez D, Panero I, Eiriz C, Moreno LM, Munarriz PM, Paredes I, Lagares A, Alén JF. Delayed extensive brain edema caused by the growth of a giant basilar apex aneurysm treated with basilar artery obliteration: a case report. BMC Neurol 2020; 20:232. [PMID: 32505180 PMCID: PMC7275367 DOI: 10.1186/s12883-020-01819-9] [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: 04/01/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Partially thrombosed giant aneurysms at the basilar apex (BA) artery are challenging lesions with a poor prognosis if left untreated. Here we describe a rare case of extensive brain edema after growth of a surgically treated and thrombosed giant basilar apex aneurysm. Case presentation We performed a proximal surgical basilar artery occlusion on a 64-year-old female with a partially thrombosed giant BA aneurysm. MRI showed no ischemic lesions but showed marked edema adjacent to the aneurysm. She had a good recovery, but 3 months after surgical occlusion, her gait deteriorated together with urinary incontinence and worsening right hemiparesis. MRI showed that the aneurysm had grown and developed intramural hemorrhage, which caused extensive brain edema and obstructive hydrocephalus. She was treated by a ventriculoperitoneal shunt placement. Follow-up MRI showed progressive brain edema resolution, complete thrombosis of the lumen and shrinkage of the aneurysm. At 5 years follow-up the patient had an excellent functional outcome. Conclusions Delayed growth of a surgically treated and thrombosed giant aneurysm from wall dissection demonstrates that discontinuity with the initial parent artery does not always prevent progressive enlargement. The development of transmural vascular connections between the intraluminal thrombus and adventitial neovascularization by the vasa vasorum on the apex of the BA seems to be a key event in delayed aneurysm growth. Extensive brain edema might translate an inflammatory edematous reaction to an abrupt enlargement of the aneurysm.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Carla Eiriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain
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27
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Paredes I, Munarriz PM, Toldos O, Castaño-León AM, Panero I, Eiriz C, García-Pérez D, Pérez-Núñez A, Lagares A, Alen JAF. True Dural Spinal Epidural Cysts: Report of 5 Cases. World Neurosurg 2019; 135:87-95. [PMID: 31841718 DOI: 10.1016/j.wneu.2019.12.010] [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: 11/12/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal arachnoid cysts are a rare cause of compressive myelopathy. Spinal extradural arachnoid cysts (SEACs) are even rarer. METHODS We retrospectively reviewed the SEACs operated on in our hospital between 2015 and 2019, according to their clinical and radiologic findings, treatments performed, and outcomes. RESULTS We identified 5 cases (2 males and 3 females), ranging in age from 21 months to 78 years. Except for the pediatric case, all patients presented with pain and 3 had some grade of neurologic impairment. Preoperative magnetic resonance imaging showed multiloculated cyst in 4 cases, and the communication with the dura was properly identified in only 1 case. The patients were operated through a laminectomy or laminoplasty and total removal of the cyst, and the communication with the dura was identified and repaired in all cases. In all cases, the defect was near the exit of a nerve root, and rootlets were seen through it, producing a ball-like valve mechanism. Histology of the cyst wall showed true dura in every case. One patient needed a reoperation for evacuation of a fluid collection (related to the dural sealant). Following Odom's criteria, 3 patients had an excellent outcome and 2 had a fair outcome. CONCLUSIONS Total excision of a symptomatic SEAC through either laminectomy or laminoplasty is a safe and effective treatment option. Although isolated repair of the dural communication without cyst removal may seem appealing, we have found it very difficult to identify the point of communication preoperatively.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Oscar Toldos
- Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Carla Eiriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Angel Pérez-Núñez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - José Antonio F Alen
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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Panero I, García-Pérez D, Lagares A. Positive Outcome of Endoscopic Third Ventriculostomy in Fourth Ventricular Outlet Obstruction. World Neurosurg 2019; 132:135-137. [DOI: 10.1016/j.wneu.2019.08.164] [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: 07/16/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022]
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García-Pérez D, Ferenczi S, Kovács KJ, Laorden ML, Milanés MV, Núñez C. Different contribution of glucocorticoids in the basolateral amygdala to the formation and expression of opiate withdrawal-associated memories. Psychoneuroendocrinology 2016; 74:350-362. [PMID: 27728875 DOI: 10.1016/j.psyneuen.2016.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 01/07/2023]
Abstract
Drug-withdrawal aversive memories generate a motivational state leading to compulsive drug taking, with plasticity changes in the basolateral amygdala (BLA) being essential in aversive motivational learning. The conditioned-place aversion (CPA) paradigm allows for measuring the negative affective component of drug withdrawal. First, CPA triggers association between negative affective consequences of withdrawal with context (memory consolidation). Afterwards, when the animals are re-exposed to the paired environment, they avoid it due to the association between the context and aversive memories (memory retrieval). We examined the influence of glucocorticoids (GCs) for a morphine-withdrawal CPA paradigm, along with plasticity changes in the BLA, in sham-operated and adrenalectomized (ADX) animals. We demonstrated that sham+morphine animals robustly displayed CPA, whereas ADX-dependent animals lacked the affective-like signs of opiate withdrawal but displayed increased somatic signs of withdrawal. Glucocorticoid receptor (GR) actions promote memory consolidation but highly depend on increases in GC levels. Interestingly, we observed that GCs were only increased in sham-dependent rodents during aversive-withdrawal memory consolidation, and that GR expression correlated with phosphorylated cAMP response element binding (pCREB) protein, early growth response 1 (Egr-1) and activity-regulated cytoskeletal-associated (Arc) mRNA induction in this experimental group. In contrast, ADX-animals displayed reduced (pCREB). GCs are also known to impair memory retrieval. Accordingly, we showed that GCs levels remained at basal levels in all experimental groups following memory retrieval, and consequently GRs no longer acted as transcriptional regulators. Importantly, memory retrieval elicited increased pCREB levels in sham+morphine animals (not in ADX+morphine group), which were directly correlated with enhanced Arc mRNA/protein expression mainly in glutamatergic neurons. In conclusion, context-withdrawal associations are accompanied plasticity changes in the BLA, which are, in part, regulated by GR signaling. Moreover, dysregulation of CREB signaling, in part through Arc expression, may enhance reconsolidation, resulting in the maintenance of excessive aversive states. These findings might have important implications for drug-seeking behavior.
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Affiliation(s)
| | - Szilamer Ferenczi
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Krisztina J Kovács
- Laboratory of Molecular Neuroendocrinology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - M Luisa Laorden
- Department of Pharmacology, University of Murcia, Murcia, Spain; Murcia Institute of Biomedical Research (IMIB), University of Murcia, Spain
| | - M Victoria Milanés
- Department of Pharmacology, University of Murcia, Murcia, Spain; Murcia Institute of Biomedical Research (IMIB), University of Murcia, Spain
| | - Cristina Núñez
- Department of Pharmacology, University of Murcia, Murcia, Spain; Murcia Institute of Biomedical Research (IMIB), University of Murcia, Spain
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García-Pérez D, Núñez C, Laorden ML, Milanés MV. Regulation of dopaminergic markers expression in response to acute and chronic morphine and to morphine withdrawal. Addict Biol 2016; 21:374-86. [PMID: 25522207 DOI: 10.1111/adb.12209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/05/2023]
Abstract
Dopamine (DA) is thought to represent a teaching signal and has been implicated in the induction of addictive behaviours. Dysfunction of DA homeostasis leading to high or low DA levels is causally linked to addiction. Previously, it has been proposed that the transcription factors Nurr1 and Pitx3, which are critical for transcription of a set of genes involved in DA metabolism in the mesolimbic pathway, are associated with addiction pathology. Using quantitative real-time polymerase chain reaction, immunofluorescence and Western blotting, we studied the effects of single morphine administration, morphine dependence and withdrawal on the DA markers DA transporters (DAT), vesicular monoamine transporters (VMAT2) and DA 2 receptor subtype (DRD2), DA 1 receptor subtype as well as tyrosine hydroxylase (TH) in the ventral tegmental area (VTA) and/or nucleus accumbens (NAc). In addition, Nurr1 and Pitx3 expression was also measured. Present data showed a high degree of colocalization of Nurr1 and Pitx3 with TH(+) neurons in the VTA. We found that the increased Nurr1 and/or Pitx3 levels during morphine dependence and in morphine-withdrawn rats were associated to an increase of DAT, VMAT2 and DRD2. Altogether, present data indicate that morphine dependence and withdrawal induced consistent alterations of most of the DA markers, which was correlated with transcription factors involved in the maintenance of DA neurons in drug-reward pathways, suggesting that Nurr1 and Pitx3 regulation might be associated with controlling adaptation to chronic morphine and to morphine withdrawal-induced alterations of DA neurons activity in the mesolimbic pathway.
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Affiliation(s)
- Daniel García-Pérez
- Group of Cellular and Molecular Pharmacology; Campus de Espinardo; University of Murcia; Spain
- IMIB, Instituto Murciano de Investigación Biosanitaria; Spain
| | - Cristina Núñez
- Group of Cellular and Molecular Pharmacology; Campus de Espinardo; University of Murcia; Spain
- IMIB, Instituto Murciano de Investigación Biosanitaria; Spain
| | - M. Luisa Laorden
- Group of Cellular and Molecular Pharmacology; Campus de Espinardo; University of Murcia; Spain
- IMIB, Instituto Murciano de Investigación Biosanitaria; Spain
| | - M. Victoria Milanés
- Group of Cellular and Molecular Pharmacology; Campus de Espinardo; University of Murcia; Spain
- IMIB, Instituto Murciano de Investigación Biosanitaria; Spain
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García-Pérez D, Sáez-Belmonte F, Laorden ML, Núñez C, Milanés MV. Morphine administration modulates expression of Argonaute 2 and dopamine-related transcription factors involved in midbrain dopaminergic neurons function. Br J Pharmacol 2015; 168:1889-901. [PMID: 23215787 DOI: 10.1111/bph.12083] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/09/2012] [Accepted: 11/25/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Alterations in transcription factors that regulate the development and maintenance of dopamine (DA) neurons (such as Nurr1 and Pitx3) play an important role in the pathogenesis of addiction diseases. We have examined the effects of acute and chronic morphine and morphine withdrawal on TH expression and activity as well as expression of Nurr1, Pitx3 and Ago2 in the ventral tegmental area (VTA) and nucleus accumbens (NAc) of the rat. EXPERIMENTAL APPROACH Rats were injected acutely with morphine and decapitated 1 or 2 h later. Another set of rats were made dependent on morphine by implantation of two morphine pellets. Precipitated withdrawal was induced by injection of naloxone. Ago2, Pitx3, Nurr1, total TH (tTH), TH phosphorylated at Ser31 and at Ser40, and 3,4-Dihydroxyphenylacetic acid, and DA determination in the VTA and/or NAc were measured using immunoblotting, HPLC and immunofluorescence. KEY RESULTS Acute morphine produced a marked increase in TH activity and DA turnover in the NAc, concomitantly with increased Nurr1 and Pitx3 expression in the VTA. In contrast, precipitated morphine withdrawal decreased TH activation, TH expression and did not increase DA turnover in the NAc. These effects paralleled decreases in Ago2 expression, which was accompanied by increased Nurr1 and Pitx3, TH activity and normalized TH protein levels in the VTA. CONCLUSIONS AND IMPLICATIONS The combined decrease in Ago2 and increases in Nurr1 and Pitx3 might represent some of the mechanisms that served to protect against accumbal TH regulation observed in morphine withdrawn rats, which may be critical for DA bioavailability to influence behaviour.
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Affiliation(s)
- D García-Pérez
- Group of Cellular and Molecular Pharmacology, Faculty of Medicine, University of Murcia, Murcia, Spain
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García-Pérez D, Laorden ML, Milanés MV. Regulation of Pleiotrophin, Midkine, Receptor Protein Tyrosine Phosphatase β/ζ, and Their Intracellular Signaling Cascades in the Nucleus Accumbens During Opiate Administration. Int J Neuropsychopharmacol 2015; 19:pyv077. [PMID: 26164717 PMCID: PMC4772269 DOI: 10.1093/ijnp/pyv077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/06/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Most classes of addictive substances alter the function and structural plasticity of the brain reward circuitry. Midkine (MK) and pleiotrophin (PTN) are growth/differentiation cytokines which, similarly to neurotrophins, play an important role in repair, neurite outgrowth, and cell differentiation. PTN or MK signaling through receptor protein tyrosine phosphatase β/ζ (RPTPβ/ζ), leads to the activation of extracellular signal-regulated kinases and thymoma viral proto-oncogene. This activation induces morphological changes and modulates addictive behaviors. Besides, there is increasing evidence that during the development of drug addiction, astrocytes contribute to the synaptic plasticity by synthesizing and releasing substances such as cytokines. METHODS In the present work we studied the effect of acute morphine administration, chronic morphine administration, and morphine withdrawal on PTN, MK, and RPTPβ/ζ expression and on their signaling pathways in the nucleus accumbens. RESULTS Present results indicated that PTN, MK, and RPTPβ/ζ levels increased after acute morphine injection, returned to basal levels during chronic opioid treatment, and were up-regulated again during morphine withdrawal. We also observed an activation of astrocytes after acute morphine injection and during opiate dependence and withdrawal. In addition, immunofluorescence analysis revealed that PTN, but not MK, was overexpressed in astrocytes and that dopaminoceptive neurons expressed RPTPβ/ζ. CONCLUSIONS All these observations suggest that the neurotrophic and behavioral adaptations that occur during opiate addiction could be, at least partly, mediated by cytokines.
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Affiliation(s)
- Daniel García-Pérez
- Group of Cellular and Molecular Pharmacology, University of Murcia, Campus de Espinardo, Murcia, Spain (Mr García-Pérez, Drs Laorden, and Milanés); IMIB, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain (Mr García-Pérez, Drs Laorden, and Milanés).
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García-Pérez D, López-Bellido R, Hidalgo JM, Rodríguez RE, Laorden ML, Núñez C, Milanés MV. Morphine regulates Argonaute 2 and TH expression and activity but not miR-133b in midbrain dopaminergic neurons. Addict Biol 2015; 20:104-19. [PMID: 23927484 DOI: 10.1111/adb.12083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 01/11/2023]
Abstract
Epigenetic changes such as microRNAs (miRs)/Ago2-induced gene silencing represent complex molecular signature that regulate cellular plasticity. Recent studies showed involvement of miRs and Ago2 in drug addiction. In this study, we show that changes in gene expression induced by morphine and morphine withdrawal occur with concomitant epigenetic modifications in the mesolimbic dopaminergic (DA) pathway [ventral tegmental area (VTA)/nucleus accumbens (NAc) shell], which is critically involved in drug-induced dependence. We found that acute or chronic morphine administration as well as morphine withdrawal did not modify miR-133b messenger RNA (mRNA) expression in the VTA, whereas Ago2 protein levels were decreased and increased in morphine-dependent rats and after morphine withdrawal, respectively. These changes were paralleled with enhanced and decreased NAc tyrosine hydroxylase (TH) protein (an early DA marker) in morphine-dependent rats and after withdrawal, respectively. We also observed changes in TH mRNA expression in the VTA that could be related to Ago2-induced translational repression of TH mRNA during morphine withdrawal. However, the VTA number of TH-positive neurons suffered no alterations after the different treatment. Acute morphine administration produced a marked increase in TH activity and DA turnover in the NAc (shell). In contrast, precipitated morphine withdrawal decreased TH activation and did not change DA turnover. These findings provide new information into the possible correlation between Ago2/miRs complex regulation and DA neurons plasticity during opiate addiction.
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Affiliation(s)
- Daniel García-Pérez
- Group of Cellular and Molecular Pharmacology; Faculty of Medicine; University of Murcia; Murcia Spain
- IMIB (Murcia Institute of Biomedical Investigation); Murcia Spain
| | - Roger López-Bellido
- Department of Biochemistry and Molecular Biology; Institute of Neurosciences; University of Salamanca; Salamanca Spain
| | - Juana M. Hidalgo
- Group of Cellular and Molecular Pharmacology; Faculty of Medicine; University of Murcia; Murcia Spain
- IMIB (Murcia Institute of Biomedical Investigation); Murcia Spain
| | - Raquel E. Rodríguez
- Department of Biochemistry and Molecular Biology; Institute of Neurosciences; University of Salamanca; Salamanca Spain
| | - Maria Luisa Laorden
- Group of Cellular and Molecular Pharmacology; Faculty of Medicine; University of Murcia; Murcia Spain
- IMIB (Murcia Institute of Biomedical Investigation); Murcia Spain
| | - Cristina Núñez
- Group of Cellular and Molecular Pharmacology; Faculty of Medicine; University of Murcia; Murcia Spain
- IMIB (Murcia Institute of Biomedical Investigation); Murcia Spain
| | - Maria Victoria Milanés
- Group of Cellular and Molecular Pharmacology; Faculty of Medicine; University of Murcia; Murcia Spain
- IMIB (Murcia Institute of Biomedical Investigation); Murcia Spain
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García-Pérez D, López-Bellido R, Rodríguez RE, Laorden ML, Núñez C, Milanés MV. Dysregulation of dopaminergic regulatory mechanisms in the mesolimbic pathway induced by morphine and morphine withdrawal. Brain Struct Funct 2014; 220:1901-19. [PMID: 24706046 DOI: 10.1007/s00429-014-0761-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
Dopamine (DA) is thought to represent a teaching signal and has been implicated in the induction of addictive behaviours. Previously, it has been proposed that the transcription factors Nurr1 and Pitx3, which are critical for transcription of a set of genes involved in DA metabolism in the mesolimbic pathway, are associated with addiction pathology. The aim of our study was to investigate abnormalities in the mesolimbic pathway associated with morphine dependence and withdrawal. Using quantitative real-time PCR, immunofluorescence, HPLC and Western blotting, here we studied the effects of single morphine administration, morphine dependence and morphine withdrawal on Nurr1 and Pitx3 expression as well as on the DA marker tyrosine hydroxylase (TH) and the turnover of DA in the ventral tegmental area (VTA) and/or nucleus accumbens. We showed that the three experimental conditions caused induction of Nurr1 and Pitx3 in the VTA, which correlated with changes in TH expression during chronic morphine administration. Present data also confirmed the colocalization of Nurr1 and Pitx3 with TH-positive neurons in the posterior VTA. Furthermore, during morphine dependence, Nurr1 was detected in the nucleus compartment of VTA TH-positive neurons, whereas Pitx3 was strongly detected in the nucleus of TH-positive neurons after single morphine administration and during morphine withdrawal. The number of TH neurons, number of Nurr1 or Pitx3-positive cells, and the number of TH neurons expressing Nurr1 or Pitx3 were not modified in the subpopulations of DA neurons. Present data provide novel insight into the potential correlation between Nurr1 and Pitx3 and DA neurons plasticity during opiate addiction in the mesolimbic pathway.
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MESH Headings
- 3,4-Dihydroxyphenylacetic Acid/metabolism
- Analysis of Variance
- Animals
- Disease Models, Animal
- Dopamine/genetics
- Dopamine/metabolism
- Gene Expression Regulation/drug effects
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Imaging, Three-Dimensional
- Male
- Microscopy, Confocal
- Morphine/pharmacology
- Morphine Dependence/pathology
- Naloxone/pharmacology
- Narcotic Antagonists/pharmacology
- Narcotics/pharmacology
- Nuclear Receptor Subfamily 4, Group A, Member 2/genetics
- Nuclear Receptor Subfamily 4, Group A, Member 2/metabolism
- RNA, Messenger/metabolism
- Rats
- Rats, Wistar
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Tyrosine 3-Monooxygenase/genetics
- Tyrosine 3-Monooxygenase/metabolism
- Ventral Tegmental Area/metabolism
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Affiliation(s)
- Daniel García-Pérez
- Group of Molecular and Cellular Pharmacology, Medical Faculty of Murcia, University of Murcia, Campus de Espinardo, 30100, Murcia, Spain
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García-Pérez D, Laorden ML, Milanés MV, Núñez C. Glucocorticoids regulation of FosB/ΔFosB expression induced by chronic opiate exposure in the brain stress system. PLoS One 2012; 7:e50264. [PMID: 23185589 PMCID: PMC3503985 DOI: 10.1371/journal.pone.0050264] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/18/2012] [Indexed: 11/25/2022] Open
Abstract
Chronic use of drugs of abuse profoundly alters stress-responsive system. Repeated exposure to morphine leads to accumulation of the transcription factor ΔFosB, particularly in brain areas associated with reward and stress. The persistent effects of ΔFosB on target genes may play an important role in the plasticity induced by drugs of abuse. Recent evidence suggests that stress-related hormones (e.g., glucocorticoids, GC) may induce adaptations in the brain stress system that is likely to involve alteration in gene expression and transcription factors. This study examined the role of GC in regulation of FosB/ΔFosB in both hypothalamic and extrahypothalamic brain stress systems during morphine dependence. For that, expression of FosB/ΔFosB was measured in control (sham-operated) and adrenalectomized (ADX) rats that were made opiate dependent after ten days of morphine treatment. In sham-operated rats, FosB/ΔFosB was induced after chronic morphine administration in all the brain stress areas investigated: nucleus accumbens(shell) (NAc), bed nucleus of the stria terminalis (BNST), central amygdala (CeA), hypothalamic paraventricular nucleus (PVN) and nucleus of the solitary tract noradrenergic cell group (NTS-A(2)). Adrenalectomy attenuated the increased production of FosB/ΔFosB observed after chronic morphine exposure in NAc, CeA, and NTS. Furthermore, ADX decreased expression of FosB/ΔFosB within CRH-positive neurons of the BNST, PVN and CeA. Similar results were obtained in NTS-A(2) TH-positive neurons and NAc pro-dynorphin-positive neurons. These data suggest that neuroadaptation (estimated as accumulation of FosB/ΔFosB) to opiates in brain areas associated with stress is modulated by GC, supporting the evidence of a link between brain stress hormones and addiction.
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Affiliation(s)
- Daniel García-Pérez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University School of Medicine, Murcia, Spain
| | - M. Luisa Laorden
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University School of Medicine, Murcia, Spain
| | - M. Victoria Milanés
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University School of Medicine, Murcia, Spain
| | - Cristina Núñez
- Group of Cellular and Molecular Pharmacology, Department of Pharmacology, University School of Medicine, Murcia, Spain
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García-Pérez D. [Vaccination in immunodeficient children]. An Esp Pediatr 1988; 29 Suppl 33:41-5. [PMID: 3074714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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