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García M, Poza J, Santamarta D, Romero-Oraá R, Hornero R. Continuous wavelet transform in the study of the time-scale properties of intracranial pressure in hydrocephalus. Philos Trans A Math Phys Eng Sci 2018; 376:rsta.2017.0251. [PMID: 29986920 PMCID: PMC6048580 DOI: 10.1098/rsta.2017.0251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 06/01/2023]
Abstract
Normal pressure hydrocephalus (NPH) encompasses a heterogeneous group of disorders generally characterized by clinical symptoms, ventriculomegaly and anomalous cerebrospinal fluid (CSF) dynamics. Lumbar infusion tests (ITs) are frequently performed in the preoperatory evaluation of patients who show NPH features. The analysis of intracranial pressure (ICP) signals recorded during ITs could be useful to better understand the pathophysiology underlying NPH and to assist treatment decisions. In this study, 131 ICP signals recorded during ITs were analysed using two continuous wavelet transform (CWT)-derived parameters: Jensen divergence (JD) and spectral flux (SF). These parameters were studied in two frequency bands, associated with different components of the signal: B1(0.15-0.3 Hz), related to respiratory blood pressure oscillations; and B2 (0.67-2.5 Hz), related to ICP pulse waves. Statistically significant differences (p < 1.70 × 10-3, Bonferroni-corrected Wilcoxon signed-rank tests) in pairwise comparisons between phases of ITs were found using the mean and standard deviation of JD and SF. These differences were mainly found in B2, where a lower irregularity and variability, together with less prominent time-frequency fluctuations, were found in the hypertension phase of ITs. Our results suggest that wavelet analysis could be useful for understanding CSF dynamics in NPH.This article is part of the theme issue 'Redundancy rules: the continuous wavelet transform comes of age'.
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Affiliation(s)
- María García
- Biomedical Engineering Group (GIB), Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
| | - Jesús Poza
- Biomedical Engineering Group (GIB), Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
- IMUVA, Instituto de Investigación en Matemáticas, University of Valladolid, Valladolid, Spain
- INCYL, Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - David Santamarta
- Servicio de Neurocirugía, Complejo Asistencial Universitario de León, León, Spain
| | - Roberto Romero-Oraá
- Biomedical Engineering Group (GIB), Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group (GIB), Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
- IMUVA, Instituto de Investigación en Matemáticas, University of Valladolid, Valladolid, Spain
- INCYL, Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
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Santamarta D, González-Martínez E, Fernández J, Mostaza A. The Prediction of Shunt Response in Idiopathic Normal-Pressure Hydrocephalus Based on Intracranial Pressure Monitoring and Lumbar Infusion. Acta Neurochir Suppl 2017; 122:267-74. [PMID: 27165919 DOI: 10.1007/978-3-319-22533-3_53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Intracranial pressure (ICP) monitoring and infusion studies have long been used in the preoperative workup of patients with suspected idiopathic normal-pressure hydrocephalus (iNPH). We have analysed the predictive values of different measures derived from both investigations, emphasising the differences between responders and nonresponders. MATERIALS AND METHODS ICP monitoring and lumbar infusion studies were routinely performed during a 6-year period. Shunting was proposed when the resistance to cerebrospinal fluid outflow (ROUT) >12 mmHg/ml/min and/or a minimum 15 % of slow waves were detected. The outcome was evaluated 6 months after surgery. Recorded data from ICP monitoring were mean pressure and pulse amplitude, the total percentage of slow waves and the presence of different types of slow waves following the classification proposed by Raftopoulos et al. Recorded data from lumbar infusion studies were mean values of pressure and pulse amplitude during three epochs (basal, early infusion and plateau), ROUT and the pulsatility response to the increase in mean pressure during the infusion. This response was quantified by two pulse amplitude indexes: the pulse amplitude index during the early infusion stage (A1) and the pulse amplitude index during the plateau stage (A2). RESULTS Thirty shunted patients were evaluated at the end of the follow-up and 23 (76.7 %) of them improved. Differences in the percentage of slow waves, ROUT and both pulsatility indexes were not statistically significant. The proportion of patients with great symmetrical waves and pulse amplitude during the early infusion stage were higher in responders (p < 0.05). The predictive analysis yielded the highest accuracy, with ROUT and A1 as a logical "OR" combination. CONCLUSION The combined use of ICP monitoring and lumbar infusion to forecast the response to shunting in patients with suspected iNPH did not improve the accuracy provided by any of them alone.
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Affiliation(s)
- David Santamarta
- Department of Neurosurgery, University Hospital of León, Altos de Nava, s/n, León, 24080, Spain.
| | - E González-Martínez
- Department of Neurosurgery, University Hospital of León, Altos de Nava, s/n, León, 24080, Spain
| | - J Fernández
- Department of Neurosurgery, University Hospital of León, Altos de Nava, s/n, León, 24080, Spain
| | - A Mostaza
- Department of Neurosurgery, University Hospital of León, Altos de Nava, s/n, León, 24080, Spain
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González-Martínez EL, Santamarta D. Does aqueductal stenosis influence the lumbar infusion test in normal-pressure hydrocephalus? Acta Neurochir (Wien) 2016; 158:2305-2310. [PMID: 27730385 DOI: 10.1007/s00701-016-2975-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/14/2016] [Accepted: 09/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late-onset idiopathic aqueductal stenosis may present with clinical features indistinct from idiopathic normal-pressure hydrocephalus (NPH). Moreover, aqueductal stenosis (AS) is not always detected by conventional magnetic resonance imaging (MRI). The aim of this study was to compare the hydrodynamic pattern among NPH patients according to the patency of the aqueduct. METHODS Fifty-six consecutive lumbar infusion tests were performed in patients with NPH syndrome. Precipitating causes of hydrocephalus were excluded, and aqueductal patency was examined through high-resolution, T2-weighted 3D MRI. Patients were classified into two groups: non-patent aqueduct and patent aqueduct. Mean values of pressure and pulse amplitude were obtained from basal and plateau stages of infusion studies. RESULTS Twelve of 56 patients with NPH-like symptoms presented with morphological AS (21.4 %). Patent aqueduct and non-patent aqueduct groups had similar values of mean opening lumbar pressure (8.2 vs. 8.1 mmHg), and mean opening pulse amplitude (3.1 vs. 2.9 mmHg). Mean pressure in the plateau stage (28.6 vs. 23.2 mmHg), and mean pulse amplitude in the plateau stage (12.5 vs. 10.6 mmHg) were higher in the patent aqueduct group. These differences were not statistically significant. Only Rout was significantly higher in the patent aqueduct group (13.6 vs. 10.1 mmHg/ml/min). One-third of NPH patients with AS presented Rout >12 mmHg/ml/min. CONCLUSIONS No differences in mean pressure or pulse amplitude during basal and plateau epochs of the lumbar infusion test in NPH patients were detected, regardless of aqueductal patency. However, Rout was significantly higher in patients with patent aqueduct.
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Affiliation(s)
| | - David Santamarta
- Department of Neurosurgery, University Hospital of León, León, Spain
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Adjei T, Abásolo D, Santamarta D. Characterisation of the complexity of intracranial pressure signals measured from idiopathic and secondary normal pressure hydrocephalus patients. Healthc Technol Lett 2016; 3:226-229. [PMID: 27733932 DOI: 10.1049/htl.2016.0018] [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: 04/01/2016] [Revised: 06/02/2016] [Accepted: 06/13/2016] [Indexed: 11/20/2022] Open
Abstract
Hydrocephalus is a condition characterised by enlarged cerebral ventricles, which in turn affects intracranial pressure (ICP); however, the mechanisms regulating ICP are not fully understood. A nonlinear signal processing approach was applied to ICP signals measured during infusion studies from patients with two forms of hydrocephalus, in a bid to compare the differences. This is the first study of its kind. The two forms of hydrocephalus were idiopathic normal pressure hydrocephalus (iNPH) and secondary normal pressure hydrocephalus (SH). Following infusion tests, the Lempel-Ziv (LZ) complexity was calculated from the iNPH and SH ICP signals. The LZ complexity values were averaged for the baseline, infusion, plateau and recovery stages of the tests. It was found that as the ICP increased from basal levels, the LZ complexities decreased, reaching their lowest during the plateau stage. However, the complexities computed from the SH ICP signals decreased to a lesser extent when compared with the iNPH ICP signals. Furthermore, statistically significant differences were found between the plateau and recovery stage complexities when comparing the iNPH and SH results (p = 0.05). This Letter suggests that advanced signal processing of ICP signals with LZ complexity can help characterise different types of hydrocephalus in more detail.
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Affiliation(s)
- Tricia Adjei
- Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK; Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Daniel Abásolo
- Centre for Biomedical Engineering, Department of Mechanical Engineering Sciences, Faculty of Engineering and Physical Sciences , University of Surrey , Guildford , UK
| | - David Santamarta
- Servicio de Neurocirugía , Hospital Universitario , León , Spain
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García M, Poza J, Bachiller A, Santamarta D, Hornero R. Effect of infusion tests on the dynamical properties of intracranial pressure in hydrocephalus. Comput Methods Programs Biomed 2016; 134:225-235. [PMID: 27480746 DOI: 10.1016/j.cmpb.2016.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/28/2015] [Revised: 05/09/2016] [Accepted: 06/28/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Hydrocephalus comprises a number of conditions characterised by clinical symptoms, dilated ventricles and anomalous cerebrospinal fluid (CSF) dynamics. Infusion tests (ITs) are usually performed to study CSF circulation and in the preoperatory evaluation of patients with hydrocephalus. The study of intracranial pressure (ICP) signals recorded during ITs could be useful to gain insight into the underlying pathophysiology of this condition and to further support treatment decisions. In this study, two wavelet parameters, wavelet turbulence (WT) and wavelet entropy (WE), were analysed in order to characterise the variability, irregularity and similarity in spectral content of ICP signals in hydrocephalus. METHODS One hundred and twelve ICP signals were analysed using WT and WE. These parameters were calculated in two frequency bands: B1 (0.15-0.3 Hz) and B2 (0.67-2.5 Hz). Each signal was divided into four artefact-free epochs corresponding to the basal, early infusion, plateau and recovery phases of the IT. We calculated the mean and standard deviation of WT and WE and analysed whether these parameters revealed differences between epochs of the IT. RESULTS Statistically significant differences (p < 1.70⋅10(-3), Bonferroni-corrected Wilcoxon signed-rank tests) in pairwise comparisons between phases of ITs were found using the mean and standard deviation of WT and WE. These differences were mainly found in B2. CONCLUSIONS Wavelet parameters like WT and WE revealed changes in the signal time-scale representation during ITs. Statistically significant differences were mainly found in B2, associated with ICP pulse waves, and included a higher degree of similarity in the spectral content, together with a lower irregularity and variability in the plateau phase with respect to the basal phase.
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Affiliation(s)
- María García
- Biomedical Engineering Group, Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain.
| | - Jesús Poza
- Biomedical Engineering Group, Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain; IMUVA, Instituto de Investigación en Matemáticas, University of Valladolid, Valladolid, Spain; INCYL, Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca, Spain
| | - Alejandro Bachiller
- Biomedical Engineering Group, Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
| | - David Santamarta
- Servicio de Neurocirugía, Hospital Universitario de León, León, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain; IMUVA, Instituto de Investigación en Matemáticas, University of Valladolid, Valladolid, Spain
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Adjei T, Abásolo D, Santamarta D. Intracranial pressure for the characterization of different types of hydrocephalus: A Permutation Entropy study. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:4198-201. [PMID: 26737220 DOI: 10.1109/embc.2015.7319320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Hydrocephalus is a condition characterized by altered cerebrospinal fluid (CSF) dynamics and chronic rises in intracranial pressure (ICP). However, the reason why hydrocephalic physiologies fail to inhibit dangerously high ICP levels is not known. Infusion studies are used to raise ICP and evaluate CSF circulation disorders. In this pilot study, ICP signals recorded during infusion tests from 33 patients with normal pressure hydrocephalus and 36 patients having developed a secondary form of normal pressure hydrocephalus were characterized using Permutation Entropy (PE), a symbolic non-linear method to quantify complexity. Each ICP signal was divided into four epochs--baseline (before infusion begins), infusion, plateau, and recovery (after infusion has stopped)--and the mean PE was calculated for each epoch. Statistically significant differences were found between PE for most epochs (p<;0.00833, Bonferroni-corrected Wilcoxon tests), with a significant decrease in the plateau phase. However, differences between PE for normal pressure and secondary hydrocephalus were not significant. Results suggest that the increase in ICP during infusion studies is associated with a significant decrease in PE. PE analysis of ICP signals could be useful for increasing our understanding of CSF dynamics in normal pressure hydrocephalus.
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García M, Poza J, Abásolo D, Santamarta D, Hornero R. Analysis of intracranial pressure signals recorded during infusion studies using the spectral entropy. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2543-6. [PMID: 24110245 DOI: 10.1109/embc.2013.6610058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hydrocephalus includes a range of disorders characterized by clinical symptoms, abnormal brain imaging and altered cerebrospinal fluid (CSF) dynamics. Infusion tests can be used to study CSF circulation in patients with hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analyzed 77 ICP signals recorded during infusion tests using the spectral entropy (SE). Each signal was divided into four artifact-free epochs. The mean SE, <SE>, and the standard deviation of SE, SD[SE], were calculated for each epoch. Statistically significant differences were found between phases of the infusion test using <SE> and SD[SE] (p<1.7 · 10(-3), Bonferroni-corrected Wilcoxon tests). Furthermore, we found significantly lower <SE> and SD[SE] values in the plateau phase than in the basal phase. These findings suggest that the increase in ICP during infusion studies is associated with a significant decrease in irregularity and variability of the spectral content of ICP signals, measured in terms of SE. We conclude that the spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.
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García M, Poza J, Santamarta D, Abásolo D, Barrio P, Hornero R. Spectral analysis of intracranial pressure signals recorded during infusion studies in patients with hydrocephalus. Med Eng Phys 2013; 35:1490-8. [PMID: 23664413 DOI: 10.1016/j.medengphy.2013.04.002] [Citation(s) in RCA: 8] [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] [Received: 02/27/2012] [Revised: 02/26/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
Hydrocephalus includes a number of disorders characterised by clinical symptoms, enlarged ventricles (observable using neuroimaging techniques) and altered cerebrospinal fluid (CSF) dynamics. Infusion tests are one of the available procedures to study CSF circulation in patients with clinical and radiological features of hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analysed seventy-seven ICP signals recorded during infusion tests using four spectral-based parameters: median frequency (MF) and relative power (RP) in three frequency bands. These measures provide a novel perspective for the analysis of ICP signals in the frequency domain. Each signal was divided into four artefact-free epochs (corresponding to the basal, early infusion, plateau and recovery phases of the infusion study). The four spectral parameters were calculated for each epoch. We analysed differences between epochs of the infusion test and correlations between these epochs and patient data. Statistically significant differences (p < 1.7 × 10(-3), Bonferroni-corrected Wilcoxon signed-rank tests) were found between epochs of the infusion test using MF and RP. Furthermore, some spectral parameters (MF in the basal phase, RP for the first frequency band and in the early infusion phase, RP for the second frequency band and in all phases of the infusion study and RP in the third frequency band and in the basal phase) revealed significant correlations (p < 0.01) between epochs of the infusion test and signal amplitude in the basal and plateau phases. Our results suggest that spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.
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Affiliation(s)
- María García
- Biomedical Engineering Group, Department T.S.C.I.T., E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain.
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González-Martínez E, Santamarta D, Lomas-García J, Ibáñez-Plágaro FJ, Fernández-Fernández JJ, Ariño TR, García-Cosamalón J. Giant-cell granuloma of the axis. J Neurosurg Spine 2012; 16:191-4. [DOI: 10.3171/2011.10.spine11156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant-cell granuloma is a benign and nonneoplastic lesion with an expansive and locally destructive behavior. It typically involves the mandible and the maxilla. Only 1 case arising from the odontoid process of the axis has been reported previously. The authors report on a 64-year-old man with a giant-cell granuloma of the axis. They review this uncommon entity, emphasizing the complexity of differentiating between this lesion and other giant-cell tumors.
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Santamarta D, Abásolo D, Hornero R. Reply to the comment by Carmelo Anile on the paper "Complexity analysis of the cerebrospinal fluid pulse waveform during infusion studies". Childs Nerv Syst 2012; 28:17-8. [PMID: 22083137 DOI: 10.1007/s00381-011-1629-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
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Lagares A, Gómez P, Alén J, Arikan F, Sarabia R, Horcajadas A, Ibañez J, Gabarros A, Morera J, Lama ADL, Ley L, Gonçalves J, Maillo A, Domínguez J, Llacer J, Arrese I, Santamarta D, Delgado P, Rodríguez Boto G, Vilalta J. Hemorragia subaracnoidea aneurismática: guía de tratamiento del Grupo de Patología Vascular de la Sociedad Española de Neurocirugía. Neurocirugia (Astur) 2011. [DOI: 10.4321/s1130-14732011000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lagares A, Gómez PA, Alén JF, Arikan F, Sarabia R, Horcajadas A, Ibañez J, Gabarros A, Morera J, de la Lama A, Ley L, Gonçalves J, Maillo A, Domínguez J, Llacer JL, Arrese I, Santamarta D, Delgado P, Rodríguez Boto G, Vilalta J. [Aneurysmal subarachnoid hemorrhage: group of study of cerebrovascular pathology of the Spanish society of neurosurgery management guideline]. Neurocirugia (Astur) 2011; 22:93-115. [PMID: 21597651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An actualized revision of the most important aspects of aneurismal subarachnoid hemorrhage is presented from the guidelines previously published by the group of study of cerebrovascular pathology of the Spanish Society of Neurosurgery. The proposed recommendations should be considered as a general guide for the management of this pathological condition. However, they can be modified, even in a significant manner according to the circumstances relating each clinical case and the variations in the therapeutic and diagnostic procedures available in the center attending each patient.
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Sarabia R, Lagares A, Fernández-Alén J, Arikan F, Vilalta J, Ibáñez J, Maillo A, Gabarros A, Domínguez J, Horcajadas A, Ballenilla F, Rodríguez-Boto G, Llacer J, Arrese I, Lama ADL, Santamarta D, Delgado P, Muñoz MF. Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients. Neurocirugia (Astur) 2010. [DOI: 10.4321/s1130-14732010000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Santamarta D, Hornero R, Abásolo D, Martínez-Madrigal M, Fernández J, García-Cosamalón J. Complexity analysis of the cerebrospinal fluid pulse waveform during infusion studies. Childs Nerv Syst 2010; 26:1683-9. [PMID: 20680300 DOI: 10.1007/s00381-010-1244-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/20/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Nonlinear dynamics has enhanced the diagnostic abilities of some physiological signals. Recent studies have shown that the complexity of the intracranial pressure waveform decreases during periods of intracranial hypertension in paediatric patients with acute brain injury. We wanted to assess changes in the complexity of the cerebrospinal fluid (CSF) pressure signal over the large range covered during the study of CSF circulation with infusion studies. METHODS We performed 37 infusion studies in patients with hydrocephalus of various types and origin (median age 71 years; interquartile range 60-77 years). After 5 min of baseline measurement, infusion was started at a rate of 1.5 ml/min until a plateau was reached. Once the infusion finished, CSF pressure was recorded until it returned to baseline. We analysed CSF pressure signals using the Lempel-Ziv (LZ) complexity measure. To characterise more accurately the behaviour of LZ complexity, the study was segmented into four periods: basal, early infusion, plateau and recovery. RESULTS The LZ complexity of the CSF pressure decreased in the plateau of the infusion study compared to the basal complexity (p=0.0018). This indicates loss of complexity of the CSF pulse waveform with intracranial hypertension. We also noted that the level of complexity begins to increase when the infusion is interrupted and CSF pressure drops towards the initial values. CONCLUSIONS The LZ complexity decreases when CSF pressure reaches the range of intracranial hypertension during infusion studies. This finding provides further evidence of a phenomenon of decomplexification in the pulsatile component of the pressure signal during intracranial hypertension.
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Affiliation(s)
- David Santamarta
- Department of Neurosurgery, University Hospital of León, León, Spain.
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Santamarta D, Martín-Vallejo J, Fernández J, Ibáñez J, García-Cosamalón J. O.014 Multilevel modelling of intracranial pressure after endoscopic third ventriculostomy. Clin Neurol Neurosurg 2008. [DOI: 10.1016/s0303-8467(08)70019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santamarta D, Martin-Vallejo J, Díaz-Alvarez A, Maillo A. Changes in ventricular size after endoscopic third ventriculostomy. Acta Neurochir (Wien) 2008; 150:119-27; discussion 127. [PMID: 18176776 DOI: 10.1007/s00701-007-1477-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [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: 09/29/2007] [Accepted: 10/30/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is general consensus that a successful endoscopic third ventriculostomy is usually followed by a decrease of ventricular size without reaching their normal size. This study was performed to determine how the change related to clinical outcome, how it developed chronologically and whether the change in ventricular size was different in acute and chronic forms of hydrocephalus. METHOD Fifty-five of 74 patients who had undergone endoscopic third ventriculostomy during the period 1997-2004 were selected by the criterion that they had both pre-operative and post-operative films and no neurosurgical manoeuvre other than a surgically successful endoscopic third ventriculostomy in the time span between both radiological studies. Ventricular size was measured with the Evans index, third ventricle index, cella media index and ventricular score. Median age was 51 years (interquartile range, 27-65 years). RESULTS The change in ventricular size detected shortly after surgery is related to clinical outcome for all ventricular ratios, except the cella media index (p = 0.08). When third ventriculostomy is clinically successful, there is a gradual decrease of ventricular size over a period of more than three months (p < 0.0001 for all ventricular ratios). The reduction is more prominent in acute hydrocephalus than in chronic forms for all ventricular ratios, except the Evans index (p = 0.12). The third ventricle exhibits the greatest reduction (25% with a 95% confidence interval: 15.4-34.5) and determines a different pattern of change in ventricular size after endoscopic third ventriculostomy between acute and chronic hydrocephalus. CONCLUSIONS A decrease of the ventricular size detected soon after endoscopic third ventriculostomy is associated with a satisfactory clinical outcome. This response continues during the first few months after surgery. The reduction is more prominent in acute forms of hydrocephalus.
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Affiliation(s)
- D Santamarta
- Department of Neurosurgery, Hospital Universitario de Salamanca, Salamanca, Spain.
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Santamarta D, Martin-Vallejo J. Evolution of intracranial pressure during the immediate postoperative period after endoscopic third ventriculostomy. Acta Neurochir Suppl 2006; 95:213-7. [PMID: 16463852 DOI: 10.1007/3-211-32318-x_44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To establish a more accurate indication for endoscopic third ventriculostomy (ETV) in patients with noncommunicating hydrocephalus through the analysis of the evolution of postoperative mean intracranial pressure (ICPM). METHOD Intracranial pressure (ICP) was recorded overnight during 8-hour periods with an intraventricular probe. A personal computer connected to the ICP monitor minutely recorded the values of ICP. Twenty-four patients were monitored from day 1 to day 3 after ETV. The evolution of ICPM was analysed with an ANOVA test for repeated measures. The relevance of different factors (age, etiology, size of the lesion leading to hydrocephalus, clinical course and outcome) on the evolution of ICPM was explored with a two-factor ANOVA. RESULTS ICPM progressively decreased from day 1 to day 3 after ETV (p = 0.03). ICPM on the first postoperative day was 15.81 +/- 2.04 mm Hg (mean +/- standard error) and 13.43 +/- 1.44 mm Hg on the third postoperative day. Different patterns in the evolution of ICPM have been detected according to the age of the patient and the clinical course of hydrocephalus. CONCLUSION ICPM progressively decreases after ETV. This pattern is not constant. It has been clearly detected in children and in acute forms of hydrocephalus.
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Affiliation(s)
- D Santamarta
- Department of Neurosurgery, University Hospital of Salamanca, Salamanca, Spain.
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Morales F, Maillo A, Díaz-Álvarez A, Merino M, Muñoz-Herrera A, Hernández J, Santamarta D. Meningiomas de la base de cráneo: Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico. Neurocirugia (Astur) 2005. [DOI: 10.4321/s1130-14732005000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morales F, Maillo A, Díaz-Alvarez A, Merino M, Muñoz-Herrera A, Hernández J, Santamarta D. [Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome]. Neurocirugia (Astur) 2005; 16:477-85. [PMID: 16378129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome. METHOD Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal. RESULTS From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001). CONCLUSIONS We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.
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Affiliation(s)
- F Morales
- Servicio de Neurocirugia. Hospital Universitario de Salamanca
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Santamarta D, Díaz Alvarez A, Gonçalves JM, Hernández J. Outcome of endoscopic third ventriculostomy. Results from an unselected series with noncommunicating hydrocephalus. Acta Neurochir (Wien) 2005; 147:377-82; discussion 382. [PMID: 15696263 DOI: 10.1007/s00701-005-0484-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic third ventriculostomy (ETV) has gained acceptance as the treatment of choice for noncommunicating hydrocephalus despite a relatively high failure rate and a higher surgical risk than the placement of a shunt. The benefits of shunt independence overcome both drawbacks. This argument also serves to consider candidates for ETV patients with a poor chance of success, a fact which may to a certain degree explain failure rates higher than 20% in most unselected series of patients with noncommunicating hydrocephalus. METHOD From 1997 to 2003 sixty-six patients with suspected noncommunicating hydrocephalus were treated with ETV. Male and female patients were equally distributed. It is an adult-based series (median age 53 years). The etiology of hydrocephalus was a space-occupying lesion in 39 patients (59%) and primary aqueductal stenosis in 27 (41%). Forty-seven patients presented an acute form of hydrocephalus (71%), the remainder presented a chronic form of hydrocephalus. The morbidity and outcome of the procedure were reviewed. Criteria for success was shunt independence and failure was considered when any surgical manoeuvre was further required for the treatment of hydrocephalus. The outcome was evaluated using the Kaplan-Meier survival method. FINDINGS The probability of remaining with a functioning ETV at 5.7 years (mean follow-up period) is 71.6% (95% confidence interval: 60.5-82.8). Failure occurred in 18 patients (27.3%). If failure occurs, there is a cumulative probability of 90% (95% confidence interval: 84-97) that the failure declares itself during the first 16 days after surgery. There were transient complications in five patients (7.5%), permanent in one (1.5%) and no mortality related to the procedure. CONCLUSIONS ETV had a 5-year success rate of 71.6% with a low rate of permanent complications. When ETV is successful, the result tends to hold up over time. Delayed failure is a rare event.
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Affiliation(s)
- D Santamarta
- Department of Neurosurgery, Hospital Universitario de Salamanca, Virgen de la Vega, Spain.
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Morales F, Maillo A, Díaz-Álvarez A, Merino M, Muñoz-Herrera A, Hernández J, Santamarta D. Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico. Neurocirugia (Astur) 2005. [DOI: 10.1016/s1130-1473(05)70374-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- J F Blanco
- Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Avda. Alfonso X el sabio, 37007 Salamanca, Spain.
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Santamarta D, Onzain I, Blázquez JA, Gómez-Moreta JA, Morales F. Ventriculostomia endoscópica: influencia de factores predisponentes al fallo y evolución del tamaño ventricular. Neurocirugia (Astur) 2004; 15:248-56; discussion 256-7. [PMID: 15239011 DOI: 10.1016/s1130-1473(04)70479-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endoscopic third ventriculostomy is the treatment of choice for non communicating hydrocephalus at our institution. Several factors have been associated with failure of endoscopic third ventriculostomy. The goals of the study have been to evaluate the outcome, the influence of factors theoretically prone to failure of ventriculostomy and the evolution of ventricular size. MATERIAL AND METHODS Fifty-six patients (mean age 48.5 yrs) treated with an endoscopic third ventriculostomy during the period 1997-2002 were analysed retrospectively. Hydrocephalus was classified as acute (68%) and chronic forms. Etiology was classified in space-occupying lesions (59%), primary aqueductal stenosis (34%) and Chiari malformation (7%). The presence of the following factors theoretically prone to failure was considered: age below one year, history of mielomeningocele, cerebrospinal fluid (CSF) infection, intracranial haemorrhage, radiotherapy, craniotomy and previous treatment of hydrocephalus with a shunt. Ventricular size was measured linearly with four ventricular index pre- and postoperatively. RESULTS The global success rate was 71.4% (mean follow-up 26 months). Endoscopic third ventriculostomy for hydrocephalus secondary to cerebral metastases obstructing CSF pathways was associated with a higher risk of failure (p=0.006). None of the risk factors considered was associated with a higher risk of failure. The evolution of the ventricular size measured with linear methods is associated with outcome. Evans ratio, third ventricle index, cella media index and ventricular score decreased in patients whose outcome is satisfactory and increased in those cases deemed clinical failures (p< 0.05). CONCLUSION The risk of failure increases in patients with cerebral metastases close to CSF pathways, likely due to the concurrence of mechanisms other than obstruction. Changes in ventricular size are associated with outcome.
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Affiliation(s)
- D Santamarta
- Servicio de Neurocirugía. Hospital Universitario. Salamanca
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Maillo A, Orfao A, Sayagues JM, Diaz P, Gómez-Moreta JA, Caballero M, Santamarta D, Santos-Briz A, Morales F, Tabernero MD. New classification scheme for the prognostic stratification of meningioma on the basis of chromosome 14 abnormalities, patient age, and tumor histopathology. J Clin Oncol 2003; 21:3285-95. [PMID: 12947064 DOI: 10.1200/jco.2003.07.156] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Meningiomas are usually considered benign tumors. However, relapses occur in 10% to 20% of all patients, including both histopathologically aggressive and benign tumors. This study explored the value of numerical abnormalities for 10 different chromosomes in meningiomas for predicting relapse-free survival (RFS). PATIENTS AND METHODS This study prospectively analyzed the frequency of numerical abnormalities of chromosomes 1, 9, 10, 11, 14, 15, 17, 22, X, and Y in 70 meningioma patients by fluorescence in situ hybridization and their relationship with disease characteristics at diagnosis and patients' outcome. RESULTS Results showed the presence of numerical abnormalities for one or more chromosomes in most patients (77%). Chromosome 22 in the whole series and chromosome Y in males were those more frequently altered, followed by chromosomes 1, 14, and X in females. Patients with abnormalities of chromosomes 1, 9, 10, 11, 14, 15, 17, the sex chromosomes, and gains of chromosome 22 were associated with adverse prognostic features, more frequent relapses, and shorter RFS. Multivariate analysis showed that tumor grade together with chromosome 14 status and age were the best combination of independent variables for predicting RFS. According to these variables, all patients with a score of two or more than two adverse prognostic factors had experienced relapse at 5 years, whereas none of those with a score of zero had experienced relapse 10 years after surgery. CONCLUSION In addition to age and histologic grade, abnormalities of chromosome 14 contribute to a better prognostic stratification of meningioma patients at diagnosis. Additional prospective studies in larger series of patients, also including larger numbers of patients who experienced relapse, are necessary to confirm the utility of the proposed predictive model.
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Affiliation(s)
- Angel Maillo
- Neurosurgery Service, Hospital Universitario de Salamanca, Salamanca, Spain.
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Santamarta D, Blázquez JA, Maillo A, Muñoz A, Caballero M, Morales F. [Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudomeningocele and infection) following surgery for posterior fossa tumors]. Neurocirugia (Astur) 2003; 14:117-26. [PMID: 12754641 DOI: 10.1016/s1130-1473(03)70548-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hydrocephalus, cerebrospinal fluid (CSF) leak, pseudomeningocele and CSF infection are potential complications related to surgical treatment of posterior fossa tumors. The objectives of this study were to review the incidence of such complications and to identify contributing factors related to them. MATERIAL AND METHODS This study is based on a retrospective review of the medical records of 71 consecutive patients who underwent posterior fossa surgery for a tumor between the period January 1997 and December 2001. Postoperative hydrocephalus was defined as enlargement of the ventricles and the subsequent clinical worsening requiring surgical treatment. Criteria for CSF leakage were:observed leak of CSF through the wound, rhinorrhea or otorrhea. Pseudomeningocele was determined when there was a large epidural CSF collection diagnosed in the postoperative period or by magnetic resonance imaging performed at least three months after posterior fossa surgery. Finally, CSF infection was defined on clinical ground and positive biochemical examination, but not necessarily positive cultures. RESULTS The series included 84 operations for resection of posterior fossa tumors on 71 patients. There were CSF related complications in 31% (26/84)with the following detailed incidence: 9.5% (8/84) postoperative hydrocephalus; 14.3% (12/84) CSF leak, 7.1% (6/84) pseudomeningocele; 8.3% (7/84) CSF infection. The mortality rate is 5.9% (5/84). The tumor size was the only statistically significant factor associated with the occurrence of CSF related complications (mean 39.43 mm, SD 18.51 mm vs.29.80 mm, SD 14.12 mm, p=0.015). In the subgroup of patients, in which hydrocephalus was managed preoperatively, the election of an external ventricular drain vs.other strategies (subcutaneous reservoir, definite shunt or endoscopic third ventriculostomy) was associated with a higher occurrence of CSF related complications (p=0.006). The mortality rate was associated with age (mean 63.60 years, SD 5.86 years vs.49.18 years, SD 16.39 years; p=0.002). The occurrence of CSF related complications also influenced mortality (p=0.030), particularly postoperative hydrocephalus (p< 0.001). Inpatient hospital stay was longer in the subgroup of patients who developed CSF related complications (p=0.002). CONCLUSIONS Tumor size was the only factor associated with the development of CSF related complications after surgery for posterior fossa tumors. In the subgroup of patients in which hydrocephalus was surgically treated preoperatively, the election of an external ventricular drain compared to other surgical modalities was associated with a higher rate of CSF related complications. The development of such complications, particularly hydrocephalus, was related with mortality.
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Affiliation(s)
- D Santamarta
- Servicio de Neurocirugía y Servicio de Otorrinolaringología y Patología Cervicofacial. Hospital Universitario de Salamanca Virgen de la Vega Salamanca, España
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Morales F, Maillo A, Hernández J, Pastor A, Caballero M, Gómez Moreta J, Díaz P, Santamarta D. [Evaluation of microsurgical treatment in a series of 121 intracranial aneurysms]. Neurocirugia (Astur) 2003; 14:5-15. [PMID: 12655379 DOI: 10.1016/s1130-1473(03)70556-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The results obtained with therapy of intracranial aneurysms, in terms of morbidity and mortality, are very important when the patient has to choose between microsurgical techniques or endovascular management. The aim of this paper is to review the information regarding current microsurgical treatment of intracranial aneurysms, and presenting our experience over the last five years. MATERIAL AND METHODS We studied 101 consecutive patients with 121 intracranial aneurysms admitted between 1996 and 2000 with the initial diagnosis of subarachnoid hemorrhage. We paid special attention to the day of admission from the onset of the symptomatic hemorrhage to the grade of Hunt&Hess scale and the possibility of early or delayed microsurgical treatment. The diagnosis was based on four vessels cerebral angiography and in a few cases with CT-angiography. All patients were treated by microsurgical technique and such treatment was completed by nimodipine, intensive care unit management and in some cases of postoperative suspected vasospasm, induced arterial hypertension was applied. Post surgical angiography was carried out in all patients to confirm the clipping of the cerebral aneurysm. The 12 months assessment was based on the Glasgow Outcome Scale (GOS). RESULTS The 92.1% of the patients were admitted with a grade equal or below III in the Hunt&Hess scale. A 80% were operated within the 72 hours of admission and in the remaining cases, the surgical treatment was delayed due to a grade IV or V or to a medical contraindication. Four patients died (3.9%). At 12 months follow up, 88.9% presented a score I or II in the GOS. CONCLUSION According to our results, there are a substantial improvements in the microsurgical treatment of cerebral aneurysms, specially in patients admitted early after the onset of the symptoms of their hemorrhage, who have a grade I to III in the Hunt&Hess scale and showed a good level of consciousness. We think that the improvement of our results are due to: l. the high percentage of patients admitted with grades I to III. 2. the high percentage of patients operated within the first 72 hours from the onset of their symptomatic hemorrhage. 3. surgery was always carried out by the same two experienced vascular neurosurgeons. 4. intraoperative measures taken to prevent the rupture of the aneurysm. 5. early administration of nimodipine, ICU management, doppler studies and in seldom cases, induced hypertension therapy to treat the vasospasm and postoperative hypotension.
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Affiliation(s)
- F Morales
- Servicio de Neurocirugía. Hospital Universitario de Salamanca. Salamanca, Spain
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Santamarta D, Morales F, Sierra JM, de Campos JM. Arachnoid cysts: entrapped collections of cerebrospinal fluid variably communicating with the subarachnoid space. Minim Invasive Neurosurg 2001; 44:128-34. [PMID: 11696880 DOI: 10.1055/s-2001-18148] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite decades of investigation and discussion of the mechanisms involved in the pathophysiology of arachnoid cysts, fundamental issues concerning these entities remain poorly defined and controversial. Cine-mode magnetic resonance imaging (MRI) has shown two patterns of cerebrospinal fluid (CSF) flow within the cavity in patients harbouring arachnoid cysts. Some cysts present a harmonic flow with a patent flow entry zone. All these patients had intermittent, non-progressive and non-localizing symptoms requiring no surgery according to our criteria. The second pattern of CSF flow is more chaotic and is characterized by the presence of swirls throughout the entire cardiac cycle. This pattern is associated with a more disabling clinical picture. Some of these patients required surgical treatment. During surgery, an endoscope was used for inspection purposes revealing, above all, that arachnoid cysts always and variably communicate with the subarachnoid space. The CSF enters the cyst either through a patent flow entry zone or through minute perforations in areas more loosely packed of the arachnoid network that behave as a flexible mesh able to modify the area of flowing CSF. The slipstreams of CSF within arachnoid cysts may not be channelled properly leading to possible damage of the surrounding brain parenchyma.
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Affiliation(s)
- D Santamarta
- Department of Neurosurgery, Hospital Virgen de la Vega, Salamanca, Spain.
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Cadiergues MC, Santamarta D, Mallet X, Franc M. First blood meal of Ctenocephalides canis (Siphonaptera: Pulicidae) on dogs: time to initiation of feeding and duration. J Parasitol 2001; 87:214-5. [PMID: 11227894 DOI: 10.1645/0022-3395(2001)087[0214:fbmocc]2.0.co;2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Two experiments were conducted on dogs to evaluate interval to initiation and duration of the first blood meal of Ctenocephalides canis (Curtis). Percentage of fed male and female fleas was calculated for fleas held on dogs for 5, 15, 30, 60 min, 6, and 24 hr. Duration of first blood meal was also measured for individual fleas confined on dogs. When fleas were free in the hair coat, 21.2% had begun blood feeding within 5 min. After 1 hr, 72.5% of fleas had fed. After 6 hr, 95.2% of males and 100% of females had taken a blood meal, and 24 hr after deposition all fleas had fed. There was no significant difference between the 2 sexes. The mean delay between deposition and biting for fleas that began feeding within 15 min was 2 min 52 sec +/- 3 min 2 sec for female fleas and 3 min 8 sec +/- 2 min 45 sec for males. The mean duration of female and male meals was 5 min 3 sec +/- 3 min 41 sec and 6 min 9 sec +/- 6 min 8 sec, respectively. There was no significant difference between the 2 sexes. The dog flea took its blood meal on dogs more slowly than the cat flea did on cats; this meal was significantly longer for Ctenocephalides felis felis (Bouche) than for C. canis.
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Affiliation(s)
- M C Cadiergues
- Dermatology-Parasitology, Ecole Nationale Vétérinaire de Toulouse, France
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Cadiergues MC, Santamarta D, Mallet X, Franc M. First Blood Meal of Ctenocephalides canis (Siphonaptera: Pulicidae) on Dogs: Time to Initiation of Feeding and Duration. J Parasitol 2001. [DOI: 10.2307/3285203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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de Campos J, Santamarta D, Kusak M. 2. Colección subdural asociada a quiste aracnoideo silviano. Presentación de dos casos y revisión de la literatura. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70877-9] [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: 10/24/2022]
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Gonçalves J, Paniagua J, Framiñán A, Maillo A, Díaz P, Morales F, Hernández J, Gómez-Moreta J, Onzain I, Santamarta D, Pastor A, Caballero M. 3. Evaluación radiológica tras laminoplastia cervical. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70847-0] [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: 10/24/2022]
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Morales Ramos F, Maillo A, Caballero M, Santamarta D, Díaz Cascajo P, Hernández J, Gómez-Moreta J. 8. ¿Es la técnica de Guglielmi detachable coil (GDC) la que ofrece mejores soluciones al tratamiento de los aneurismas intracraneales rotos? Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morales Ramos F, Maillo A, Cabellera M, Santamarta D, Díaz Cascajo P, Hernández J, Gómez Moreta J, Pastor Zapata A. 5. Cirugía versus terapia endovascular. Indicaciones en el tratamiento de los aneurismas intracraneales. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70939-6] [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: 10/24/2022]
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Caballero M, Morales F, Santamarta D. 3. Monitorización con microdiálisis cerebral en 29 pacientes. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morales Ramos F, Muñoz Herrero A, Caballero M, Pastor A, Hernández J, Santamarta D, Maíllo A, Salamanca H. 3. Meningiomas de ángulo ponto-cerebeloso (A P C). Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70778-6] [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: 10/24/2022]
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Santamarta D, Caballero M, Pastor A, Hernández J, Díaz Cascajo P, Morales F. 4. Hemorragia en el IV ventrículo secundaria a hemangioblastoma de la unión bulbomedular. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70830-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Santamarta D, Caballero M, Gómez-Moreta J, Pastor A, Morales F, de Campos J, Ladera V, Perea M. 1. Biopsia endoscópica de tumores pineales. Neurocirugia (Astur) 2001. [DOI: 10.1016/s1130-1473(01)70950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVES The fibreoptic device is a type of intracranial pressure monitor which seems to offer certain advantages over conventional monitoring systems. This study was undertaken to analyse the accuracy, drift characteristics, and complications of the Camino fibreoptic device. METHODS One hundred and eight Camino intracranial pressure (ICP) devices, in their three modalities, were implanted during 1997. The most frequent indication for monitoring was severe head injury due to road traffic accidents. RESULTS Sixty eight probe tips were cultured; 13.2% of the cases had a positive culture without clinical signs of infection, and 2.9% had a positive culture with clinical signs of ventriculitis. The most common isolated pathogen was Staphylococcus epidermidis. All patients were under cephalosporin prophylaxis during monitoring. Haemorrhage rate in patients without coagulation disorders was 2.1% and 15.3% in patients with coagulation abnormalities. Drift characteristics were studied in 56 cases; there was no drifting from the values expected according to the manufacturer's specifications in 34 probes. There was no relation between direction of the drift and duration of placement, nor between drift and time. CONCLUSIONS Although the complication and drift rates were similar to those reported elsewhere, there was no correlation between the direction of the drift and long term monitoring despite the fact that some published papers refer to overestimation of values with time with this type of device.
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Affiliation(s)
- R M Martínez-Mañas
- Department of Neurosurgery, Hospital Clinic i Provincial, University of Barcelona, Spain.
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Santamarta D, Kusak ME, de Campos JM, Sierra JM. Increased cerebrospinal fluid flow through the foramen of Magendie after decompression for Chiari I malformation. J Neurol Neurosurg Psychiatry 1999; 66:799. [PMID: 10329762 PMCID: PMC1736395 DOI: 10.1136/jnnp.66.6.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Santamarta
- Department of Neurosurgery, Hospital del Rio Hortega, Valladolid, Spain
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Abstract
The management of pineal tumours remains controversial. During 1994 we treated four consecutive adults (16-44 yrs) harbouring a pineal tumour with a neuroendoscopic procedure. All of them presented with hydrocephalus. Pre-operative workup included cranial computerized tomography (CT), craniospinal magnetic resonance imaging (MRI) and serum levels of biological tumour markers. The endoscopic procedure consisted of a third ventriculostomy followed by biopsy with a flexible, steerable neuroendoscope. Histological diagnosis was achieved in three patients who no longer required a shunt device. Recorded complications were: bleeding during ventriculostomy that prevented us from obtaining a good sample for biopsy, short-term memory loss that cleared over a two-week period, and transient increase of pre-operative hemiparesis. Complications and morbidity are emphasized so as to be avoided with further technical experience. Neuroendoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region lesions: 1) CSF sample for analysis of tumour markers. 2) Treatment of hydrocephalus by third ventriculostomy. 3) Several biopsy specimens can be obtained identifying tumours which will require further open surgery or adjuvant radiation and/or chemotherapy.
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Affiliation(s)
- E Ferrer
- Department of Neurosurgery, Hospital Clinic, University of Barcelona, Spain
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Santamarta D, Caral L. [Image of the month: pontine cavernoma]. Neurologia 1996; 11:229. [PMID: 8768679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- D Santamarta
- Servicio de Neurocirugía, Hospital Clínic i Provincial, Barcelona
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Pujol J, Santamarta D. [Functional MRI of the motor area]. Neurologia 1996; 11:32. [PMID: 8714173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J Pujol
- Centro Diagnóstico Pedralbes, Barcelona
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Santamarta D, Pujol J. [Simulated craniotomy]. Neurologia 1996; 11:33. [PMID: 8714174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- D Santamarta
- Servicio de Neurocirugía, Hospital Clínic i Provincial, Barcelona
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Santamarta D, Aguas J, Ferrer E. The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 1995; 38:133-7. [PMID: 8750654 DOI: 10.1055/s-2008-1053473] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arachnoid cysts are space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid matter. They are regarded as a development abnormality of the arachnoid, originating from a splitting or duplication of this membrane. However, precise etiology and natural history remain controversial. Different hypotheses have been developed including agenesis of brain structures, arachnoiditis, active fluid secretion, and pulsatile pump. We present a review of the literature concerning these items and report one case of a suprasellar arachnoid cyst in which a slit-valve mechanism was observed by means of cine-mode MRI preoperatively and confirmed during the endoscopic intervention.
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Affiliation(s)
- D Santamarta
- Department of Neurosurgery, Hospital Clinic i Provincial Barcelona, Spain
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Conde C, García G, Rumia J, Santamarta D, Gastón F. Ecografía intraoperatoria en neurocirugía: ecografía intraoperatoria raquimedular. Neurocirugia (Astur) 1993. [DOI: 10.1016/s1130-1473(93)70831-3] [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: 10/24/2022]
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