A Bescós

Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain

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Publications (6)2.06 Total impact

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    ABSTRACT: Introduction The authors present the results of a series of 121 cases of posterior vertebral fixation carried out from Sept 2008 to Sept 2010 using Flouro 2D-TC assisted Vector Vision o Kolibri navigator. (Brain LAB, Feldkirchen, Germany). Material The sample included 68 males and 53 females. Age range was 24–75 with an average of 50.35., all with indication for instrumentation by different pathologies. Method Patients presenting vertebral lesions of varying ethiology and lesion level with vertebral posterior fixation indication were included in the study. All underwent a CT before surgery, according to navigation protocol, and the images obtained were merged in the navigator with those obtained in the operating room with a Flouro 2D, which allowed a high quality 3D reconstruction to be performed and thus the capacity to navigate in a real-virtual manner. To evaluate the results of the implant a post-op CT was performed and the position of the implant was defined according to the Heary scale. The calabration time of the material was also evaluated, number of shots with the Flouro-2D, and for clinical evaluation VAS scales were employed, Oswestry and JOA (L), as well as the degree of satisfaction and acceptance of the procedure. Results A total of 580 screws were implanted, distributed in 62 cervicals of which 24 were in C1-C2, 38 dorsals, 370 lumbar and 110 sacral. Open surgery was performed in 42 cases, MIS in 28 and percutaneous in 51. The presision of the implant was 98.45% with a global deviation of 1.55%, that according to the Heary scale was distributed in grade ll: 2 (1 cervical, 1 lumbar) grade lll: 4 (1 cervical, 2 dorsal, 1 lumbar), grade IV: 3 (1 cervical, 2 lumbar). General average time of calibration per procedure was 2 min. 49 seconds and the mean flouroscopic exposure was one shot at cervical and dorsal and two shots at lumbar level. The clinical evaluation at one month of 121 patients was 8.6/3.0 in the VAS, 68.0%/23.0% in Oswestry and 6.4/13.1 in JOA (L), with those parameters remaining stable at 3 months in 100 and at 6 months in 87 patients respectively, and the degree of satisfaction between being completely and very satisfied with the procedure was 94.9%, and those who would submit to another treatment was more than 94%. Conclusion Navigation with Flouro-2D-CT is a high precision technique that reduces complications of varying severity according to the level operated well as number of reinterventions, radiation exposure and surgical time.
    Neurocirugia (Asturias, Spain) 06/2011; 22(3):224–234. · 0.34 Impact Factor
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    ABSTRACT: The authors present the results of a series of 121 cases of posterior vertebral fixation carried out from Sept 2008 to Sept 2010 using Flouro 2D-TC assisted Vector Vision o Kolibri navigator. ( Brain LAB, Feldkirchen, Germany). The sample included 68 males and 53 females. Age range was 24-75 with an average of 50.35., all with indication for instrumentation by different pathologies. Patients presenting vertebral lesions of varying ethiology and lesion level with vertebral posterior fixation indication were included in the study. All underwent a CT before surgery, according to navigation protocol, and the images obtained were merged in the navigator with those obtained in the operating room with a Flouro 2D, which allowed a high quality 3D reconstruction to be performed and thus the capacity to navigate in a real-virtual manner. To evaluate the results of the implant a post-op CT was performed and the position of the implant was defined according to the Heary scale. The calabration time of the material was also evaluated, number of shots with the Flouro-2D, and for clinical evaluation VAS scales were employed, Oswestry and JOA (L), as well as the degree of satisfaction and acceptance of the procedure. A total of 580 screws were implanted, distributed in 62 cervicals of which 24 were in C1-C2, 38 dorsals, 370 lumbar and 110 sacral. Open surgery was performed in 42 cases, MIS in 28 and percutaneous in 51. The presision of the implant was 98.45% with a global deviation of 1.55%, that according to the Heary scale was distributed in grade ll: 2 (1 cervical, 1 lumbar) grade lll: 4 (1 cervical, 2 dorsal, 1 lumbar), grade IV: 3 (1 cervical, 2 lumbar). General average time of calibration per procedure was 2 min. 49 seconds and the mean flouroscopic exposure was one shot at cervical and dorsal and two shots at lumbar level. The clinical evaluation at one month of 121 patients was 8.6/3.0 in the VAS, 68.0% / 23.0% in Oswestry and 6.4/13.1 in JOA (L), with those parameters remaining stable at 3 months in 100 and at 6 months in 87 patients respectively, and the degree of satisfaction between being completely and very satisfied with the procedure was 94.9%, and those who would submit to another treatment was more than 94%. Navigation with Flouro-2D-CT is a high precision technique that reduces complications of varying severity according to the level operated well as number of reinterventions, radiation exposure and surgical time.
    Neurocirugia (Asturias, Spain) 06/2011; 22(3):224-34. · 0.34 Impact Factor
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    ABSTRACT: The stabilization of C1-C2 segment has evolved with the appearance of several techniques from sublaminar, transarticular or interarticular fixation and over recent years with the introduction of neuronavegation systems. The aim of the study was to review patients treated in our center with transarticular and interarticualr fixation and compare the results obtained with both techniques. Thirty six patients with C1-C2 instability that required a surgical fixation between 1995-2008 were retrostpectively analized. The causes of instability were principaly traumatic (18 cases) or degeneritive (16) and two cases of neoplasic lesions. In the first period (1995-2001) 20 patients were treated with transarticular fixation (Magerl's technique), and later (2002-2008) with interarticular fixation (Goel-Harms technique) in another 16 patients. Data was obtainned regarding complications, radiological evolution and clinical results (EVA pain score) and functionals (PROLO score) at 3, 6, 12 and >12 months post-op, as well as post-op cervical mobility and signs of bone fusion. A good result was considered if clinical improvement exi ted with decrease in EVA pain score > 5 points and funcional if a PROLO score > 4, regular if EVA decreased but <5 and PROLO <3 , and bad if there was no clinical or functional improvement. The results were statistically compared between both techniques. Of the 20 patients treated with transarticular fixation, good results were obtained in 17 cases (85%) , regular in 2 (10%), and bad in 1 (5%). Complications included 1 case of vertebral artery lesion and 3 screw misplacements, one case in contact with vertebral artery. Regarding those treated with interarticualr fixation, in 14 (89%), good results were obtained, regular in 2 (12.5%) with 1 case of screw misplacement and another of postsurgical infection. No statistical significant differences were recorded between both techniques, although in those treated with interarticular fixation there was a higher rate of bone fusion and no cases of vertebral arterial lesions were recorded. Transarticular and interarticular C1- C2 fixation is safe and provides a high rate of good results with few complications. The introduction of neuronavigation systems can increase the efficacy and safety of these techniques.
    Neurocirugia (Asturias, Spain) 04/2011; 22(2):140-9. · 0.34 Impact Factor
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    ABSTRACT: Objective The stabilization of C1–C2 segment has evolved with the appearance of several techniques from sublaminar, transarticular or interarticular fixation and over recent years with the introduction of neuronavegation systems. The aim of the study was to review patients treated in our center with transarticular and interarticualr fixation and compare the results obtained with both techniques. Methods Thirty six patients with C1–C2 instability that required a surgical fixation between 1995–2008 were retrostpectively analized. The causes of instability were principaly traumatic (18 cases) or degeneritive (16) and two cases of neoplasic lesions. In the first period (1995–2001) 20 patients were treated with transarticular fixation (Magerl's technique), and later (2002–2008) with interarticular fixation (Goel-Harms technique) in another 16 patients. Data was obtainned regarding complications, radiological evolution and clinical results (EVA pain score) and functionals (PROLO score) at 3, 6, 12 and >12 months post-op, as well as post-op cervical mobility and signs of bone fusion. A good result was considered if clinical improvement exis ted with decrease in EVA pain score > 5 points and funcional if a PROLO score > 4, regular if EVA decreased but <5 and PROLO <3, and bad if there was no clinical or functional improvement. The results were statistically compared between both techniques. Results Of the 20 patients treated with transarticular fixation, good results were obtained in 17 cases (85%), regular in 2 (10%), and bad in 1 (5%). Complications included 1 case of vertebral artery lesion and 3 screw misplacements, one case in contact with vertebral artery. Regarding those treated with interarticualr fixation, in 14 (89%), good results were obtained, regular in 2 (12.5%) with 1 case of screw misplacement and another of postsurgical infection. No statistical significant differences were recorded between both techniques, although in those treated with interarticular fixation there was a higher rate of bone fusion and no cases of vertebral arterial lesions were recorded. Conclusions Transarticular and interarticular C1–C2 fixation is safe and provides a high rate of good results with few complications. The introduction of neuronavigation systems can increase the efficacy and safety of these techniques.
    Neurocirugia (Asturias, Spain) 04/2011; 22(2):140–149. · 0.34 Impact Factor
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    ABSTRACT: There are various surgical approaches to treat Chiari I malformation. In spite of the good clinical results that are reported with most of them, there is still controversy about the optimal treatment of this pathology. To compare the clinical and radiological results of surgical treatment of the Chiari I malformation with suboccipital craniectomy, posterior arch of C1 resection with or without dural graft, analyzing clinical and radiological findings and describing the complications. Retrospectively clinical cases series of patients who underwent Chiari I malformation surgery between 1998 and 2006 in the Hospital Germans Trias i Pujol in Badalona. The inclusion criteria consisted in: patients older than 18 years, who have had surgery in our hospital, detailed neurological examination before and after surgery (calculating the EDSS scale punctuation), craniospinal magnetic resonance imaging before and after surgery and minimal follow up period of 6 months. The election of the surgical approach was left to the discretion of the main surgeon. Patients were divided in two groups depending of the surgical technique: Group A (with dural graft) and Group B (without dural graft). To evaluate the morphological results in both groups, measurements of the position of the fastigium above a basal line in the midsagittal T1 weighted magnetic resonance images were obtained. In patients with syringomyelia, siringo-to-cord ratio was measured before and after surgery. To evaluate the clinical results, neurological examination was recorded in both groups before and after surgery. The mean age of Group A patients was 47 (-/+12.89) years, and of Group B was 38.3 (-/+7.77) years. Mean follow up period was 2.48 (-/+2.44) years in Group A and 4.2 (-/+4.46) in Group B. Creation of an artificial cisterna magna was observed en 35.7% of Group A patients and only in 3.5% of Group B patients (p=0.022). In 8 patients front Group A, 8 patients (28.6%) an upward migration of the cerebellum was seen, whereas any of the Group B patients presented it (p=0.022) Siringo-to-cord ratios were decreased in both groups without significant differences. All of the Group A patients improved their clinical exploration. In Group B, 60% of the patients improved and the 40% left maintained clinical stability. Any patient worsened. All patients that maintained clinical stability belonged to Group B, the differences between the two groups were statistically significant (p=0.04). Five patients presented immediate surgical complications (2 pseudomeningoceles, 2 meningitis and 1 hydrocephalus). All this patients where operated with dural graft (p=0.049). According to our study, suboccipital craniectomy with resection of the posterior arch of C1 and dural graft shows better clinical and radiological results than without dural graft. Nevertheless this technique can increase the incidence of surgical complications.
    Neurocirugia (Asturias, Spain) 06/2008; 19(3):233-41. · 0.34 Impact Factor
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    ABSTRACT: Existen múltiples tratamientos descritos para la malformación de Chiari tipo I. Se reportan buenos resultados clínicos con la mayoría de las variantes. Aún así, sigue habiendo controversia acerca del tratamiento óptimo de esta entidad. Objetivo. Comparar los resultados clínico-radiológicos del tratamiento quirúrgico de la malformación de Chiari tipo I mediante craniectomía suboccipital, resección del arco posterior de C1 con o sin duroplastia, analizando las variables clínicas, radiológicas y describiendo las complicaciones. Material y métodos. Se realizó un estudio retrospectivo de los pacientes intervenidos en nuestro centro entre los años 1998 y 2006. La muestra cumplía los siguientes criterios de inclusión: pacientes mayores de 18 años, que hubieran sido intervenidos en nuestro centro en todas las ocasiones, examen neurológico preoperatorio y de control postoperatorio (calculando su puntuación en la escala EDSS), estudio de imagen craneoespinal preoperatorio y postoperatorio y tiempo mínimo de seguimiento clínico de 6 meses. Los pacientes se intervinieron con una u otra técnica en función del criterio del cirujano principal. Dividimos a los pacientes en dos grupos según la técnica utilizada: Grupo A (intervenidos mediante duroplastia) y grupo B (intervenidos sin duroplastia). Para evaluar los resultados radiológicos en los dos grupos se midieron en la resonancia magnética, antes y después de la cirugía: la migración cerebelosa siguiendo el método de Duddy y Williams y la ratio siringo espinal en los pacientes con siringomielia. Para evaluar el resultado clínico, se recogió en los dos grupos la exploración neurológica antes y después de la cirugía. Resultados. La edad media de los pacientes del grupo A fue de 47 (±12,89) años, mientras que la del grupo B fue de 38,30 (±7,77) años. El tiempo medio de seguimiento de los pacientes del grupo A fue de 2,48 (±2,44) años y en el grupo B de 4,20 (±4,46) años. En los pacientes del grupo A se observó creación de una nueva cisterna magna en el 35,7% de los pacientes, mientras que sólo se observó en el 3,5% de los pacientes de grupo B (p=0,022). En el grupo A, 8 pacientes (28,6%) presentaron ascenso cerebeloso, mientras que ningún paciente del grupo B lo presentó, siendo la diferencia estadísticamente significativa (p=0,022). La cavidad siringomiélica disminuyó en los dos grupos de pacientes, sin diferencias estadísticamente signi- ficativas entre ambos. Todos los pacientes del grupo A experimentaron mejoría clínica. En el grupo B, el 60% de los pacientes mejoraron mientras que el 40% se mantuvieron estables. Ningún paciente empeoró. Los pacientes que se mantuvieron estables, pertenecían al grupo intervenido sin duroplastia, siendo la diferencia entre los dos grupos estadísticamente significativa (p =0.04). Cinco pacientes presentaron complicaciones postquirúrgicas inmediatas (2 pseudomeningoceles, 2 meningitis y 1 caso de hidrocefalia postquirúrgica). Todos los casos de complicaciones se dieron en pacientes intervenidos mediante duroplastia (p=0.049). Conclusiones. Según nuestro estudio, la descompresión de la fosa posterior mediante duroplastia, proporciona mejores resultados clínicos y radiológicos que la misma técnica pero sin duroplastia. Sin embargo, también puede aumentar la incidencia de complicaciones postquirúrgicas.
    Neurocirugia (Asturias, Spain) 01/2008; · 0.34 Impact Factor