G García-March

Hospital Clínico Universitario de Valencia, Valenza, Valencia, Spain

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Publications (33)37.69 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Postraumatic chronic cervical instability has almost always been treated by conservative measures. Nowadays when these methods fail, surgical treatment by posterior approach has his role in order to stabilize the cervical spine. We present a group of 31 patients with female preponderance and 27.5 years of mean age affected of postraumatic chronic cervical instability of ligamentous origin treated by cervical fixation through articular mass screws and plates. Clinical remission was reached in 93.5%. Physiologic cervical lordosis was corrected in all except in one case. 77.4% of patients have returnned to work. No complications were detected. Our results showed that lateral mass plating is a safe, effective technique for managing this kind of instability that represents a major advance over other procedures.
    Neurocirugia (Asturias, Spain) 07/2013; 11(2):95–102. · 0.32 Impact Factor
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    ABSTRACT: The role of the microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue minimizing the postoperative morbidity. The purpose of our paper has been to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. A total of 17 patients operated on for resection of cortical or subcortical tumors in motor areas were included in the series. Preoperative planning for multimodal navigation was done integrating anatomic studies, motor functional MRI (f-MRI) and subcortical pathways volumes generated by diffusion tensor imaging (DTI). Intraoperative neuromonitorization included motor mapping by direct cortical and subcortical electrical stimulation (CS and sCS) and localization of the central sulcus using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortical and subcortical stimulated points with positive motor response was stored in the navigator and correlated with the cortical or subcortical motor functional structures defined preoperatively. The mean tumoral volumetric resection was 89.1±14.2% of the preoperative volume, with a total resection (≥100%) in twelve patients. Preoperatively a total of 58.8% of the patients had some motor deficit, increasing 24 hours after surgery to 76.5% and decreasing to 41.1% a month later. There was a great correlation between anatomic and functional data, both cortically and subcortically. However, in six cases it was not possible to identify the central sulcus and in many cases fMRI gave contradictory information. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response, being in these cases 7.3±3.1 mm the mean distance from the stimulated point to the subcortical tract. The integration of preoperative and intraoperative anatomic and functional studies allows a safe functional resection of the brain tumors located in eloquent areas, compared to the tumoral resection based on anatomic imaging studies. Multimodal navigation allows the integration and correlation among preoperative and intraoperative anatomic and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MRI and fMRI and subcortical motor pathways with TDI and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol we achieved a mean of 90% of volumetric resection in cortical and subcortical tumors located in eloquent motor areas with an increase of neurological deficits in the immediate postoperative period that significantly decreased one month later. Ongoing studies will define the safe limits for functional resection taking into account the intraoperative brain shift. Finally, it must be demonstrated if this protocol has any benefit for patients concerning disease free or overall survival.
    Neurocirugia (Asturias, Spain) 02/2011; 22(1):23-35. · 0.32 Impact Factor
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    ABSTRACT: Objectives The role of the microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue minimizing the postoperative morbidity. The purpose of our paper has been to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. Materials and methods A total of 17 patients operated on for resection of cortical or subcortical tumors in motor areas were included in the series. Preoperative planning for multimodal navigation was done integrating anatomic studies, motor functional MRI (f-MRI) and subcortical pathways volumes generated by diffusion tensor imaging (DTI). Intraoperative neuromonitorization included motor mapping by direct cortical and subcortical electrical stimulation (CS and sCS) and localization of the central sulcus using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortical and subcortical stimulated points with positive motor response was stored in the navigator and correlated with the cortical or subcortical motor functional structures defined preoperatively. Results The mean tumoral volumetric resection was 89.1 ± 14.2% of the preoperative volume, with a total resection (≥100%) in twelve patients. Preoperatively a total of 58.8% of the patients had some motor deficit, increasing 24 hours after surgery to 76.5% and decreasing to 41.1% a month later. There was a great correlation between anatomic and functional data, both cortically and subcortically. However, in six cases it was not possible to identify the central sulcus and in many cases fMRI gave contradictory information. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response, being in these cases 7.3 ± 3.1 mm the mean distance from the stimulated point to the subcortical tract. Conclusions The integration of preoperative and intraoperative anatomic and functional studies allows a safe functional resection of the brain tumors located in eloquent areas, compared to the tumoral resection based on anatomic imaging studies. Multimodal navigation allows the integration and correlation among preoperative and intraoperative anatomic and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MRI and fMRI and subcortical motor pathways with TDI and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol we achieved a mean of 90% of volumetric resection in cortical and subcortical tumors located in eloquent motor areas with an increase of neurological deficits in the immediate postoperative period that significantly decreased one month later. Ongoing studies will define the safe limits for functional resection taking into account the intraoperative brain shift. Finally, it must be demonstrated if this protocol has any benefit for patients concerning disease free or everall survival.
    Neurocirugia (Asturias, Spain) 02/2011; 22(1):23–35. · 0.32 Impact Factor
  • Clinical Neurophysiology 10/2010; 121. · 2.98 Impact Factor
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    ABSTRACT: Nowadays the role of microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue, minimizing the postoperative morbidity. The purpose of this paper was to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. A total of 17 patients who underwent resection of cortical or subcortical tumors in motor areas have been included in the series. The preoperative planning for multimodal navigation was done by integrating anatomical studies, motor functional MR (fMR) imaging, and subcortical pathway volumes generated by diffusion tensor (DT) imaging. Intraoperative neuromonitoring included motor mapping by direct cortical stimulation (CS) and subcortical stimulation (sCS), and localization of the central sulcus by using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortically and subcortically stimulated points with positive motor response was stored in the navigator and correlated with the cortical and subcortical motor functional structures defined preoperatively. The mean tumoral volumetric resection was 89.1 +/- 14.2% of the preoperative volume, with a total resection (> or = 100%) in 8 patients. Preoperatively a total of 58.8% of the patients had some kind of motor neurological deficit, increasing 24 hours after surgery to 70.6% and decreasing to 47.1% at 1 month later. There was a great correlation between anatomical and functional data, both cortically and subcortically. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response; in these cases the mean distance from the stimulated point to the subcortical tract was 7.3 +/- 3.1 mm. The integration of anatomical and functional studies allows a safe functional resection of the brain tumors located in eloquent areas. Multimodal navigation allows integration and correlation among preoperative and intraoperative anatomical and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MR and fMR imaging and subcortical motor pathways with DT imaging and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol the authors achieved a good volumetric resection in cortical and subcortical tumors located in eloquent motor areas, with an increase in the incidence of neurological deficits in the immediate postoperative period that significantly decreased 1 month later. Ongoing studies must define the safe limits for functional resection, taking into account the intraoperative brain shift. Finally, it must be demonstrated whether this protocol has any long-term benefit for patients by prolonging the disease-free interval, the time to recurrence, or the survival time.
    Neurosurgical FOCUS 02/2010; 28(2):E5. · 2.14 Impact Factor
  • G García-March, M J Sánchez-Ledesma, J Broseta
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    ABSTRACT: The vagus nerve stimulation (VNS) therapy is a new neurostimulation technique used for treating pharmacoresistant epilepsy. It can be considered an effective and safe alternative for the treatment of refractory epilepsy patients. In the present review, we describe the surgical implantation technique, its indications and results achieved until now. We will also summarize the possible mechanisms of action of VNS therapy. Finally, we will comment on the difficulties and inconveniences that did not allow this antiepileptic surgical technique to become more widely used.
    Neurocirugia (Asturias, Spain) 11/2008; 19(5):416-26. · 0.32 Impact Factor
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    ABSTRACT: La estimulación intermitente vagal es una técnica de neuroestimulación de reciente incorporación en el tratamiento de pacientes con epilepsia refractaria al tratamiento farmacológico convencional. Hasta el momento presente y, a pesar de algunos resultados dispares, se ha mostrado como una alternativa eficaz y segura en el tratamiento de estos pacientes. El presente trabajo de revisión pretende acercar la técnica quirúrgica de implantación, comentar las indicaciones y resultados obtenidos hasta la actualidad, y profundizar en los posibles mecanismos de acción de este tipo de estimulación, para finalmente realizar una aproximación crítica a la misma, intentando puntualizar cúales han sido los problemas e inconvenientes que han impedido la utilización generalizada de esta alternativa quirúrgica antiepiléptica
    Neurocirugia (Asturias, Spain) 01/2008; · 0.32 Impact Factor
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    ABSTRACT: Spinal cord stimulation (SCS) is used to treat chronic pain and requires an awake patient for optimized lead positioning to locate paresthesias. Epidural anesthesia may be a suitable anesthetic but has not been evaluated. We performed an open-label, prospective, observational, single-center study to evaluate the safety and efficacy of laminectomy lead placement under epidural anesthesia for the treatment of neuropathic chronic pain. The results in our study demonstrate that epidural anesthesia is a suitable technique for SCS lead implant. This is the first study using epidural anesthesia for SCS lead implants by laminectomy. The technique seems to be safe and effective.
    Anesthesia and analgesia 12/2007; 105(5):1458-61, table of contents. · 3.42 Impact Factor
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    ABSTRACT: To determine the grade of neuroprotection of combined treatment with moderate hypothermia, tirilazad and magnesium sulfate. Cerebral ischemia is one of the problems of great interest at present, with limited therapeutic measures. Hypothermia, one of the more efficient measures, together with neuroprotector pharmaceuticals, could be a valid alternative. Experimental study with a control group and two levels of application of therapeutic measures. Experimental laboratory of the Medicine Faculty. Twenty-eight Wistar rats underwent global cerebral ischemia of 10 minutes duration by the combination of bilateral carotid clamping and controlled hypotension (mean arterial pressure: 45 mmHg). Three groups were used: group I, normothermia maintenance; group II, moderate hypothermia (32-33 degrees C) for 2 hours; group III, hypothermia and administration of tirilazad mesylate and magnesium sulfate during the reperfusion and two hours after ischemia. The animals were sacrificed at 7 days and, after processing the tissue, the neurons preserved in layer CA1 of the hippocampus were counted. There is a significantly greater neuronal preservation in group III with regard to group I (55.4 +/- 5.1 versus 38.7 +/- 8.8, p < 0.0001). If we compare groups II and III, significant differences are only obtained on the right side and in the hippocampus considered globally, favoring the group with hypothermia and drugs. When groups I and II are compared there are no significant differences. Association of moderate hypothermia, magnesium sulfate and tirilazad mesylate in the experimental model of transitory global ischemia used is confirmed as an effective neuroprotector measure, surpassing the degree of neuronal preservation of hypothermia alone.
    Medicina Intensiva 05/2007; 31(3):113-9. · 1.24 Impact Factor
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    ABSTRACT: Objective To determine the grade of neuroprotection of combined treatment with moderate hypothermia, tirilazad and magnesium sulfate. Cerebral ischemia is one of the problems of great interest at present, with limited therapeutic measures. Hypothermia, one of the more efficient measures, together with neuroprotector pharmaceuticals, could be a valid alternative. Design Experimental study with a control group and two levels of application of therapeutic measures. Context Experimental laboratory of the Medicine Faculty. Participants and method Twenty-eight Wistar rats underwent global cerebral ischemia of 10 minutes duration by the combination of bilateral carotid clamping and controlled hypotension (mean arterial pressure: 45 mmHg). Three groups were used: group I, normothermia maintenance; group II, moderate hypothermia (32-33 °C) for 2 hours; group III, hypothermia and administration of tirilazad mesylate and magnesium sulfate during the reperfusion and two hours after ischemia. The animals were sacrificed at 7 days and, after processing the tissue, the neurons preserved in layer CA1 of the hippocampus were counted. Results There is a significantly greater neuronal preservation in group III with regard to group I (55.4 ± 5.1 versus 38.7 ± 8.8, p < 0.0001). If we compare groups II and III, significant differences are only obtained on the right side and in the hippocampus considered globally, favoring the group with hypothermia and drugs. When groups I and II are compared there are no significant differences. Conclusions Association of moderate hypothermia, magnesium sulfate and tirilazad mesylate in the experimental model of transitory global ischemia used is confirmed as an effective neuroprotector measure, surpassing the degree of neuronal preservation of hypothermia alone.
    Medicina Intensiva 04/2007; 31(3):113-119. · 1.24 Impact Factor
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    ABSTRACT: Based on previous experimental studies showing that cervical spinal cord stimulation increases carotid and brain blood flow in brain iscnemia models, this technique was used in 10 patients presenting with various cerebral low perfusion syndromes. Though not constant, an increase in alertness, retention, speech, emotional status and performance in skilled acts was achieved. SPECT readings showed an increase in blood flow in the penumbra perilesional area.
    Neurocirugia (Asturias, Spain) 01/1998; 9(4):307–311. · 0.32 Impact Factor
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    ABSTRACT: We report a case of an aneurysm arising from a hemispheric branch of the superior cerebellar artery. The patient was a 68-year-old woman with long-term hypertension and chronic renal failure. She was admitted because of a subarachnoid hemorrhage mainly in the posterior fossa. An angiogram showed a small aneurysm located on a hemispheric branch of the superior cerebellar artery. During the preoperative period, the renal failure was aggravated and the patient suffered from uremic encephalopathy. The operation was carried out 40 days after subarachnoid hemorrhage when she was asymptomatic. The aneurysm was successfully clipped and extirpated by using an infratentorial supracerebellar approach. The postoperative course was complicated by severe hypertension which was finally controlled. The pathological examination was consistent with a saccular aneurysm. The final outcome was entirely satisfying.
    Neurocirugia (Asturias, Spain) 01/1998; 9(3):257–260. · 0.32 Impact Factor
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    ABSTRACT: The use of syringosubarachnoid shunt in the treatment of syringomyelia has been widely practiced. We report our surgical results with this method in a series of 9 patients. In 7 of them, Chiari malformation was also found. The postoperative follow-up ranged from 1 to 6,3 years, the average and the median being of 3,4. Symptoms stabilized in 4 patients, improved in 3 and worsened in 2. The follow-up MRI examinations showed complete resolution or considerable shrinkage of the syrinx in 7 patients, and no significant changes in 3. The clinical results were not absolutely congruent with the morphological, as there were cases with clinical improvement without changes in the MRI, and others in wich the shrinkage of de syrinx was not associated with improvement of the symptoms.
    Neurocirugia (Asturias, Spain) 01/1996; 7(3):199–207. · 0.32 Impact Factor
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    ABSTRACT: The authors report a case of a 63 year-old man who developed an excruciating lumbar pain and paraparesis because of a spinal epidural abscess caused by Serratia Liquefaciens. The MRI showed the level of the lesiono Surgical evacuation by laminectomy provided a definitive diagnosis, immediately relieved the pain and improved the neurological symptoms.
    Neurocirugia (Asturias, Spain) 01/1996; 7(3):223–226. · 0.32 Impact Factor
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    ABSTRACT: Today it is accepted that chronic infusion of baclofen produces significant relaxation and drastic reduction of spasms, amelioration of cramping pain and improvement of sphincter functions in spasticity of spinal cord origin. Based on these results our group had the opportunity of treating 11 cases with refractory spasticity and dystonic symptoms due to central damage caused by head injury in 8 cases and to cerebral palsy in 3 using cervical intrathecal infusion of baclofen. During the trial period with percutaneous intrathecal infusion of a daily bolus of 12.5-75 micrograms of baclofen through a reservoir, improvement of mentation and speech conditions, marked improvement of dystonic and abnormal movements of the upper limbs and trunk and a notable reduction of hypertonia were observed in all cases, which led to a better performance of motor activities in skilled acts and transfer. With these preliminary results in mind, in all cases the previous cervical subarachnoid catheter was attached to a programmable pump that infused a daily total dose varying from 100 to 190 micrograms of baclofen in a continuous or multistep complex mode. After a mean follow-up of 21 months previous results were long-lasting. Neither overdose side effects nor malfunction of the system were observed.
    Stereotactic and Functional Neurosurgery 02/1994; 62(1-4):108-12. · 1.48 Impact Factor
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    ABSTRACT: Previous studies of our group showed that C1-C2 spinal cord stimulation increases carotid and brain blood flow in normal conditions in the goat and dog and it has a beneficial vasomotor effect in a model of vasospasm in the rat. For further clinical application it seemed rational to investigate the possible vascular changes mediated by this technique in experimental brain infarction. To this aim, 45 New Zealand rabbits were used. Brain infarction was produced by bilateral carotid ligation in 15, unilateral microcoagulation of the middle cerebral artery in 15 and by microcoagulation of the vertebral artery at the craniocervical junction in the other 15. One week later, following daily clinical scoring and cortical and posterior fossa blood flow readings by laser Doppler, a period of 120 min of right C1-C2 spinal cord electric stimulation was performed. A mean of 27% increase in previous blood flow recordings was obtained at the right hemisphere and a mean of 32% in the posterior fossa. This procedure was used in 10 patients presenting with various cerebral low perfusion syndromes. Though not constant, an increase in alertness, retention, speech, emotional lability and performance in skilled acts was achieved. No MR changes were observed, though SPECT readings showed an increase in blood flow in the penumbral perilesional area.
    Stereotactic and Functional Neurosurgery 02/1994; 62(1-4):171-8. · 1.48 Impact Factor
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    ABSTRACT: Six patients with foramen magnum meningioma treated during the last two years are presented. Initial symptoms were reather ambiguous, mimicking cervical spondylosis in most of the cases. Definitive diagnosis was confirmed by posterior fossa and upper cervical canal CT scanning and MRI. With these imaging procedures a well delimited intradurally and extramedullary tumoral mass was found in all cases which was located laterally in 4 cases and anteriorly in 2 cases. In all cases, the intradural tumor was completely removed through a posterior approach via suboccipital craniectomy and upper cervical laminectomy. The diagnosis of meningioma was demonstrated by pathological study. After a mean follow-up of 9,5 months, the clinical outcome was satisfactory in most of the cases. In 5 patients marked recovery was observed and the other patient developed discrete hemiparesis. Recurrences have not been detected.
    Neurocirugia (Asturias, Spain) 01/1994; 5(3):230–236. · 0.32 Impact Factor
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    ABSTRACT: It is presumed today that spinal cord stimulation induces local delivery of vasoactive substances, such as prostacyclins, histamine, substance P, and vasoactive neuropeptides, in the perivascular environment and the vascular wall to mediate the segmental vasodilator response. To investigate this mechanism, 9 dogs were subjected to low thoracic spinal cord stimulation. Venous and arterial blood samples from the paraesthesic area in the lower limbs were obtained before and 120 min after stimulation to measure changes in the plasma concentration of vasoactive intestinal peptide, substance P, and histamine. The results were compared with those obtained from vessels of the upper limbs. Blood flow changes following stimulation were recorded by electromagnetic flowmeters. Local arterial vasoactive intestinal peptide showed a mean increase of 33% after 60 min of stimulation. Changes concerning substance P were inconclusive. Local arterial and venous histamine concentrations increased 26 and 29%, respectively, after 60 min of stimulation.
    Stereotactic and Functional Neurosurgery 02/1990; 54-55:224-31. · 1.48 Impact Factor
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    ABSTRACT: On the basis of previous experimental and clinical studies, 14 patients with severe spasticity due to central or spinal cord damage, resistant to all conservative treatments, were selected after a percutaneous trial period for chronic intrathecal baclofen infusion by programmable pumps. The agent was delivered at C4 in quadriplegic patients or in cases with central spasticity and in the neighbouring areas on the affected segments in paraplegic patients. The daily baclofen dose varied from 25 to 260 micrograms and was infused in a bolus, continuously infused or both combined according to the results during the trial period. After a mean follow-up period of 11 months, constant decrease of rigidity, absence of spasms, improvement of bladder function, cramping pain remission, and moderate improvement in walking capacity and transfer activities were usually observed. Neither complications nor side effects were noted.
    Stereotactic and Functional Neurosurgery 02/1990; 54-55:147-53. · 1.48 Impact Factor
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    ABSTRACT: It is presumed today that spinal cord stimulation induces local delivery of vasoactive substances, such as prostacyclins, histamine, substance P, and vasoactive neuropeptides, in the perivascular environment and the vascular wall to mediate the segmental vasodilator response. To investigate this mechanism, 9 dogs were subjected to low thoracic spinal cord stimulation. Venous and arterial blood samples from the paresthesic area in the lower limbs were obtained before and 120 min after stimulation to measure changes in the plasma concentration of vasoactive intestinal peptide, substance P, and histamine. The results were compared with those obtained from vessels of the upper limbs. Blood flow changes following stimulation were recorded by electromagnetic flowmeters. Local arterial vasoactive intestinal peptide showed a mean increase of 33&percnt; after 60 min of stimulation. Changes concerning substance P were inconclusive. Local arterial and venous histamine concentrations increased 26 and 29&percnt;, respectively, after 60 min of stimulation.
    Stereotactic and Functional Neurosurgery - STEREOTACT FUNCT NEUROSURG. 01/1990; 54:224-231.

Publication Stats

347 Citations
37.69 Total Impact Points

Institutions

  • 1994–2008
    • Hospital Clínico Universitario de Valencia
      Valenza, Valencia, Spain
  • 2007
    • University of Valencia
      • Surgery
      Valenza, Valencia, Spain
  • 1989–1998
    • Universidad de Salamanca
      • Departamento de Neurocirugía
      Helmantica, Castille and León, Spain
    • Hospital Universitario de Salamanca
      Helmantica, Castille and León, Spain