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ABSTRACT: To establish some therapeutic criteria about the treatment of AVMs of III, IV and V grade of Spetzler and Martin and to analyse the results in the subgroup of preoperative embolization plus surgery.
We perform a retrospective analysis of a group of 31 patients with arteriovenous malformations (AVMs) treated in our center between 1999 and 2004. There were 19 women and 12 men, with a mean age of 31.6 years old (range, 1-62a). Their symptoms upon admission were intracranial hemorrhage in 77.4%, seizures in 12.9%, headache, ischemic event and incidental finding in 3.2% each group. Diagnostic angiography was performed in 29 cases and anatomopathologic diagnostic in 2 cases. The malformations were classified with Spetzler and Martin Grading Scale, in 10.3% grade I, 24.1% grade II, 37.9% grade III, 24.1% grade IV and 3.4% grade V. Patients were classified in 6 subgroups of treatment (surgery, embolization, radiosurgery, embolization plus surgery, embolization plus radiosurgery and conservative treatment).
AVMs grade III, IV and V (19 patients) were treated with surgery (6 cases), embolization plus surgery (5 cases), but also other kind of treatments (embolization alone, radiosurgery and conservative) were used. Functional results in these groups of patients were 36.8% (7 cases) with no symptoms or slights symptoms (modified Rankin 0-1), 52.6% (10 cases) minor disability (mRankin 2), 5.3% (1 case) moderate disability and 5.3% (1 case) mortality. We observe a high rate of postembolization hemorrhage in the group of patients in which the combination of preoperative embolization plus surgery was used. In these cases, early surgery was performed with a good functional recovery. There was one case of postoperative mortality.
We should consider some factors like the natural history, clinical presentation (hemorrhage), angiographic features (deep arterial supply, aneurisms), Spetzler and Martin Grading and the clinical condition of the patient before treating a cerebral AVM. In the subgroup of treatment with embolization plus surgery, we recommend to achieve a subtotal preoperative embolization > 50%, not to obliterate more than 50% in one session, to perform staged embolization waiting from 4 to 6 weeks between procedures, and from 1 to 3 weeks between the last embolization and surgery.
Neurocirugia (Asturias, Spain) 10/2007; 18(5):394-404; discussion 404-5. · 0.54 Impact Factor
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ABSTRACT: Neurophysiological monitoring during surgery to avoid damaging of eloquent brain areas is a useful tool. We are performing intraoperative neurophysiological test to locate motor, sensitive and speech areas with cortical stimulation and cranial nerves during cerebellopontine cranial base surgery. Neurophysiological monitoring during brain stem surgery has been less described. Brain stem surgery implies a careful selection of patients for surgery given the high risk of morbidity and mortality. For this reason, conservative treatment is usually indicated when an asymptomatic cavernoma is incidentally found. Instead, when bleeding or neurological deficit appear, operative treatment may be indicated and then the goal of surgery is to avoid the disability linked to the natural history. We present the case of a 29 year old woman with diagnosis of multiple cavernomas. She was admitted at our hospital because she presented weakness and sensitive disturbance of left limbs and dizziness. The CT scan and MRI showed a pontine haemorrhage caused by a cavernous hemangioma. We operated her on using neurophysiological monitoring of VII, VIII, X and XII cranial nerves with electromyographic recordings. Postoperative disability could be reduced with a better knowledge of entry zone into the brain stem and early physiotherapy.
Neurocirugia (Asturias, Spain) 05/2005; 16(2):117-23. · 0.54 Impact Factor
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ABSTRACT: The authors report the case of a 78-year-old woman suffering from right occipital neuralgia in whom computerized tomography and magnetic resonance images demonstrated an irregular bone mass in the C-2 vertebral body. This "bone tumor" happened to be an exuberant callus formation that arose as a result of a previous axis body fracture. The patient's occipital pain was immediately relieved after she underwent C2-3 root release.
Journal of Neurosurgery 01/1997; 85(6):1170-1. · 2.96 Impact Factor
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European Neurology 02/1996; 36(4):239-40. · 1.81 Impact Factor
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ABSTRACT: Up to 40% of the patients with cancer have cerebral metastases, so that their incidence in the general population reaches 0.15%. Different treatments for metastases have been described. Most aim to eradicate one or several metastases so as to improve the quality of life and life expectancy of the patients.
The main factors determining the prognosis and indication for surgery are age, functional state and extent of the neoplastic disease. The presence of more than one metastasis does not contraindicate surgery.
The development of new surgical techniques over the past twenty years has led to a reduction in operative morbidity and mortality. Surgery followed by holocranial radiotherapy is still the method of choice for the treatment of metastases. In cases in which surgical treatment is not indicated, radiosurgery may be done.
Revista de neurologia 31(12):1247-9. · 0.65 Impact Factor
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Neurocirugía: Organo oficial de la Sociedad Española de Neurocirugía, ISSN 1130-1473, Vol. 16, Nº. 2, 2005, pags. 117-123.
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ABSTRACT: Objetivos. Establecer unos criterios terapéuticos en las malformaciones arteriovenosas (MAVs) grados III, IV y V de Spetzler y Martin y análisis de resultados en el subgrupo de tratamiento con embolización más cirugía. Material y métodos. Estudio retrospectivo de 31 pacientes con MAVs cerebrales tratados en nuestro servicio entre 1999 y 2004. Se trata de 19 mujeres y 12 hombres, con una edad media de 31,6 años (rango de 1 a 62a). La forma de presentación fue en un 77,4% hemorragia intracraneal, en un 12,9% crisis comicial y en un 3,2% cefalea, infarto isquémico y hallazgo casual en cada uno de ellos. En 29 casos se realizó arteriografía diagnóstica y en 2 casos el diagnóstico fue anatomopatológico. Según la clasificación de Spetzler y Martin, 10,3% fueron de Grado I, 24,1% de Grado II, 37,9% de Grado Ill, 24,1% de Grado IV y 3,4% de Grado V. Se clasificaron en 6 grupos según el tratamiento realizado (cirugía, embolización, radiocirugía, embolización más cirugía, embolización más radiocirugía y tratamiento conservador). Resultados. Las MAVs grado III, IV y V (19 pacientes) fueron tratadas en su mayoría por cirugía (6 casos) y embolización más cirugía (5 casos) pero también se utilizaron otras modalidades de tratamiento (embolización, radiocirugía y conservador). Los resultados funcionales de estos 3 subgrupos muestra un 36,8% (7 casos) de asintomáticos o con mínimos síntomas (Rankin m 0-1), un 52,6% (10 casos) de discapacidad leve pero independientes (Rankin m=2), un 5,3% (1 caso) de moderada discapacidad (Rankin m=3), y un 5,3% (1 caso) de mortalidad. En el manejo combinado embolización más cirugía de malformaciones complejas, se observa un alto porcentaje de sangrado postembolización que motivó cirugía precoz con buen resultado funcional. Hubo un caso de mortalidad postquirúrgica. Conclusiones. En el tratamiento de las MAVs cerebrales se debe tener en cuenta factores como la historia natural, la forma de presentación (hemorragia), las características angioestructurales (presencia de aporte arterial profundo, aneurismas), la escala de Spetzler y Martin y el estado clínico del paciente. En el tratamiento con embolización más cirugía es recomendable obtener una embolización prequirúrgica subtotal > 50%, no ocluir más del 50% por sesión, mantener un intervalo entre sesiones de embolización entre 4 y 6 semanas y un intervalo entre última embolización y cirugía entre 1 y 3 semanas.
Neurocirugía: Organo oficial de la Sociedad Española de Neurocirugía, ISSN 1130-1473, Vol. 18, Nº. 5, 2007, pags. 394-405.
