Alberto Prats-Galino

• MD, PhD
• Managing Director at University of Barcelona

Introduction The meningo-orbital band (MOB) is an intricate dural structure extending between the periorbita, the frontal dura, and the temporal dura. The endoscopic transorbital approach (ETOA) provides a more thorough understanding of its anatomy. Materials and methods Anatomical dissections were performed on 15 human head specimens (30 orbits)...

BACKGROUND AND OBJECTIVES Several surgical techniques have been developed to treat mesial temporal lobe epilepsy, the most common form of drug-resistant epilepsy. Although surgical treatment for mesial temporal lobe epilepsy has proven to be highly effective in controlling seizures and improving patients' quality of life, it carries potential risk...

The clinoidal segment of the internal carotid artery (ICA) is a complex transition zone between the intracavernous and intradural spaces. It is bordered by the distal dural ring (DDR), proximal dural ring (PDR), and anterior clinoid process (ACP). This study provides an endoscopic anatomical analysis of the clinoidal region using the endonasal endo...

Objective: to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex). Methods: Anatomical dissections were performed bilaterally on two human cadaveric heads via a transorbital approach, in which screws and...

Nowadays, consent to use donor bodies for medical education and research is obtained from the body donors and their families before the donation. Recently, the International Federation of Associations of Anatomists (IFAA) published guidelines that could restrict the appearance of cadaveric images in commercial anatomical resources such as textbooks...

Cauda equina nerve roots may become damaged during neuraxial anesthesia, and post-puncture headache may appear in the case of cerebrospinal fluid leakage if needle tips are deformed due to bone contact when several attempts are needed. Our aim was to verify the correlation between skin–transverse process distance (st) and skin–dural sac distance (d...

Background Different approaches to the obturator nerve have been described. However, few have focused on the injection point inferior the iliopubic ramus, specifically at the exit of the obturator canal. This study aims to anatomically evaluate the ultrasound-guided obturator nerve block at the exit of the obturator canal, detailing anatomical land...

BACKGROUND Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle. OBJECTIVE Our hypothesis was that the anaesthetic injectate would fully cover both...

The petrous apex is the bony limit at the postero-medial middle fossa floor, separating it from the posterior fossa. It is the antero-medial portion of the petrous part of the temporal bone, and it is surrounded by multiple neurovascular structures. The petrous apex area, though deep-seated, can be reached via the endoscopic transorbital approach,...

OBJECTIVE: to study the anatomical feasibility of laser fiber insertion for interstitial thermal therapy via transorbital approach to the temporo-mesial structures (amygdala-hippocampus-parahippocampus complex) METHODS: Anatomical dissections were performed on two human cadaveric heads via a transorbital approach, in which screws and laser fibers w...

The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community. Beginning with an introduction and historical persp...

BACKGROUND AND OBJECTIVES Minimally invasive endoscopic approaches in cranial base surgery have been developing in the past decades. The transorbital (TO) route is one promising alternative, yet its adequacy for intracranial vascular lesions remains unclear. The present anatomic work aimed to test the feasibility and to provide a qualitative descri...

Background The erector spinae plane block (ESP block) is frequently employed for thoracic, abdominal, and spinal surgeries, yet its precise mechanism of action remains a subject of debate. While initially postulated to influence both ventral and dorsal rami of the spinal nerve, recent studies indicate a predominant impact on the dorsal rami with li...

OBJECTIVE The endoscopic transorbital approach (ETOA) has been demonstrated to be a feasible ventral route to the petrous apex. Yet, it has been pointed to as a deep and narrow corridor for anterior petrosectomy; particularly, medialization of the instruments can become an issue when targeting the petroclival area. To overcome this limitation, an E...

Background The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still,...

OBJECTIVE The endoscopic superior eyelid transorbital approach has garnered significant consideration and gained popularity in recent years. Detailed anatomical knowledge along with clinical experience has allowed refinement of the technique as well as expansion of its indications. Using bone as a consistent reference, the authors identified five m...

This chapter aims to describe the gross and microscopic anatomy of structures within the spinal canal, which are the targets of drugs used for various medical treatments and procedures presented in this book. This chapter also describes the barriers protecting axons that shape the nervous system at the spinal level. A detailed description is made o...

Application for ESRA Abstract Prizes I apply as an Anesthesiologist (Aged 35 years old or less) Background and Aims Genicular nerve block (GNB) is an increasingly popular technique for pain relief after knee surgery. However, the reproducibility in terms of local anesthetic diffusion in each nerve of the block remains unclear. The objective of pre...

Background and Aims A freely available visual guide with optimal angles for paramedian approaches, depending on the skin-dural sac distance (S-DS-d) (http://diposit.ub.edu/dspace/handle/2445/179594 ) and viable paths for needle insertions, perpendicular to the back, below the upper spinous process in a given interspinous space, had been described....

Background and Aims Suprascapular nerve block (SSNB) is commonly used for shoulder analgesia. Two approaches are described but associated with risk and difficulties. We designed a cadaveric anatomical study to assess availability of an easier posterior approach. Methods The probe is place above the scapula, move from medial to lateral to identify...

Background and Aims A freely available visual guide with optimal angles for paramedian approaches, depending on the skin-dural sac distance (S-DS-d) (http://diposit.ub.edu/dspace/handle/2445/179594 ) and viable paths for needle insertions perpendicular to the back, below the upper spinous process in a given interspinous space, had been described. O...

BACKGROUND AND OBJECTIVES The superior eyelid endoscopic transorbital approach has rapidly gained popularity among neurosurgeons for its advantages in the treatment, in a minimally invasive fashion, of a large variety of skull base pathologies. In this study, an anatomic description of the internal carotid artery (ICA) is provided to identify risky...

Objective Starting from an anatomic study describing the possibility of reaching the temporal region through an endoscopic transorbital approach, many clinical reports have now demonstrated the applicability of this strategy when dealing with intra-axial lesions. The study aimed to provide both a qualitative anatomic description of the temporal reg...

Background The clavipectoral fascia plane block (CPB) is a novel anesthetic management strategy proposed by Valdes-Vilches for clavicle fractures. This study aimed to investigate the distribution of the injected solution around the clavicle and the surrounding tissues. Methods Twelve clavicle samples were acquired from six cadavers. CPB was conduc...

Dissection Rooms (DRs) are key facilities that allow teaching and research on human anatomy, where students and researchers work with human bodies to acquire, increase, or create new knowledge. Usually, DRs work with a Body Donation Program (BDP), where living donors bequeath their bodies for use in teaching and research after they expire. Despite...

Introduction Paraspinal fascial plane blocks have become popular and include the erector spinae plane (ESP) and intertransverse process (ITP) blocks. Controversy exists regarding the exact mechanism(s) of these blocks. We aimed to evaluate the spread of local anesthetic (LA) following ESP and ITP blocks as compared with paravertebral (PV) blocks in...

Objectives: To conduct brainstem MRI shape analysis across neurodegenerative parkinsonisms and control subjects (CS), along with its association with clinical and cerebrospinal fluid (CSF) correlates. Methodology: We collected demographic and clinical variables, performed planimetric and shape MRI analyses, and determined CSF neurofilament-light...

Purpose The petroclival region represents the “Achille’s heel” for the neurosurgeons. Many ventral endoscopic routes to this region, mainly performed as isolated, have been described. The aim of the present study is to verify the feasibility of a modular, combined, multiportal approach to the petroclival region to overcome the limits of a single ap...

Background: Combined endonasal and transorbital multiportal surgery has been recently described for selected skull base pathologies. Nevertheless, a detailed anatomic description and a quantitative comprehensive anatomic study of the skull base areas where these 2 endoscopic routes converge, a so-called connection areas, are missing in the scienti...

Background: The cavernous sinus (CS) is accessed through several approaches, both transcranially and endoscopically. The transorbital endoscopic approach is the newest proposed route in the literature. Objective: The aim is to quantify and observe the areas of the CS reach from 2 endoscopic and 1 transcranial approaches to the CS in the cadaver...

Objective Superior eyelid endoscopic transorbital approach (SETOA) is nowadays gaining progressive application in neurosurgical scenarios. Both anatomic and clinical reports have demonstrated the possibility of taking advantage of the orbital corridor as a minimally invasive route to reach anterior and middle cranial fossae and manage selected surg...

Background In the last decades, skull base surgery had passed through an impressive evolution. The role of neuroanatomic research has been uppermost, and it has played a central role in the development of novel techniques directed to the skull base. Indeed, the deep and comprehensive study of skull base anatomy has been one of the keys of success o...

Introduction Inadvertent intraneural injection is not infrequent during peripheral nerve blocks. For this reason, injection pressure monitoring has been suggested as a safeguard method that warns the clinician of a potentially hazardous needle tip location. However, doubts remain whether it is superior to the sonographic nerve swelling in terms of...

Background: There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conve...

Background: The endoscopic superior eyelid transorbital route to the skull base is gaining progressive popularity in the neurosurgical community. Objective: To evaluate the anatomy of the middle cranial fossa from this novel ventral perspective to reach the skull base through the transorbital route and to show limits for possible safe middle fos...

Background and Aims Continuous peripheral nerve blocks (cPNB) are widely used and have potential benefits for providing pain relief for several days. Successful insertion of cPNBs and avoidance of their dislocation can represent a challenge.Dislocation of cPNBs can result in failure of the block and is poorly described in the literature. The rate o...

Background Epilepsy surgery has played an important role in the treatment of patients with medically intractable seizures. Different authors have proposed an endoscopic technique to perform disconnective procedures. However, a detailed description of intracerebral anatomy seen through an endoscopic transcallosal corridor has never been reported. Ou...

Background: The recent development of the superior eyelid endoscopic transorbital approach (SETOA) offered a new route for the management of cavernous sinus and middle cranial fossa tumors. As a result, a constant anatomic landmark of the surgical pathway after drilling the medial edge of the greater sphenoid wing (GSW) is represented by a triangu...

Spinal anesthesia can be affected by gaps in the ligamentum flavum that may confuse epidural needle placement; cause Quincke needle deformation if the vertebral bone is hit, expanding the dural sac hole and leading to cerebrospinal fluid (CSF) leakage and post-dural puncture headache; and variability in CSF volume, altering intrathecal drug dilutio...

Computer applications have been incorporated as valuable elements in teaching, thanks to the innovation of new technologies in recent decades. The implementation of these computer developments in the field of medical education has been a true revolution. The authors present a computer development designed for PC environments that allows visualizing...

The latest technological advances in postprocessing of images have made possible the generation of three-dimensional (3D) models from 2D radiological images. The use of these models in PDF file allows interaction, providing useful visualization tools and management that facilitate the work and understanding of the anatomical region of the study are...

The neurosurgical practice is always evolving, achieving new technologies and new techniques every day. From the beginning in the anatomic laboratory, the neurosurgeon could visualize on specimens all the structures and all the areas of the brain. When facing a lesion, the treatment must be carefully planned, and all the information collected by ea...

Background The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical...

Background Injection pressure monitoring using in-line devices is affordable and easy to implement into a regional anesthesia practice. However, solid evidence regarding their performance is lacking. We aimed to evaluate if opening injection pressure (OIP), measured with a disposable in-line pressure monitor, can prevent intraneural (subepineural)...

Objective: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesi...

Objective To better understand the unexpected spread of contrast medium observed by conventional fluoroscopic X‐ray images during standard neuraxial techniques used in the treatment of pain. The support of 3D reconstruction of MRI images of structures within the lumbar spine was used to better understand the space of Okada. Methods Lumbar facet jo...

Background and objective: Surgical approaches to the petrous apex region are extremely challenging; while subtemporal approaches and variations represent the milestone of the surgical modules to reach such deep anatomical target, in a constant effort to develop minimally invasive neurosurgical routes, the endoscopic endonasal approach (EEA) has be...

The Extended Frontal Aslant Tract (exFAT) is a recently described tractography-based extension of the Frontal Aslant Tract connecting Broca’s territory to both supplementary and pre-supplementary motor areas, and more anterior prefrontal regions. In this study, we aim to characterize the microstructural properties of the exFAT trajectories as a mea...

The extended frontal aslant tract (exFAT) is a tractography-based extension of the frontal aslant tract (FAT) which has been shown to be related with language and working memory performance in healthy human adults, but whether those functional implications map to structurally separate regions along its trajectory is still an open question. We prese...

The course of the internal carotid artery (ICA) and its segment classifications were reviewed by means of a new and freely available 3D interactive model of the artery and the skull base, based on human neuroimages, that can be freely downloaded at the Public Repository of the University of Barcelona ( http://diposit.ub.edu/dspace/handle/2445/11244...

Aim: To assess the feasibility of using an endoscopic-assisted lateral supraorbital (LSO) approach and an endoscopic endonasal transclival approach (EETA) for basilar apex (BAX) aneurysms. Material and methods: Ten cases with LSO approaches, with or without posterior clinoidectomy and endoscopic assistance, and 10 cases with EETA, with or withou...

Objectives. Anatomy of the craniovertebral junction (CVJ) includes the foramen magnum located in the occipital bone, atlas (C1), and axis (C2) united by ligaments and muscles, the lower cranial and upper spinal nerves, the caudal brainstem and rostral spinal cord, the vertebral arteries and their branches, the venous drainages through the jugular v...

The Kocher-Monro trajectory to the cerebral ventricular system represents one of the most common surgical procedures in the field of neurosurgery. Several studies have analyzed the specific white matter disruption produced during this intervention, which has no reported adverse neurological outcomes. In this study, a graph-theoretical approach was...

A computer development that allows to visualize and interact with the musculature of the female pelvis reconstructed from serial sections of high resolution magnetic resonance in a virtual environment is presented. The possibilities of representing these structures three-dimensionally in any spatial orientation, together with sectional radiological...

In recent years there has been an accelerated technological development in all areas of life, including teaching and learning, especially in health sciences and Human Anatomy. This study offers an interactive system which creates three dimensional anatomic models of the eyeball and visual pathway for educational and clinical purposes. The tool is b...

We pretend show the possibilities of use and handling of three-dimensional biomedical models (3D) stored in PDF (portable document format). It is used in the maxillofacial region. Many free and paid programs are available for the creation of 3D models. Currently, the latest versions of the computed tomography (CT) machines software include compatib...

STUDIO COMPARATIVO MEDIANTE LE VIE TRANSORBITARIA ED ENDONASALE

STUDIO COMPARATIVO MEDIANTE LE VIE ENDONASALE E TRANSORBITARIA

Resumen Introducción El bloqueo en el plano del erector espinal (erector spinae plane [ESP]) a nivel torácico se ha introducido cómo método analgésico postoperatorio. Sin embargo, a pesar de que su empleo a nivel lumbar ha sido publicada, su distribución y su mecanismo de acción no han sido esclarecidos. Nos propusimos describir la técnica de punc...

Introduction Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20 ml of solution administered at the leve...

Purpose: The erector spinae plane (ESP) block is an interfascial analgesic technique first described as an alternative for pain control at the thoracic level. The objective of this observational study was to determine the anatomical spread of dye following a T7 ESP block in a cadaveric model. Methods: An ultrasound-guided ESP block was performed...

Background and objective Management of selected spheno-orbital meningiomas via the endoscopic transorbital route has been reported. Surgical maneuverability in a narrow corridor as that offered by the orbit may be challenging. We investigate the additional use of an extra-orbital (EXO) path to be used in combination with the endo-orbital (EO) corri...

Objective: Our aim was to study the posterior lumbar epidural space with 3D reconstructions of magnetic resonance images (MRIs) and to compare and validate the findings with targeted anatomic microdissections. Design: We performed 3D reconstructions of high-resolution MRIs from seven patients and normal-resolution MRIs commonly used in clinical...

Computer applications have been incorporated as valuable components in teaching, especially thanks to the advancement and innovation of new technologies during the last decades. The implementation of these computer developments in medicine and in the field of medical teaching with different utilities has been a revolution. This is manifested with g...

A widely known alternative for reading and exchanging digital files is the PDF file, by Adobe. This type of file has become the most used for the electronic exchange of files. It is platform-independent, suitable for the exchange of medical data in electronic academic publication. PDF can support additional resources such image, media, even, three-...

PDF is a standard file format to present and exchange documents reliably, independent of the software, hardware or operating system. Therefore, it is very useful and is widely used for the communication of information through the Internet and for the electronic academic publication. The PDF allows embedding 3D objects in the latest versions, and al...

Computer developments as didactic resources are gaining an increasingly relevant role as new technologies are integrated into the teaching activity. A good knowledge and interpretation of radiological procedures, such as nuclear magnetic resonance and ultrasound, is essential to carry out correct clinical diagnoses, especially in an anatomical area...

The fascia iliaca compartment is the compartment confined by the fascia iliaca (FI) and a muscular layer formed by the iliac- and psoas muscle. This compartment creates a virtual tunnel that contains the femoral nerve (FN), the obturator nerve (ON), and the lateral femoral cutaneous nerve (LFCN) of the lumbar plexus. In this pilot study, we aimed t...

Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was p...

( Reg Anesth Pain Med 2017;42:709–718) Postdural puncture headache (PDPH) is commonly explained by intracranial hypotension due to cerebrospinal fluid leakage. An association between larger size dural punctures and an increased incidence of PDPH has been widely accepted. It was generally believed that pencil-point type needles produced smaller dura...

The Frontal Aslant Tract (FAT) is a tract recently described as having implications on language function. The originally proposed anatomical FAT definition characterizes a connection between Broca’s territory and anterior supplementary and pre-supplementary motor areas in the Superior Frontal Gyrus (SFG). Here we propose an extended definition of t...

Working memory groups. Boxplots showing adjusted exFAT volume index distribution in working memory extreme groups. The triangle indicates the mean value. Whiskers extend 0.5*IQR beyond the first and third quartile lines. Notches indicate confidence interval around the median. (TIF)

Descriptors for global sample. Histograms (1, 2) and scatter plots (3, 4, 5, 6) characterizing the global sample (N = 834) for left (1, 3, 5) and right (2, 4, 6) exFAT adjusted volume indices. (TIF)

Language extreme groups. Boxplots showing adjusted exFAT volume index distribution in language extreme groups. The triangle indicates the mean value. Whiskers extend 0.5*IQR beyond the first and third quartile lines. Notches indicate confidence interval around the median. (TIF)

We analyzed a total of 36 partial or complete mummies containing neural structures from Sharuna and Qarara (Middle Egypt) and Dra Abu-el Naga, West Thebes (Upper Egypt). Individual TT16 13.3-B06-Ind07 corresponded to a partial mummy from T2 to T11. At distal levels, it showed a structure compatible with the lower spinal cord (SC). Under magnificati...

BACKGROUND Treatment of intrinsic lesions of the ventral brainstem is a surgical challenge that requires complex skull base antero- and posterolateral approaches. More recently, endoscopic endonasal transclival approach (EETA) has been reported in the treatment of selected ventral brainstem lesions. OBJECTIVE In this study we explored the endoscop...

OBJECTIVE The extended endoscopic endonasal transtuberculum transplanum approach is currently used for the surgical treatment of selected midline anterior skull base lesions. Nevertheless, the possibility of accessing the lateral aspects of the planum sphenoidale could represent a limitation for such an approach. To the authors’ knowledge, a clear...

Background: While the subtemporal approach represents the surgical module milestone designed to reach the petrous apex, a novel ventral route, which is the superior eyelid endoscopic transorbital approach, has been proposed to access the skull base. Accordingly, we aimed to evaluate the feasibility of this route to the petrous apex, providing a qu...

We describe a new and freely available 3D interactive model of the intracranial internal carotid artery (ICA) and the skull base that also allows to display and compare its main segment classifications. High-resolution 3D human angiography (isometric voxel's size 0.36 mm) and Computed Tomography angiography images were exported to Virtual Reality M...