Pablo Miranda

BACKGROUND AND OBJECTIVES In patients with syndromic craniosynostosis, early synostosis of the cranial base synchondroses may occur, potentially increasing the frequency of abnormalities in the cranial base. We aim to estimate the prevalence of platybasia, basilar invagination, odontoid retroflexion, Chiari malformation type I (CMI), and cervical s...

To review a multicentric series of lateral-type posterior fossa ependymomas operated in the last ten years and to analyze the factors related to clinical evolution and tumor survival. Descriptive, retrospective study. Active members of the Spanish Society of Pediatric Neurosurgery were invited to participate in this multicentric study. Clinical and...

Purpose Endoscopic endonasal approaches in the pediatric population pose specific challenges. Management of postoperative cerebrospinal fluid [CSF] leak is probably the major concern. The purpose of the present investigation is to describe and analyze the incidence of postoperative CSF leaks in our pediatric series of endoscopic endonasal approache...

Purpose: To present a descriptive analysis of pediatric craniopharyngiomas (PedCPG) treated in various Spanish hospitals, defining factors related to recurrence and performing a critical analysis of the results. Methods: We undertook a multicenter retrospective review of PedCPG treated between 2000 and 2017. Data collected included epidemiologic...

Introduction: Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results. Objective: To review the cli...

Objectives The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effe...

Introduction Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results. Objective To review the clinica...

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as th...

Background: Gangliogliomas are neoplastic lesions composed by a mixed population of neoplastic glial and dysplastic neural cells. They represent around 5% of all CNS tumors in the pediatric population. These usually are well-differentiated, slow-growing tumors, meaning that complete resection could cure most of these patients. Although most lesion...

Objective The endoscopic endonasal odontoidectomy (EEO) is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we show EEO in the basilar invagination (BI) and describe in detail the technical aspects, advantages, and disadvantages of this approach (Fig. 1). Methods We describe EEO using audi...

A 12-year-old girl presented with headache, nasal voice, and anosmia. Magnetic resonance imaging demonstrated a 11 × 9 × 8-cm tumor extending from the nasal cavity to the frontal lobes. Histological analysis was consistent with transitional meningioma WHO grade I. As far as we know, this is the first reported case of a giant olfactory groove mening...

CSF rhinorrhea is a rare presenting symptom of a clival chordoma as these tumors do not tend to show dural invasion as a histological feature. Here we discuss the case of a 61 years old female with spontaneous rhinorrhea secondary to a clival chordoma, and the value of some specific MRI sequences in accurate identification of a tumor with such atyp...

Background Closure of the skin defect in myelomeningocele repair determines the quality of the surgical result. In large myelomeningoceles, the direct closure or by skin undermining may not be possible. In these cases, the skin defect must be closed using flaps to provide a tension-free and successful closure. Methods In this procedure, after neur...

Purpose Hydrocephalus is a common condition in pediatric neurosurgeon’s clinical practice. Peritoneal and atrial shunting is the treatment of choice in the immense majority of patients. Sometimes, there are complex cases that may need innovative solutions in order to implant the distal catheter of the shunt: in these situations, the gallbladder is...

Background The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the end...

Cranial deformation in infants is a common problem in paediatric consultations. The most accurate medical diagnostic imaging methodologies are Computed Tomography (CT) and Magnetic Resonance Image (MRI). However, these radiological imaging technologies involve high costs and are invasive, especially for infants. Therefore, they are only used for se...

OBJECTIVE One of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and cl...

Resumen Objetivos: Descripción del protocolo diagnóstico y técnica quirúrgica para el manejo de un quiste hidatídico cerebral gigante en una paciente de edad pediátrica. Métodos: Se presenta el caso de una paciente de 8 años de origen marroquí, con historia de cefalea mensual de un año de evolución, exacerbada dos días previo al ingreso y asociada...

The use of smartphones cameras for photogrammetric purposes is increasing. However, the suitability of smartphones for 3D modelling for medical purposes in general, and for cranial deformation in particular, is still to be analysed. This paper investigates the suitability of smartphone video cameras to create 3D models for cranial deformation analy...

Cranial deformation affects a large number of infants. The methodologies commonly employed to measure the deformation include, among others, calliper measurements and visual assessment for mild cases and radiological imaging for severe cases, where surgical intervention is considered. Visual assessment and calliper measurements usually lack the req...

Background: The surgical approach to the petrous apex (PA) and petroclival junction (PCJ) remains a challenge. The carotid-clival window (CCW) represents the widest window available to approach the PCJ from a mediolateral endoscopic route. Here we define the CCW radiologically in nonpathological conditions, to establish the anatomic variability of...

Background: Cranial deformation, including deformational plagiocephaly, brachycephaly and craniosynostosis, is a condition that affects a large number of infants. Despite of its prevalence there are no standards for the systematic evaluation of the cranial deformation. Usually, the deformation is manually measured using callipers. However, experts...

Background In this work, the applicability of ICG-VA to skull base endoscopic surgery and its capacity to locate the internal carotid artery are shown. Methods An adapted optical module to perform ICG-VA was used to perform endoscopic procedures. There were two intraoperative phases of interest that were used to evaluate the ICA: upon exposure of t...

Background: Surgical approaches to skull base lesions that affect the maxillary nerve are complex, due to deep location and presence of relevant neurovascular structures surrounding this area. Method: We propose the transantral endoscopic approach (TEA) for the treatment of lesions affecting the maxillary nerve or its vicinity. More specifically...

Introduction This work reports the first indocyanine green videoangiography (IGV) in negative published with video format support. This technique, so called because its first phase is performed with occlusion of the vessel suspected of being pathologic, is used for the diagnosis of spinal arteriovenous fistula (sDAVF). Case Report The authors pres...

Background: Progesterone has been associated with robust positive effects in animal models of traumatic brain injury (TBI) and with clinical benefits in two phase 2 randomized, controlled trials. We investigated the efficacy and safety of progesterone in a large, prospective, phase 3 randomized clinical trial. Methods: We conducted a multination...

Indocyanine green videoangiography (ICGVA) procedures have become widespread within the spectrum of microsurgical techniques for neurovascular pathologies. We have conducted a review to identify and assess the impact of all of the methodological variations of conventional ICGVA applied in the field of neurovascular pathology that have been publishe...

Background: The petroclival junction (PCJ) is a challenging skull base location from neurosurgical point of view, especially if the retrocarotid space has to be reached. Method: In response to this challenge, this report provides a detailed full description of the endoscopic endonasal expanded approach (EEA) to the petroclival region and retroca...

Meckel's cave is an anatomically complex region that can be approached surgically via several routes, namely the posterolateral, lateral, anterolateral, and, due to recent advancements, anteromedial routes, with the latter being represented by the expanded endonasal approaches. We describe in detail the surgical technique of the suprapetrous endona...

Introducción Los meningiomas sin implantación dural MSID son una rara entidad. Presentamos el primer caso publicado en nuestro conocimiento, de MSID implantado en la superficie ventral del tronco cerebral. Dicha localización permite la realización de un abordaje quirúrgico endonasal expandido transclival para su tratamiento. Caso clínico Paciente...

The endoscopic techniques used in pituitary surgery have evolved greatly in recent years. Our objective in this study was to conduct a review of the systematic reviews published in the English language literature, to examine their consistency and conclusions reached following studies comparing microsurgery and endoscopic surgery in hypophyseal surg...

Introduction and objective The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review of the likewise systematic reviews in published English language literature, to examine the evidence and conclusions reached in these studies comparing tra...

The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review of the likewise systematic reviews in published English language literature, to examine the evidence and conclusions reached in these studies comparing transcranial and endoscopic ap...

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with...

The complex anatomical relationships within the skull base have been described from an endoscopic point of view. However, systematic surgical, not just anatomical, management of the eustachian tube (ET) and the approach to the styloid and parapharyngeal spaces have not yet been described. The authors describe the full endoscopic endonasal extreme f...

Purpose Indocyanine green videoangiography (IGV) has proven its effectiveness in the field of exovascular neurosurgery, both in the intracranial and spinal compartment, but is necessary to define a systematic process for the performance of the IGV to facilitate its interpretation during the procedure. We have defined and applied the concept of vide...

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with...

IntroductionWe report a fully endoscopic transcribiform-transfovea ethmoidalis endonasal expanded approach (EEA) for the treatment of esthesioneuroblastoma and review the literature about this entity available in English, establishing a precise surgical technique and describing our intraoperative experience.Case reportOur patient was a 65-year old...

We report a fully endoscopic transcribiform-transfovea ethmoidalis endonasal expanded approach (EEA) for the treatment of esthesioneuroblastoma and review the literature about this entity available in English, establishing a precise surgical technique and describing our intraoperative experience. Our patient was a 65-year old female with anosmia an...

Expanded endonasal approaches (EEA) are becoming a first-level technique for the treatment of skull base pathologies. In some cases, the endoscopic procedures make it possible to dissect structures manipulated with greater difficulty in the classic approaches. We report a full endoscopic transpterygoid EEA for the treatment of a fibrous dysplasia (...

IntroductionExpanded endonasal approaches (EEA) are becoming a first-level technique for the treatment of skull base pathologies. In some cases, the endoscopic procedures make it possible to dissect structures manipulated with greater difficulty in the classic approaches. We report a full endoscopic transpterygoid EEA for the treatment of a fibrous...

Intraventricular haemorrhage and posthemorrhagic hydrocephalus are the most important neurological complications in preterm infants during the neonatal period91. The prevalence of germinal matrix-intraventricular haemorrhage widely varies depending on the population of study19,36,47,56,61,71,93, but it is in any case increasing due both to the high...

Intraventricular haemorrhage and posthemorrhagic hydrocephalus are the most important neurological complications in preterm infants during the neonatal period. The prevalence of germinal matrix intraventricular haemorrhage widely varies depending on the population of study, but it is in any case increasing due both to the higher incidence of multip...

Obstruction is the most common complication of ventriculoperitoneal shunts in patients with hydrocephalus. Despite technical advances, rates of obstruction have barely decreased and remain at over 40% of cases. Patients suffering from preterm-related posthaemorrhagic hydrocephalus are considered a group with a particularly high risk of obstruction....

The expanded endonasal approaches to the skull base are modular approaches that arise from the sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications. Available flaps for reconstruction include the pedicled nasoseptal flap, the transpterygoid temporoparietal fascia flap, and the posterior pe...

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of...

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of...

Spondylotic cervical mielopathy is a common complication in young patients with Cerebral Child Palsy with an important dystonic and athetoid component. Its surgical treatment is a challenge, due to elevate incidence of early faliure of the arthrodesis, both in anterior and posterior approaches. We report an historical review about the treatment of...

Introduction We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. Case report A 60 years old woman consulted with doctor because she fe...

Introduction. We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. Case report. A 60 years old woman consulted with doctor because she f...

we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. a 60 years old woman consulted with doctor because she felt progressive clumsiness...

Intraventricular hemorrhage and posthemorrhagic hydrocephalus are the most important neurological complications in preterm infants during the neonatal period. The incidence of germinal matrix-intraventricular hemorrhage widely ranges from 5% to 90%, depending on the population of study. Although the incidence of intraventricular hemorrhage increase...

In patients with traumatic spinal cord injury, several studies correlate neurological impairment and radiological findings. However, little information is available about this correspondence in the particular group of acute traumatic central cord syndrome. The object of the present work was to describe the clinical and radiological features of a se...

Introduction Meningiomas are relatively uncommon in childhood. They represent 1% to 2% of all intracranial tumours of infancy and childhood and 1.5% to 1.8% of all intracranial meningiomas. Occasionally, meningiomas may develop without dural attachment. Clear cell meningioma is a histological distinctive uncommon variant of meningioma that may beha...

Spinal intramedullary lipoma extending to the posterior fossa is very rare in children. We made a revision of the literature and report the diverse opinions and surgical procedures. We report the case of a 16-month-old male infant who was operated on in the Pediatric Neurosurgical Unit of our hospital; his clinical and surgical outcome are related....

La regresión espontánea de las malformaciones arteriovenosas cerebrales (MAVs) es poco frecuente. Este hecho parece ser más común en aquellas MAVs de pequeño tamaño, cuyo modo de presentación clínica preferente es con hemorragia cerebral, con una única arteria aferente, y una sola vena de drenaje. No se conocen con exactitud cuáles son los factores...

Spontaneous regression of intracranial arteriovenous malformations (AVMs) is a rare phenomenon. Such an event is more likely to occur with small AVMs that present with intracranial hemorrhage, which are fed by a unique artery and drained through a single vein. The factors responsible for AVMs regression remain unclear. Thrombosis of the AVM seconda...

The objective of this study was to describe clinical and radiological features of a series of patients presenting with Brown-Sequard syndrome after blunt spinal trauma and to determine whether a correlation exists between cervical plain films, CT, MRI and the clinical presentation and neurological outcome. A retrospective review was done of the med...

A 10-month-old girl was evaluated for unilateral leukokoria. Quick growth in association with normal growth hormone levels occurred during the first years of development. Physical features were characteristic of Sotos syndrome (Figure 1). Developmental delay was also observed. Figure 1. Note some diagnostic features typically listed as Sotos syndro...

A growing fracture is a rare complication of skull fractures characterized by progressive diastatic enlargement of the fracture line. Growing skull fractures related to birth trauma were only occasionally reported. As far as we know, only one previous case of a neonatal growing fracture secondary to coronal suture disruption has been reported. We p...

Background: The initial decrease in the level of consciousness after subarachnoid hemorrhage (SAH) is commonly considered secondary to cerebral hypoperfusion and metabolic depression. Age, intracranial pressure, and the amount of cisternal blood are closely related to the clinical grade on admission after SAH. Transcranial Doppler (TCD) may partia...

Astroblastoma is a rare glial neoplasm of unknown origin and uncertain prognosis. It usually presents in young adults as a well circumscribed hemispheric mass, often associated with a cystic component. The histological features of astroblastoma are the presence of typical astroblastic perivascular pseudorosettes and perivascular hyalinization. Two...

El astroblastoma es un tumor glial infrecuente de origen desconocido y pronóstico incierto. Habitualmente se presenta en adultos como una masa hemisférica bien definida, presentando a menudo un componente quístico. Las características histopatológicas de este tumor incluyen la presencia de pseudorrosetas perivasculares astroblásticas típicas y la h...

Hypothalamic hamartomas are associated with precocious puberty, gelastic seizures and severe refractory epilepsy. Treatment options include surgical resection, radiofrequency and radiosurgery. A 7-month-old girl presented with gelastic seizures and developmental delay related to a giant hypothalamic hamartoma. The patient was operated through a sub...

El xantogranuloma del plexo coroideo es un tumor benigno de etiología desconocida que raramente produce síntomas. Su comportamiento en los estudios de resonancia magnética se ha descrito en pocas ocasiones y no está bien definido. Presentamos un nuevo caso de xantogranuloma del tercer ventriculo con caraterísticas atípicas en los estudios de CT y R...

Lymphocytic hypophysitis (LH) is an infrequent primary inflammatory disorder, which is usually diagnosed after surgery for lesions suspected to be pituitary adenomas. Some radiological features have been described that may allow a preoperative diagnosis, such as a symmetric enlargement of the gland with diffuse contrast enhancement extending to the...

Gliomas are the most frequent primary tumors of the brain. The standard treatment includes surgery, radiotherapy and chemotherapy, but the outcomes of patients with these tumors have remained nearly unchanged for past years. Hopefully, recent advances in molecular biology are rising new clinical expectation for patients with brain tumors. Among the...

Utilidad de la TAC secuencial y la monitorización de la presión intracraneal para detectar nuevo efecto masa intracraneal en pacientes con traumatismo craneal grave y lesión inicial Tipo I-II

El xantogranuloma del plexo coroideo es un tumor benigno de etiología desconocida que raramente produce síntomas. Su comportamiento en los estudios de resonancia magnética se ha descrito en pocas ocasiones y no está bien definido. Presentamos un nuevo caso de xantogranuloma del tercer ventriculo con caraterísticas atípicas en los estudios de CT y R...

Objective: To determine the incidence of pathological and intracranial pressure (ICP) changes during the acute posttraumatic period in severe head injury patients presenting with lesions Types I-II (TCDB classification) in the admission CT scan with the aim of defining the most appropriate strategy of sequential CT scanning and ICP monitoring for...

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Gliomas are the most frequent primary tumors of the brain. The standard treatment includes surgery, radiotherapy and chemotherapy, but the outcomes of patients with these tumors have remained nearly unchanged for past years. Hopefully, recent advances in molecular biology are rising new clinical expectation for patients with brain tumors. Among the...

The case of a 68 year-old man who developed a fatal intracranial hemorrhagic complication following percutaneous compression of the gasserian ganglion for trigeminal neuralgia is reported. The complication was likely related to improper placement of the Fogarty catheter into the temporal fossa out of the Meckel's cave. The anatomical structures at...

Cerebellar hemorrhage after supratentorial surgery is a very infrequent complication. Most cases occur following aneurysm or brain tumor surgery, or evacuation of extracerebral collections. The underlying mechanism of formation of these hematomas is unclear. We present an example of cerebellar hemorrhage following transsphenoidal resection of a pit...

Se presenta el caso de un paciente de 68 años de edad con neuralgia esencial del trigémino que fue operado mediante compresión percutanea del ganglio de Gasser y desarrolló una hemorragia intracraneal que resultó fatal. La complicación se relacionó probablemente con el emplazamiento erróneo del cateter de Fogarty y el inflado del balón fuera del ca...

Posttraumatic and postcraniectomy subdural fluid collections have been usually described with the general term of hygroma. Recently, different clinical entities have been described, such as simple or complex hygroma, subdural effusion or external hydrocephalus, based on the mechanisms of formation of the fluid collection, its biochemical compositio...

Among the group of pituitary adenomas surgically treated, about 25–30% are not associated with clinical or analytical findings of hormonal hypersecretion. The development of immunohistochemical techniques has allowed the demonstration of a subgroup of adenomas that show inmunoreactivity against several hormones among the group of, apparently, non-f...

Despite recent improvements in microsurgical and radiotherapy techniques, treatment of basal posterior fossa meningiomas still carries an elevated risk of morbidity. We present our results in a series of patients with this type of tumor and review the recent literature looking for the results obtained with different approaches and the new tendencie...

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that has been recognized to occur almost all along the organism. Since its description in 1996 at the meninges, a total of 59 cases of meningeal SFT have been reported. Different authors have emphasized the difficulties in the differential diagnosis with other more frequent meningeal neoplasms...

Among the group of pituitary adenomas surgically treated, about 25-30% are not associated with clinical or analytical findings of hormonal hypersecretion. The development of immunohistochemical techniques has allowed the demonstration of a subgroup of adenomas that show immunoreactivity against several hormones among the group of, apparently, non-f...

Posttraumatic and postcraniectomy subdural fluid collections have been usually described with the general term of hygroma. Recently, different clinical entities have been described, such as simple or complex hygroma, subdural effusion or external hydrocephalus, based on the mechanisms of formation of the fluid collection, its biochemical compositio...

Subdural hematomas of the posterior fossa are very rare and most cases are related to head injury. The influence of anticoagulation in cases of spontaneous development is well known. Although diagnosis is easily achieved by CT sean, atypical forms may lead to the wrong diagnosis of cerebellar hematoma. We present a case of a posterior fossa acute s...