Santiago Gil-Robles

• Md PhD
• Head of Neurosurgery Department at Grupo Hospitalario Quirón

Research on the neural imprint of dual-language experience, crucial for understanding how the brain processes the first (L1) and second language (L2), remains inconclusive. Conflicting evidence suggests either similarity or distinction in neural processing, with implications for bilingual patients with brain tumors. Preserving dual-language functio...

Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the case of the precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial...

Key points Due to the slow growth of Low‐grade gliomas (LGGs), cognitive impairments can be quite difficult to detect at early stages There is a lack of staff specialized on the cognitive and emotional assessment of patients, such as neuropsychologists and speech therapists Brain tumor patients are often misclassified as asymptomatic at the moment...

Bi/multilingualism refers to the ability to use two or more languages in everyday life. Increasing interest has been paid to unveil the neural basis of bilingual language processing; however, the brain representation of language in bilinguals is still a matter of debate. Currently, there is a weak level of evidence supporting that the best probable...

Simple Summary Low-grade glioma (LGG) patients constitute an ideal in vivo pathological model to investigate cerebral neuroplasticity associated with major architectural disruption to the language network. Bilingual LGG patients offer a unique opportunity to study the neural capacity to negotiate L1 and L2 processing before and after the resection...

Recent evidence suggests that damage to the language network triggers its functional reorganization. Yet, the spectro-temporal fingerprints of this plastic rearrangement and its relation to anatomical changes is less well understood. Here, we combined magnetoencephalographic recordings with a proxy measure of white matter to investigate oscillatory...

Purpose of review: First, an anatomical and functional review of these cortical areas and subcortical connections with T-fMRI and tractography techniques; second, to demonstrate the value of this approach in neurosurgical planning in a series of patients with tumors close to the SMA. Recent findings: Implications in language and cognitive networ...

Picture naming tasks are currently the gold standard for identifying and preserving language-related areas during awake brain surgery. With multilingual populations increasing worldwide, patients frequently need to be tested in more than one language. There is still no reliable testing instrument, as the available batteries have been developed for...

Cognitive explorations have demonstrated the activation of plastic mechanisms in slow-growing brain lesions, generating structural and functional changes. Due to its incidence, it is essential to investigate the reorganization of functional areas in brain tumor patients as well as formulating new approaches for predicting patient’s quality of life...

Background Awake surgery has become a key treatment of diffuse low-grade gliomas (DLGG) and is divided in three main phases: opening, tumor resection – during which the patient needs to be fully awake – and closure. The anesthetic management of awake neurosurgery is a challenge, and there are currently no guidelines.Objective The objective of the s...

Picture naming tasks are currently the gold standard for identifying and preserving language-related areas during awake brain surgery. With multilingual populations increasing worldwide, patients frequently need to be tested in more than one language. There is still no reliable testing instrument, as the available batteries have been developed for...

Purpose: The practical management of cavernous angioma located within eloquent brain area before, during and after surgical resection is poorly documented. We assessed the practical pre-operative, intra-operative, and post-operative management of cavernous angioma located within eloquent brain area. Method: An online survey composed of 61 items...

BACKGROUND The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area. OBJECTIVE To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery. M...

INTRODUCTION The postoperative outcomes and the predictors of seizure control are poorly documented for supratentorial cavernous angiomas within or close to eloquent brain area. We assessed the predictors of preoperative and postoperative seizure control and ability to work, and the safety of the surgery. METHODS Multicenter international retrospe...

Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraope...

Diffuse low-grade glioma form a rare entity affecting young people. Despite advances in surgery, chemotherapy, and radiation therapy, diffuse low-grade glioma are still incurable. According to current guidelines, maximum safe resection, when feasible, is the first line of treatment. Apart from surgery, all other treatment modalities (temozolomide,...

Insula and paralimbic region represent a common location for gliomas in adulthood. However, limbic and paralimbic tumors are rare in children. Reports of pediatric insular tumors are scarce in literature, and most of them are included in adult’s series, so their management and outcome can be outlined only after extracting data from these reports. D...

Diffusion tensor imaging (DTI) and tractography provide the neurosurgeon with a valid 3D view of the white matter tracts of the brain for the presurgical planning of the treatment of lesions close to eloquent areas, this being one of the principal clinical applications of this technique. In this article, we describe through practical cases the anat...

Cirugía guiada por estimulación intraoperatoria: estudio de correlación anatomo-funcional, impacto en el grado de resección y déficit postoperatorio

Objective To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3 T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. Material and methods We present a series of 14 patien...

BACKGROUND Study of the corticosubcortical functional anatomy of reading and picture naming. OBJECTIVE To study the role of the left basal occipitotemporal area and its white matter pathways. METHODS Three patients underwent awake surgery for lesions in the left basal posterotemporal region with intraoperative electrostimulations. Intraoperative...

Surgery for infiltrative gliomas aims to balance tumor removal with preservation of functional integrity. The usefulness of intraoperative stimulation mapping (ISM) has not been addressed in randomized trials. This study addresses glioma surgery outcome on the basis of a meta-analysis of observational studies. A systematic search retrieved 90 repor...

OBJECTIVE: To describe the detection of cortical areas and subcortical pathways involved in language observed in MRI activation studies and tractography in a 3T MRI scanner and to correlate the findings of these functional studies with direct intraoperative cortical and subcortical stimulation. MATERIAL AND METHODS: We present a series of 14 patien...

To analyze the 3-dimensional relationships of the inferior fronto-occipital fasciculus (IFOF) within the temporal stem using anatomic dissection and to study the surgical application. Ten postmortem human hemispheres (5 right, 5 left) were dissected using the Klingler fiber dissection technique. The 3-dimensional relationships of the IFOF with diff...

Recent surgical studies have demonstrated that the extent of resection is significantly correlated with median survival in WHO Grade II gliomas. Consequently, thanks to advances in intraoperative functional mapping, the authors questioned whether it is actually necessary to leave a "security" margin around eloquent structures. The authors first rev...

There is increasing evidence that the extent of tumor removal in low-grade glioma surgery is related to patient survival time. Thus, the goal of resecting the largest amount of tumor possible without leading to permanent neurological sequelae is a challenge for the neurosurgeon. Electrical stimulation of the brain to detect cortical and axonal area...

Direct invasive EEG recordings of the insula - due to its particular anatomical position, deeply seated between both opercula - can only be performed with intracerebral electrodes. To date, the technique most commonly used for insular stereoelectroencephalography (SEEG) is the orthogonal-transopercular electrode approach with the Talairach methodol...

Despite electrostimulation studies of the white matter pathways, supporting the role of the inferior fronto-occipital fasciculus (IFOF) in semantic processing, little is known about the precise anatomical course of this fascicle, especially regarding its exact cortical terminations. Here, in the lights of these new functional data, we dissected 14...

To compare the reliability of preoperative stereoencephalography (SEEG) and intraoperative electrostimulation regarding functional mapping, and to select the indication for surgery for focal cortical dysplasia (FCD) in language areas. The authors present the case of a 21-year-old, right-handed female, suffering from chronic pharmacologically resist...

Although the goal of surgery for World Health Organization Grade II gliomas is maximal extent of resection, complete tumor removal is not always possible when the glioma involves eloquent areas. The authors propose a multistage surgical approach to highly crucial areas that are classically considered inoperable, enabling optimization of the extent...

Background To analyze the functional and oncological results after re-operation for recurrent WHO grade II Glioma located in eloquent regions. Method We reviewed a consecutive series of 19 patients with GIIG within functional areas who underwent two operations separated by at least 1 year. Intraoperative electrical stimulation mapping was used in a...

Deep brain stimulation is now accepted as a safe and efficient treatment for movement disorders including selected types of dystonia and dyskinesia. Very little, however, is known about its effect on other movement disorders, particularly for "choreic" movements. Huntington disease is a fatal autosomal-dominant neurodegenerative disorder characteri...

When treating patients harboring a brain tumor, it is mandatory to integrate the dogmas of epilepsy into a neuro-oncological viewpoint. The frequency of seizures differs widely between low- and high-grade tumors because of different mechanisms of epileptogenesis. The modern theories of pathological neural networks, especially in low-grade gliomas,...

The Lesch-Nyhan syndrome is an X-linked recessive disorder caused by a deficiency in hypoxanthine-guanine phosphoribosyl transferase, a purine salvage enzyme. Affected individuals exhibit a characteristic neurobehavioral disorder with delayed acquisition of motor skills, dystonia, severe self-mutilations, and aggressive behavior. Deep brain stimula...

To present the post-surgery clinical results of deep brain stimulation of the internal globus pallidus (GPi) in a group of paediatric patients with primary and secondary dystonic-dyskinetic syndrome. Between November 1996 and May 2006, 121 patients were submitted to interventions with bilateral deep brain stimulation of the GPi, 58 of whom were chi...

EUROPEAN JOURNAL OF NEUROLOGY Volume 13, Issue s2, September 2006, Pages: 9–41, Article first published online : 12 SEP 2006, DOI: 10.1111/j.1468-1331.2006.01620.x

El quiste óseo aneurismático es una patología infrecuente que asienta generalmente en las metáfisis de huesos largos y vértebras. La afectación del seno esfenoidal es excepcional. Su origen se encuentra aún por definir, pero podemos considerarlos como un fenómeno vascular secundario a una lesión del hueso subyacente. Puede asociarse a otras enferme...

Aneurysmal bone cyst is an uncommon lesion that occurs mainly in long bones and vertebrae, being the location in the sphenoid sinus extremely rare. Its origin is unknown, but it can be considered as a vascular phenomenon secondary to a primary lesion. Other primary diseases that may be associated to aneurysmal bone cyst are polyostotic fibrous dysp...

The role of the striatum in language remains poorly understood. Intraoperative electrical stimulation during surgery for tumours involving the caudate nucleus or putamen in the dominant hemisphere might be illuminating. To study the role of these structures in language, with the aim of avoiding postoperative definitive aphasia. 11 patients with cor...

Spinal ependymoma is a benign central nervous system tumor described as an intramedullary lesion more frequently located at the conus medullaris. It has been described exceptionally in the literature as an intradural extramedullary tumor. Presentation of an extremelly rare location and evolution of extremedullary ependymoma and discussion of its pr...

PURPOSE/AIM On the basis of the brain mapping data, specific subcortical tracts seem to be essential for language and reading. These tracts are clearly identified in diffusion tensor imaging (DTI) studies, being situated near the cortical language areas. We review the function and the anatomic relations of these tracts based on the DTI studies. We...