G García-March

Hospital Clínico Universitario de Valencia, Valenza, Valencia, Spain

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Publications (33)

  • M.J. Sánchez-Ledesma · J. Gonçalves · G. García-March · [...] · A. Framiñán
    [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.
    Article · Jul 2013 · Neurocirugia (Asturias, Spain)
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    G García-March · M.ª J. Sánchez Ledesma · J Broseta
    [Show abstract] [Hide abstract] 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
    Full-text Article · Dec 2008 · Neurocirugia (Asturias, Spain)
  • G García-March · M J Sánchez-Ledesma · J Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Nov 2008 · Neurocirugia (Asturias, Spain)
  • [Show abstract] [Hide abstract] 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.
    Article · May 2007 · Medicina Intensiva
  • [Show abstract] [Hide abstract] 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.
    Article · Apr 2007 · Medicina Intensiva
  • M.J. Sánchez-Ledesma · J. Gonçalves · G. García-March · [...] · J. Broseta
    [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.
    Article · Jan 2000
  • JV Pseudo · M Laguia · P Roldan · [...] · JL Barcia
    [Show abstract] [Hide abstract] ABSTRACT: Osteo-muscular hydatidosis is rare, the spine being involved in about 50% of the cases,Preoperative diagnosis is difficult and surgical treatment is also problematic because of the invasion of the bone, In this report we present the case of a 36-year-old farmer who complained about low back pain and bilateral sciatica, The CT scan and MRI showed a large paraspinal cystic mass extending from T10 to L2 with local spreading to the spinal canal and the 10th rib. The postoperative pathological evaluation confirmed the diagnosis of a echinococcal cyst. The patient was reoperated on some months later, with excision of another hidatid cyst of intrapulmonary location.
    Article · Jan 1998 · Neurocirugia (Asturias, Spain)
  • JV Pseudo · P Roldan · G Garcia-March · [...] · JL Barcia
    [Show abstract] [Hide abstract] 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.
    Article · Jan 1998 · Neurocirugia (Asturias, Spain)
  • [Show abstract] [Hide abstract] 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.
    Article · Jan 1998 · Neurocirugia (Asturias, Spain)
  • MJ Sanchez-Ledesma · G Garcia-March · J Goncalves · J Broseta
    [Show abstract] [Hide abstract] ABSTRACT: Based on previous experimental studies showing that cervical spinal cord stimulation increases carotid and brain blood flow in brain ischemia 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.
    Article · Jan 1998 · Neurocirugia (Asturias, Spain)
  • M.J. Sánchez-Ledesma · G. García-March · J. Gonçalves · J. Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Jan 1998 · Neurocirugia (Asturias, Spain)
  • [Show abstract] [Hide abstract] 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.
    Article · Dec 1996 · Neurocirugia (Asturias, Spain)
  • [Show abstract] [Hide abstract] 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.
    Article · Dec 1996 · Neurocirugia (Asturias, Spain)
  • G. García-March · J.L. Llacer · J.A. Barcia · [...] · J. Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Dec 1994 · Neurocirugia (Asturias, Spain)
  • J Broseta · G García-March · M J Sánchez-Ledesma · [...] · J L Barcia-Salorio
    [Show abstract] [Hide abstract] 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.
    Article · Feb 1994 · Stereotactic and Functional Neurosurgery
  • J Conçalves · G García-March · M J Sánchez-Ledesma · [...] · J Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Feb 1994 · Stereotactic and Functional Neurosurgery
  • J. Broseta · G. García-March · Mª.J. Sánchez-Ledesma · [...] · I. Silva
    [Show abstract] [Hide abstract] ABSTRACT: En el último período se han recogido 5 adultos y 3 niños con estados disráficos ocultos, en forma de lipomielomeningoceles lumbosacros, asociados o no a médula anclada, cuya afectación neurológica y ortopédica fue atribuida inicialmente a otros procesos. Siguiendo la escala clínica para estas lesiones del Sick Children Hospital de Toronto, sólo 1 caso se encontraba en el grado 0, al mostrar únicamente problemas esfinterianos vesicales ocasionales; el resto presentaba algún tipo de estigma externo, como lipomas subcutáneos, senos dérmicos e hipertricosis, diversos grados de debilidad y alteraciones sensitivas en miembros inferiores, deformidades otopédicas generalmente en pie y cadera, alteraciones en la marcha y, finalmente, trastornos esfinterianos. En los primeros casos de la serie el diagnóstico se basó exclusivamente en el estudio simple, mielográfico y mediante TC del raquis lumbosacro; en los cuatro últimos, el estudio de la lesión se completó con RM. Con esta batería de pruebas se confirmó siempre la presencia de una masa lipomatosa de diferente entidad, y generalmente con extensión extrarraquídea, en contacto con las estructuras neurales segmentarias, asociándose a dilatación local y oclusión parcial o total del fondo de saco dural en 5 casos, a diastematomielia en 1, a filum terminale engrosado en 2 y a médula anclada en 4.
    Article · Dec 1991
  • G. García-March · M.aJ. Sánchez-Ledesma · J. Anaya · [...] · J. Broseta
    [Show abstract] [Hide abstract] ABSTRACT: Based on previous experimental and clinical studies, 22 patients with severe spasicity, in 17 due to spinal cord damage, resulting from multiple sclerosis in 7 cases and postraumatic paraplejia in 8 and other situations in 2, and in 5 due to traumatic central spasticity, that were resistent to all conservative attempts, were selected to a trial with morphine and baclofen intratecally administered through a catheter placed in the spinal subaracnoidal space, attached to a subcutaneous reservoir. Whereas morphine single bolus did not show any benefit, baclofen bolus of 12.5 to 60 μg revealed a marked decrease of spasticity and associated symptoms in 17 cases. In them, after checking the clinical effect during a period of 3 weeks and the changes in electroneurophysiological studies and bladder manometry, the catheter was attached to a subcutaneous programmable pump able to be refilled percutaneously that administered baclofen continuously or more often following a multistep complex program in total doses of 25 to 225 μg per day. After a mean follow-up of 13.5 months all cases showed an absence of spasms and pain, a notable bettering of sphincterian functions and a marked relaxation that improves motor ability, though not motor potency, leading to increase deambulation or movility capacities. Neither complications nor side-effects were observed.
    Article · Dec 1990 · Neurocirugia (Asturias, Spain)
  • M. J. Sánchez-Ledesma · G. Garcia-March · J. Gonçalves · [...] · J. Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Nov 1990 · Stereotactic and Functional Neurosurgery
  • M J Sánchez-Ledesma · G García-March · J Gonçalves · [...] · J Broseta
    [Show abstract] [Hide abstract] 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.
    Article · Feb 1990 · Stereotactic and Functional Neurosurgery

Publication Stats

541 Citations

Institutions

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