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Article ; Online: Positive outcome after endoscopic treatment of a symptomatic convexity arachnoid cyst in an elderly.

García-Pérez, Daniel / Panero, Irene / Paredes, Igor

2021 Volume 38, Issue 2, Page(s) 540–541

Abstract: Cerebral convexity arachnoid cysts (ACs) only represent around 10-14% of the cysts. Symptomatic ACs in the elderly are rare. We present a 66-year-old woman with headache and a focal epileptic seizure. Imaging revealed a left parietal AC. Conservative ... ...

Abstract	Cerebral convexity arachnoid cysts (ACs) only represent around 10-14% of the cysts. Symptomatic ACs in the elderly are rare. We present a 66-year-old woman with headache and a focal epileptic seizure. Imaging revealed a left parietal AC. Conservative management chosen but the patient's neurological condition worsened, and an endoscopic fenestration was then performed. Postoperatively, her symptoms completely resolved and MRI image showed significant shrinkage of the AC.
MeSH term(s)	Humans ; Female ; Aged ; Arachnoid Cysts/diagnostic imaging ; Arachnoid Cysts/surgery ; Endoscopy/methods ; Magnetic Resonance Imaging ; Headache/etiology ; Conservative Treatment ; Treatment Outcome
Language	English
Publishing date	2021-01-19
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.1080/02688697.2021.1872774
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Article ; Online: Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center.

García-Pérez, Daniel / Panero, Irene / Lagares, Alfonso / Gómez, Pedro Antonio / Alén, José F / Paredes, Igor

Neurocirugia (English Edition)

2023 Volume 34, Issue 1, Page(s) 12–21

Abstract: Background: Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the ... ...

Abstract	Background: Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature. Methods: Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients. Results: Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD. Conclusions: Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
MeSH term(s)	Humans ; Adolescent ; Retrospective Studies ; Trauma Centers ; Atlanto-Occipital Joint/diagnostic imaging ; Atlanto-Occipital Joint/injuries ; Tomography, X-Ray Computed/methods ; Joint Dislocations/diagnostic imaging ; Joint Dislocations/epidemiology ; Joint Dislocations/etiology ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnostic imaging ; Brain Injuries, Traumatic/epidemiology
Language	English
Publishing date	2023-01-07
Publishing country	Spain
Document type	Journal Article
ISSN	2529-8496
ISSN (online)	2529-8496
DOI	10.1016/j.neucie.2022.11.004
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Article ; Online: Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes.

Javier Afonso-Argilés, F / Comas Serrano, M / Castells Oliveres, X / Cirera Lorenzo, I / García Pérez, D / Pujadas Lafarga, T / Ichart Tomás, X / Puig-Campmany, M / Vena Martínez, A B / Renom-Guiteras, A

Revista clinica espanola

2023 Volume 223, Issue 10, Page(s) 585–595

Abstract: Objectives: To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical ... ...

Abstract	Objectives: To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. Method: This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. Results: A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. Conclusions: Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; Retrospective Studies ; Ambulatory Care Sensitive Conditions ; Hospitalization ; Pulmonary Disease, Chronic Obstructive ; Emergency Service, Hospital
Language	English
Publishing date	2023-10-12
Publishing country	Spain
Document type	Observational Study ; Multicenter Study ; Journal Article
ISSN	2254-8874
ISSN (online)	2254-8874
DOI	10.1016/j.rceng.2023.10.001
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Article ; Online: Racemose Fourth Ventricle Neurocysticercosis Excision Through Telovelar Approach and Hydrodissection.

García-Pérez, Daniel / García-Posadas, Guillermo / Paredes, Igor / Jiménez-Roldán, Luis

World neurosurgery

2022 Volume 165, Page(s) 91

Abstract: Intraventricular neurocysticercosis is associated with more severe complications and a worse overall outcome. ...

Abstract	Intraventricular neurocysticercosis is associated with more severe complications and a worse overall outcome.
MeSH term(s)	Adult ; Cysts/surgery ; Female ; Fourth Ventricle/diagnostic imaging ; Fourth Ventricle/pathology ; Fourth Ventricle/surgery ; Humans ; Hydrocephalus/diagnostic imaging ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Magnetic Resonance Imaging/adverse effects ; Neurocysticercosis/complications ; Neurocysticercosis/diagnostic imaging ; Neurocysticercosis/surgery ; Ventriculostomy/methods
Language	English
Publishing date	2022-06-16
Publishing country	United States
Document type	Case Reports ; Video-Audio Media
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.06.043
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Article ; Online: A Frontal Route to Middle and Posterior Cranial Fossa: Quantitative Study for the Lateral Transorbital Endoscopic Approach and Comparison with the Subtemporal Approach.

García-Pérez, Daniel / Abarca, Javier / González-López, Pablo / Nieto, Juan / Lagares, Alfonso / Paredes, Igor

World neurosurgery

2022 Volume 167, Page(s) e236–e250

Abstract: Background: Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous ...

Abstract	Background: Skull base lesions within the middle cranial fossa (MCF) remain challenging. Recent reports suggest that transorbital endoscopic approaches (TOEAs) might be particularly suitable to access the MCF and expose the lateral wall of the cavernous sinus and the Meckel's cave. Methods: The present study was developed to compare the nuances of the subtemporal approach (STA) with those of the lateral TOEA (LTOEA) to the MCF and posterior cranial fossa (PCF) in cadaveric specimens. After orbital craniectomy, interdural opening of the cavernous sinus lateral wall (CSlw), exposure of the Gasserian ganglion, and extradural elevation of the temporal lobe was performed. Next, anterior endoscopic petrosectomy was performed and the PCF was accessed. We quantitatively analyzed and compared the angles of attack and distances between LTOEA and STA to different structures at the CSlw, petrous apex (PA), and PCF. Results: Cadaveric dissection through the LTOEA completely exposed the CSlw and PA. LTOA exhibited larger distances than the STA to all targets. Importantly, these differences were greater at the PA and its surrounding key anatomic landmarks. The horizontal and vertical angles of attack allowed by the LTOA were smaller both for the CSlw and PA. However, these differences were not significant for the vertical angle of attack at the CSlw. Conclusions: LTOEA provides a direct ventral route to the medial aspect of MCF, PA, and PCF. Although TOEAs are versatile approaches, the unfamiliar surgical anatomy and limited instrument maneuverability demand extensive cadaveric dissection before moving to the clinical setting.
MeSH term(s)	Humans ; Skull Base/surgery ; Skull Base/anatomy & histology ; Cranial Fossa, Posterior/surgery ; Cranial Fossa, Posterior/anatomy & histology ; Endoscopy/methods ; Cranial Fossa, Middle/surgery ; Cranial Fossa, Middle/anatomy & histology ; Cadaver
Language	English
Publishing date	2022-08-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.07.129
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Article ; Online: Pathogenesis of spinal intramedullary lipomas: two case reports.

Moreno Gómez, Luis Miguel / García-Pérez, Daniel / González-León, Pedro Juan / Munarriz, Pablo M / Castaño-León, Ana María

Journal of medical case reports

2023 Volume 17, Issue 1, Page(s) 317

Abstract: Background: Spinal lipomas not associated with dysraphism are rare and have an unknown natural history. In this report, we describe two cases; they showed recurrence during long-term follow-up, which makes us doubt a benign malformative etiology.: ... ...

Abstract	Background: Spinal lipomas not associated with dysraphism are rare and have an unknown natural history. In this report, we describe two cases; they showed recurrence during long-term follow-up, which makes us doubt a benign malformative etiology. Case reports: Two patients, a 19-year-old South American woman and a 14-year-old boy with spinal lipomas, underwent surgical resection. The lipomas were not associated with dysraphism and were located in the cervicothoracic and craniocervical junctions. In both cases, we decided to operate due to clinical progression; the former had a progressive natural course, and the latter experienced clinical worsening after recurrence from previous surgeries. The surgery took place with the assistance of neurophysiological monitoring and intraoperative ultrasound; a partial resection and medullary decompression were done, following the more recent recommendations. Discussion: The natural history of these lesions is currently unknown due to their rarity and the heterogeneity in the long-term follow-up of previously reported cases. Although previous reports describe good outcomes after surgical resection, long follow-ups, especially in young subjects, may show differences in these outcomes with progression and recurrence. We contribute to this last piece of evidence by describing two more cases of progression and recurrence. Lessons: Long-term close follow-up should be done in young subjects with spinal lipomas, as they are more prone to an aggressive course. Metabolism and hormonal changes may be behind this progression. Reoperation must be considered if neurological decline is detected.
MeSH term(s)	Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Lipoma/diagnostic imaging ; Lipoma/surgery ; Lipoma/pathology ; Neurosurgical Procedures ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2023-07-25
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-023-04048-z
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Article: Prognostic Value of a New Tool (the 3D/3D+) for Predicting 30-Day Mortality in Emergency Department Patients Aged 75 Years and Older.

Garcia-Pérez, Dolors / Vena-Martínez, Anabelén / Robles-Perea, Laura / Roselló-Padullés, Teresa / Espaulella-Panicot, Joan / Arnau, Anna

Journal of clinical medicine

2023 Volume 12, Issue 20

Abstract: The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to ... ...

Abstract	The 3D/3D+ multidimensional geriatric assessment tool provides an optimal model of emergency care for patients aged 75 and over who attend the Emergency Department (ED). The baseline, or static, component (3D) stratifies the degree of frailty prior to the acute illness, while the current, or dynamic, component (3D+) assesses the multidimensional impact caused by the acute illness and helps to guide the choice of care facility for patients upon their discharge from the ED. The objective of this study was to evaluate the prognostic value of the 3D/3D+ to predict short- and long-term adverse outcomes in ED patients aged 75 years and older. Multivariable logistic regression models were used to identify the predictors of mortality 30 days after 3D/3D+ assessment. Two hundred and seventy-eight patients (59.7% women) with a median age of 86 years (interquartile range: 83-90) were analyzed. According to the baseline component (3D), 83.1% (95% CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) presented alterations in 60.1% (95% CI: 54.1-65.9). The choice of care facility at ED discharge indicated by the 3D/3D+ was considered appropriate in 96.4% (95% CI: 93.0-98.0). Thirty-day all-cause mortality was 19.4%. Delirium and functional decline were the dimensions on the 3D/3D+ that were independently associated with 30-day mortality. These two dimensions had an area under receiver operating characteristic of 0.80 (95% CI: 0.73-0.86) for predicting 30-day mortality. The 3D/3D+ tool enhances the provision of comprehensive care by ED professionals, guides them in the choice of patients' discharge destination, and has a prognostic validity that serves to establish future therapeutic objectives.
Language	English
Publishing date	2023-10-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12206469
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Article ; Online: A prospective study to identify preoperative serum parameters for spinal implant infection detected by sonication fluid culture.

García-Pérez, Daniel / García-Posadas, Guillermo / San-Juan, Rafael / Brañas, Patricia / Panero-Pérez, Irene / Delgado-Fernández, Juan / Paredes, Igor

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

2023 Volume 32, Issue 5, Page(s) 1818–1829

Abstract: Purpose: Low-virulent microorganisms identified on pedicle screws by sonication fluid culture (SFC) are an important cause of implant loosening. While sonication of explanted material improves the detection rate, the risk of contamination exists and no ... ...

Abstract	Purpose: Low-virulent microorganisms identified on pedicle screws by sonication fluid culture (SFC) are an important cause of implant loosening. While sonication of explanted material improves the detection rate, the risk of contamination exists and no standardized diagnostic criteria for chronic low-grade spinal implant-related infection (CLGSII) are stablished. Besides, the role of serum C-reactive protein (CRP) and procalcitonin (PCT) in CLGSII has not been adequately investigated. Methods: Blood samples were collected prior to implant removal. To increase sensitivity, the explanted screws were sonicated and processed separately. Patients exhibiting at least one positive SFC were classified in the infection group (loose criteria). To increase specificity, the strict criteria only considered multiple positive SFC (≥ 3 implants and/or ≥ 50% of explanted devices) as meaningful for CLGSII. Factors which might promote implant infection were also recorded. Results: Thirty-six patients and 200 screws were included. Among them, 18 (50%) patients had any positive SFCs (loose criteria), whereas 11 (31%) patients fulfilled the strict criteria for CLGSII. Higher serum protein level was the most accurate marker for the preoperative detection of CLGSSI, exhibiting an area under the curve of 0.702 (loose criteria) and 0.819 (strict criteria) for the diagnosis of CLGSII. CRP only exhibited a modest accuracy, whereas PCT was not a reliable biomarker. Patient history (spinal trauma, ICU hospitalization and/or previous wound-related complications) increased the likelihood of CLGSII. Conclusion: Markers of systemic inflammation (serum protein level) and patient history should be employed to stratify preoperative risk of CLGSII and decide the best treatment strategy.
MeSH term(s)	Humans ; Prospective Studies ; Prosthesis-Related Infections/diagnosis ; Prosthesis-Related Infections/etiology ; Sonication ; Device Removal/adverse effects ; Prostheses and Implants/adverse effects
Language	English
Publishing date	2023-03-10
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1115375-1
ISSN	1432-0932 ; 0940-6719
ISSN (online)	1432-0932
ISSN	0940-6719
DOI	10.1007/s00586-023-07628-1
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Article ; Online: Role of glucocorticoids on noradrenergic and dopaminergic neurotransmission within the basolateral amygdala and dentate gyrus during morphine withdrawal place aversion.

García-Pérez, Daniel / Milanés, Maria Victoria

Addiction biology

2019 Volume 25, Issue 2, Page(s) e12728

Abstract: Aversive memories related to drug withdrawal can generate a motivational state leading to compulsive drug taking. However, the mechanisms underlying the generation of these withdrawal memories remain unclear. Limbic structures, such as the basolateral ... ...

Abstract	Aversive memories related to drug withdrawal can generate a motivational state leading to compulsive drug taking. However, the mechanisms underlying the generation of these withdrawal memories remain unclear. Limbic structures, such as the basolateral amygdala (BLA) and the dentate gyrus (DG) of the hippocampus, play a crucial role in the negative affective component of morphine withdrawal. Given the prominent role of glucocorticoids (GCs), noradrenaline (NA), and dopamine (DA) in memory-related processes, in the present study, we employed the conditioned place aversion (CPA) paradigm to uncover the role of GCs on NA and DA neurotransmission within the BLA and NA neurotransmission within the DG during opiate-withdrawal conditioning (memory formation consolidation), and after reexposure to the conditioned environment (memory retrieval). We observed that adrenalectomy impaired naloxone-induced CPA. Memory retrieval was associated with an increase in dihydroxyphenylacetic acid (DOPAC) levels in the BLA in morphine-addicted animals in a GC-independent manner. Importantly, NA turnover was related with the expression of withdrawal physical signs during the conditioning phase and with locomotor activity during the test phase. On the other hand, reduced DA concentration in the BLA was correlated with the CPA score. Our results indicate that while noradrenergic system is more associated with the somatic consequences of withdrawal, dopaminergic neurotransmission modulates the affective state. Nevertheless, it seems necessary that both systems work together with GCs to enable aversive-memory formation and recall.
MeSH term(s)	Animals ; Basolateral Nuclear Complex/drug effects ; Basolateral Nuclear Complex/metabolism ; Dentate Gyrus/drug effects ; Dentate Gyrus/metabolism ; Disease Models, Animal ; Dopamine/metabolism ; Glucocorticoids/pharmacology ; Male ; Morphine/metabolism ; Norepinephrine/metabolism ; Rats ; Rats, Wistar ; Substance Withdrawal Syndrome/metabolism ; Synaptic Transmission/drug effects
Chemical Substances	Glucocorticoids ; Morphine (76I7G6D29C) ; Dopamine (VTD58H1Z2X) ; Norepinephrine (X4W3ENH1CV)
Language	English
Publishing date	2019-02-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1324314-7
ISSN	1369-1600 ; 1355-6215
ISSN (online)	1369-1600
ISSN	1355-6215
DOI	10.1111/adb.12728
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Article ; Online: Positive Outcome of Endoscopic Third Ventriculostomy in Fourth Ventricular Outlet Obstruction.

Panero, Irene / García-Pérez, Daniel / Lagares, Alfonso

World neurosurgery

2019 Volume 132, Page(s) 135–137

Abstract: We report a case of headache due to a hydrocephalus with associated syringomyelia. Magnetic resonance imaging showed a fourth ventricular outlet obstruction. An endoscopic third ventriculostomy (ETV) was performed with successful clinical and radiologic ... ...

Abstract	We report a case of headache due to a hydrocephalus with associated syringomyelia. Magnetic resonance imaging showed a fourth ventricular outlet obstruction. An endoscopic third ventriculostomy (ETV) was performed with successful clinical and radiologic outcome. Fourth ventricular outlet obstruction is an uncommon cause of obstructive hydrocephalus, but it must be kept in mind. As far as we know, there are few reports that propose ETV as treatment. Therefore our case supports that ETV could be a successful option for the management of this condition.
MeSH term(s)	Adult ; Female ; Fourth Ventricle/surgery ; Headache/etiology ; Humans ; Hydrocephalus/etiology ; Hydrocephalus/surgery ; Syringomyelia/complications ; Syringomyelia/surgery ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculostomy/methods
Language	English
Publishing date	2019-08-31
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2019.08.164
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