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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

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: Impact of a Hospitalist Co-Management Program on Medical Complications and Length of Stay in Neurosurgical Patients.

Marchán-López, Álvaro / Lora-Tamayo, Jaime / de la Calle, Cristina / Jiménez Roldán, Luis / Moreno Gómez, Luis Miguel / Sáez de la Fuente, Ignacio / Chico Fernández, Mario / Lagares, Alfonso / Lumbreras, Carlos / García Reyne, Ana

Joint Commission journal on quality and patient safety

2024 Volume 50, Issue 5, Page(s) 318–325

Abstract: Background: The impact of co-management on clinical outcomes in neurosurgical patients is uncertain. This study aims to describe the implementation of a hospitalist co-management program in a neurosurgery department and its impact on the incidence of ... ...

Abstract	Background: The impact of co-management on clinical outcomes in neurosurgical patients is uncertain. This study aims to describe the implementation of a hospitalist co-management program in a neurosurgery department and its impact on the incidence of complications, mortality, and length of stay. Methods: The authors used a quasi-experimental study design that compared a historical control period (July-December 2017) to a prospective intervention arm. During the intervention period, patients admitted to a neurosurgery inpatient unit who were older than 65 years, suffered certain conditions, or were admitted from ICUs were included in the co-management program. Two hospitalists joined the surgical staff and intervened in the diagnostic and therapeutical plan of patients, participating in clinical decisions and coordinating patient navigation with neurosurgeons. The incidence of moderate or severe complications measured by the Accordion Severity Grading System, in-hospital mortality, and length of stay of the two cohorts were compared. Multivariate regression was used to adjust for confounders, and the average treatment effect was estimated using inverse probability of treatment weighting. Results: The adjusted incidence of moderate or severe complications was lower among co-managed patients (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39-0.91). Mortality was unchanged (OR 0.83, 95% CI 0.15-4.17). Length of stay was lower in co-managed patients, with a 1.3-day reduction observed after inverse probability of treatment weighting analysis. Conclusion: Hospitalist co-management was associated with a reduced incidence of complications and length of stay in neurosurgical patients, but there was no difference in in-hospital mortality.
MeSH term(s)	Humans ; Length of Stay/statistics & numerical data ; Hospitalists ; Female ; Male ; Aged ; Hospital Mortality ; Neurosurgical Procedures ; Postoperative Complications/epidemiology ; Middle Aged ; Prospective Studies ; Incidence
Language	English
Publishing date	2024-01-09
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/j.jcjq.2024.01.003
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Zs.B 2055: Show issues

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Article: Task synergies in neurovascular surgery: Image-guided navigation using a thermoplastic facial mask for the resection of a symptomatic occult to MRI brain microarteriovenous malformation.

Castaño-Leon, Ana M / Moreno Gomez, Luis Miguel / Jimenez Roldan, Luis / Gonzalez, Pedro / Campollo, Jorge / Lagares, Alfonso

Journal of neuroradiology = Journal de neuroradiologie

2022 Volume 50, Issue 2, Page(s) 237–240

Abstract: Due to the size of microarteriovenous malformations (mAVM), its precise angioarchitecture description often requires a supraselective DSA and detecting the nidus during microsurgical resection is challenging. An accurate intraoperative navigation system ... ...

Abstract	Due to the size of microarteriovenous malformations (mAVM), its precise angioarchitecture description often requires a supraselective DSA and detecting the nidus during microsurgical resection is challenging. An accurate intraoperative navigation system is desirable but available softwares which can combine DSA and MRI are not always available. The authors present here a technical note describing the use of a stereotactic thermoplastic mask with a fiducial box to guide the resection of a mAVM.
MeSH term(s)	Humans ; Intracranial Arteriovenous Malformations ; Magnetic Resonance Imaging ; Neuroimaging ; Imaging, Three-Dimensional ; Brain
Language	English
Publishing date	2022-08-27
Publishing country	France
Document type	Journal Article
ZDB-ID	131763-5
ISSN	1773-0406 ; 0150-9861
ISSN (online)	1773-0406
ISSN	0150-9861
DOI	10.1016/j.neurad.2022.08.002
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Zs.A 1062: Show issues

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Article ; Online: Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging.

García-Pérez, Daniel / Panero, Irene / Munarriz, Pablo M / Jimenez-Roldán, Luis / Lagares, Alfonso / Alén, José A

Neurocirugia (English Edition)

2022 Volume 33, Issue 3, Page(s) 141–148

Abstract: Background: Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in ... ...

Abstract	Background: Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. Methods: We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. Results: Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. Conclusions: This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
MeSH term(s)	Cerebellum/diagnostic imaging ; Hemodynamics/physiology ; Humans ; Hyperemia/etiology ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/surgery ; Tomography, X-Ray Computed/adverse effects
Language	English
Publishing date	2022-04-27
Publishing country	Spain
Document type	Case Reports
ISSN	2529-8496
ISSN (online)	2529-8496
DOI	10.1016/j.neucie.2020.12.005
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Article ; Online: Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging.

García-Pérez, Daniel / Panero, Irene / Munarriz, Pablo M / Jimenez-Roldán, Luis / Lagares, Alfonso / Alén, José A

Neurocirugia (English Edition)

2021

Abstract	Background: Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. Methods: We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. Results: Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. Conclusions: This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
Language	Spanish
Publishing date	2021-03-11
Publishing country	Spain
Document type	Case Reports
ISSN	2529-8496
ISSN (online)	2529-8496
DOI	10.1016/j.neucir.2020.12.006
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Article: Predicting Regions of Local Recurrence in Glioblastomas Using Voxel-Based Radiomic Features of Multiparametric Postoperative MRI.

Cepeda, Santiago / Luppino, Luigi Tommaso / Pérez-Núñez, Angel / Solheim, Ole / García-García, Sergio / Velasco-Casares, María / Karlberg, Anna / Eikenes, Live / Sarabia, Rosario / Arrese, Ignacio / Zamora, Tomás / Gonzalez, Pedro / Jiménez-Roldán, Luis / Kuttner, Samuel

Cancers

2023 Volume 15, Issue 6

Abstract: The globally accepted surgical strategy in glioblastomas is removing the enhancing tumor. However, the peritumoral region harbors infiltration areas responsible for future tumor recurrence. This study aimed to evaluate a predictive model that identifies ... ...

Abstract	The globally accepted surgical strategy in glioblastomas is removing the enhancing tumor. However, the peritumoral region harbors infiltration areas responsible for future tumor recurrence. This study aimed to evaluate a predictive model that identifies areas of future recurrence using a voxel-based radiomics analysis of magnetic resonance imaging (MRI) data. This multi-institutional study included a retrospective analysis of patients diagnosed with glioblastoma who underwent surgery with complete resection of the enhancing tumor. Fifty-five patients met the selection criteria. The study sample was split into training (N = 40) and testing (N = 15) datasets. Follow-up MRI was used for ground truth definition, and postoperative structural multiparametric MRI was used to extract voxel-based radiomic features. Deformable coregistration was used to register the MRI sequences for each patient, followed by segmentation of the peritumoral region in the postoperative scan and the enhancing tumor in the follow-up scan. Peritumoral voxels overlapping with enhancing tumor voxels were labeled as recurrence, while non-overlapping voxels were labeled as nonrecurrence. Voxel-based radiomic features were extracted from the peritumoral region. Four machine learning-based classifiers were trained for recurrence prediction. A region-based evaluation approach was used for model evaluation. The Categorical Boosting (CatBoost) classifier obtained the best performance on the testing dataset with an average area under the curve (AUC) of 0.81 ± 0.09 and an accuracy of 0.84 ± 0.06, using region-based evaluation. There was a clear visual correspondence between predicted and actual recurrence regions. We have developed a method that accurately predicts the region of future tumor recurrence in MRI scans of glioblastoma patients. This could enable the adaptation of surgical and radiotherapy treatment to these areas to potentially prolong the survival of these patients.
Language	English
Publishing date	2023-03-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15061894
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Article ; Online: Neuropsychological management of the awake patient surgery: A protocol based on 3-year experience with glial tumors.

Navarro-Main, Blanca / Jiménez-Roldán, Luis / González Leon, Pedro / Castaño-León, Ana M / Lagares, Alfonso / Pérez-Nuñez, Ángel

Neurocirugia (English Edition)

2020 Volume 31, Issue 6, Page(s) 279–288

Abstract: Introduction: Glial brain tumours usually require neurosurgical treatment and they are associated with cognitive, emotional and behavioural impairments. Awake intraoperative brain mapping is the gold standard technique used to optimize the onco- ... ...

Title translation	Protocolo de intervención neuropsicológica en la cirugía del paciente despierto: experiencia de 3 años con tumores gliales.
Abstract	Introduction: Glial brain tumours usually require neurosurgical treatment and they are associated with cognitive, emotional and behavioural impairments. Awake intraoperative brain mapping is the gold standard technique used to optimize the onco-functional balance. Neuropsychological assessment and intervention have relevance in this type of procedures. Currently, there is a lack of protocolled structure for the neuropsychological intervention being able to satisfy patient needs. Method: A retrospective descriptive study of 52 patients was performed, all of them with a diagnosis of glial tumour. The structure of the protocol developed in our centre is reported, also data of neuropsychological evaluation, comparing baseline performance with both immediate posterior performance, and long term performance. Results: We describe our experience in each step of the intervention, highlighting the development of eight neurocognitive protocols for intraoperative brain mapping. The results of the neuropsychological examination objectify deficits in the immediate after surgery assessment which are reduced in the long-term assessment. Conclusions: We emphasize the need of providing and structuring the cognitive and emotional aspects of patients suffering from any pathology that entails acquired brain damage in hospital environment. This type of approach is aimed at increasing the quality of life of cancer patients by structuring and optimizing tasks during their surgical intervention and attending to the neuropsychological difficulties they suffer.
MeSH term(s)	Brain Mapping ; Brain Neoplasms/surgery ; Glioma/complications ; Glioma/surgery ; Humans ; Neurosurgical Procedures ; Quality of Life ; Retrospective Studies ; Wakefulness
Language	Spanish
Publishing date	2020-04-18
Document type	Journal Article
ISSN	2529-8496
ISSN (online)	2529-8496
DOI	10.1016/j.neucir.2020.02.005
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Article: Ligaments disruption: a new perspective in the prognosis of spinal cord injury.

Martinez-Perez, Rafael / Jimenez-Roldan, Luis / Lagares, Alfonso

Neural regeneration research

2014 Volume 9, Issue 5, Page(s) 456–457

Language	English
Publishing date	2014-08-26
Publishing country	India
Document type	Journal Article
ZDB-ID	2388460-5
ISSN	1876-7958 ; 1673-5374
ISSN (online)	1876-7958
ISSN	1673-5374
DOI	10.4103/1673-5374.130053
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Article ; Online: Intracranial Pressure Monitoring in Patients With Severe Traumatic Brain Injury: Extension of the Recommendations and the Effect on Outcome by Propensity Score Matching.

Castaño-Leon, Ana M / Gomez, Pedro A / Jimenez-Roldan, Luís / Paredes, Igor / Munarriz, Pablo M / Perez, Irene Panero / Eiriz Fernandez, Carla / García-Pérez, Daniel / Moreno Gomez, Luis Miguel / Sinovas, Olga Esteban / Posadas, Guillermo Garcia / Lagares, Alfonso

Neurosurgery

2022 Volume 91, Issue 3, Page(s) 437–449

Abstract: Background: Intracranial pressure (ICP) monitoring is recommended for patients with traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) <9 on admission and revealing space-occupying lesions or swelling on computed tomography. However, previous ... ...

Abstract	Background: Intracranial pressure (ICP) monitoring is recommended for patients with traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) <9 on admission and revealing space-occupying lesions or swelling on computed tomography. However, previous studies that have evaluated its effect on outcome have shown conflicting results. Objective: To study the effect of ICP monitoring on outcome after adjustment of patient's characteristics imbalance and determine the potential benefit on patients with higher GCS that deteriorates early or in the absence of computed tomography results suggesting high ICP. Methods: We searched for adult patients with TBI admitted between 1996 and 2020 with a GCS <9 on admission or deterioration from higher scores within 24 hours after TBI. Patients were divided into groups if they fulfilled strict (Brain Trauma Foundation guidelines) or extended criteria (patients who worsened after admission or without space-occupying lesions) for ICP monitoring. Propensity score analyses based on nearest neighbor matching was performed. Results: After matching, we analyzed data from 454 patients and 184 patients who fulfilled strict criteria or extended criteria for ICP monitoring, respectively. A decreased on in-hospital mortality was detected in monitored patients following strict and extended criteria . Those patients with a higher baseline risk of poor outcome showed higher odds of favorable outcome if they were monitored. Conclusion: ICP monitoring in patients with severe TBI within 24 hours after injury following strict and extended criteria was associated with a decreased in-hospital mortality. The identification of patients with a higher risk of an unfavorable outcome might be useful to better select cases that would benefit more from ICP monitoring.
MeSH term(s)	Adult ; Brain Injuries ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnostic imaging ; Glasgow Coma Scale ; Humans ; Intracranial Pressure ; Monitoring, Physiologic/methods ; Propensity Score
Language	English
Publishing date	2022-07-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002044
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Zs.A 1424: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 539: Show issues

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Article ; Online: Implant Microbial Colonization Detected by Sonication as a Cause for Spinal Device Failure: A Prospective Study.

García-Pérez, Daniel / Lagares, Alfonso / Castaño-León, Ana María / Panero, Irene / Munarriz, Pablo M / Delgado-Fernández, Juan / Jiménez-Roldán, Luis / Pérez-Núñez, Angel / Alén, Jose Antonio F / Paredes, Igor

Spine

2021 Volume 46, Issue 21, Page(s) 1485–1494

Abstract: Study design: A prospective single center observational study.: Objectives: The aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to ... ...

Abstract	Study design: A prospective single center observational study. Objectives: The aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to describe risk factors and radiological findings associated with spinal implant infection. Summary of background data: Although PS loosening has mainly been attributed to mechanical overload, implant colonization and biofilm formation have recently been suggested. Culturing of sonication fluid implants is promising in the field of spine instrumentation infection, but little data are available. Methods: We prospectively included all patients who were subjected to implant removal. PS loosening was assessed with computed tomography (CT) scan. Different clinical and radiological parameters which could serve as indicators of implant infection were studied. Results: Thirty-eight patients were included in the study and 11 of them (29%) had a positive sonication result. Patients with spinal implant infection were associated with screw loosening (P = 0.005). Particularly, those screws with a positive microbiological culture showed signs of screw loosening in the preoperative CT scan (P < 0.001). Our results also showed that radiological screw loosening at L1-L3 level, and loosened larger constructs were associated with screw microbial colonization. The most common isolated microorganisms were coagulase-negative staphylococci and Cutibacterium acnes. An implant-based multivariate analysis indicated that screw loosening, the absence of prophylactic cefazolin, ICU hospitalization, screw breakage, and L1-L3 spine level were independent risk factors for implant-associated infection. Our model exhibited a high predictive power with an area under the curve of 0.937. Conclusion: As clinical presentation of deep implant chronic infection is unspecific, consideration of these factors enables preoperative prediction and risk stratification of implant colonization, thus helping patient's management.Level of Evidence: 3.
MeSH term(s)	Equipment Failure ; Humans ; Lumbar Vertebrae ; Pedicle Screws ; Prospective Studies ; Sonication
Language	English
Publishing date	2021-10-07
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0000000000004063
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