Servicio de Neurocirugia

Rosario del Tala, Argentina

Servicio de Neurocirugia

Rosario del Tala, Argentina
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Perez-Millan M.I.,CONICET | Berner S.I.,Hospital Santa Lucia | Luque G.M.,CONICET | De Bonis C.,Servicio de Neurocirugia | And 3 more authors.
Pituitary | Year: 2013

The role of angiogenesis in human pituitary tumor progression is questioned. Our aim was to characterize the morphologic changes that occur in the vasculature of pituitary adenomas, in correlation with the expression of nestin, a protein found in endothelial cells of newly formed vessels of developing organs. We also evaluated the relation of angiogenic markers and nestin with Ki-67 index. Immunohistochemical studies were performed on paraffin embedded samples of 47 pituitary adenomas and six normal pituitaries. We determined microvessel density (number of CD31+ or CD34+ vessels per square millimetre), vascular area (cumulative area occupied by vessels), average vessel size, and further classified vessels as small (<100 μm2) or large (>100 μm2). We correlated the above parameters with nestin expression and Ki-67 index. Lower vascular area compared to normal tissue was found in adenomas (p < 0.05). Interestingly, pituitary adenomas had significantly more small vessels than control pituitaries (p < 0.04 for CD31 and CD34). In tumors many capillaries were positive for nestin, while scarce staining was detected in controls, so that nestin positive area was significantly higher in tumors. Furthermore, nestin area correlated positively with the % of small vessels. Ki-67 correlated neither with vascular area nor with nestin expression. In human pituitary tumors there was a predominance of small capillaries in correlation with increased expression of the progenitor marker nestin. We suggest that angiogenesis is an active process in these tumors, in spite of their low total vascular area when compared to normal pituitaries. © 2012 Springer Science+Business Media, LLC.


Villar Gomez De Las Heras K.,SSCC Del Servicio de Salud de Castilla La Mancha SESCAM | Serrano-Heras G.,Complejo Universitario Hospital AlbaceteAlbacete | Segura T.,Complejo Universitario Hospital AlbaceteAlbacete | Perona-Moratalla A.B.,Complejo Universitario Hospital AlbaceteAlbacete | And 3 more authors.
Orphanet Journal of Rare Diseases | Year: 2015

Background: Von Hippel-Lindau (VHL) disease is a rare oncological disease with an incidence of 1:36,000, and is characterized by the growth of different types of tumors: hemangioblastomas in the central nervous system (CNS) and retina, renal carcinoma, pheochromocytomas, pancreatic serous cystadenoma, and endolymphatic sac tumors. These tumors do not express VHL protein (pVHL). pVHL ubiquitinates hypoxia inducible factor (HIF) protein for degradation by the proteasome; in the absence of VHL, HIF translocates to the nucleus to activate the expression of its target genes. Targeting VHL-derived tumors with drugs that have reduced side effects is urgent to avoid repeat CNS surgeries. Recent reports have shown that propranolol, a β-blocker used for the treatment of hypertension and other cardiac and neurological diseases, is the best option for infantile hemangioma (IH). Propranolol could be an efficient treatment to control hemangioblastoma growth in VHL disease because of its antiangiogenic effects demonstrated in IH and the hypothetical impact on HIF levels. Methods: HeLa 9X (HRE) hypoxia responsive element cell line and primary hemangioblastoma-derived cells were subjected to propranolol treatment and cell viability and apoptosis were evaluated. HIF1-α and Hif-2α expression after propranolol treatment was analyzed by western blotting. Quantitative PCR was performed to study the mRNA expression of HIF target genes. Vascular endothelial growth factor (VEGF) was measured in culture supernatants by immunoassay. Results: Propranolol downregulated HIF-dependent transcription in HeLa 9XHRE cells. Under hypoxic conditions, propranolol decreased the expression of HIF target genes in hemangioblastoma cells, which stopped proliferating and died following long-term treatment. These results suggests that propranolol treatment promoted reduced HIF protein expression and corresponding downregulation of HIF target genes, and inhibited cell proliferation in parallel with induction of cell death by apoptosis. Conclusions: Our results suggest that propranolol could reduce the growth of HIF-dependent tumors and may thus be a promising treatment to delay surgery in VHL patients. © 2015 Albiñana et al.


Munoz A.,Complutense University of Madrid | Martinez-Leon M.,Servicio de Radiodiagnostico | Vazquez E.,Hospital Materno Infantil del Complejo Hospitalario Carlos Haya | Vazquez E.,Hospital Universitario Vall dHebron | And 2 more authors.
Journal of Neuroimaging | Year: 2014

Residual giant-cystic craniopharyngiomas are amenable to intracavitary bleomycin treatment. Radiologic identification of potential cyst leaks is of paramount for treatment decisions. This report describes our experience in the use of intracystic Gadolinium (Gd)-enhanced MR imaging to determine potential communications between the tumoral cysts and other intra-axial spaces in 4 pediatric patients with residual giant-cystic craniopharyngiomas in whom intracavitary bleomycin treatment was planned after the injection of .1-2 mL of gadopentetate dimeglumine (Gd-DTPA). In three cases no leaks were found. In one case, whose previous water-soluble iodinated contrast-enhanced CT cystography was negative for leaks, intracystic Gd-enhanced MR showed intraventricular Gd enhancement. We conclude that MR imaging after intracystic administration of Gd-based contrast paramagnetic agents is useful in the detection of potential leaks in cases of giant residual craniopharyngiomas. © 2012 by the American Society of Neuroimaging.


PubMed | Servicio de Neurocirugia, CSIC - Biological Research Center, SSCC del Servicio de Salud de Castilla La Mancha SESCAM and Complejo Universitario Hospital Albacete
Type: | Journal: Orphanet journal of rare diseases | Year: 2015

Von Hippel-Lindau (VHL) disease is a rare oncological disease with an incidence of 1:36,000, and is characterized by the growth of different types of tumors: hemangioblastomas in the central nervous system (CNS) and retina, renal carcinoma, pheochromocytomas, pancreatic serous cystadenoma, and endolymphatic sac tumors. These tumors do not express VHL protein (pVHL). pVHL ubiquitinates hypoxia inducible factor (HIF) protein for degradation by the proteasome; in the absence of VHL, HIF translocates to the nucleus to activate the expression of its target genes. Targeting VHL-derived tumors with drugs that have reduced side effects is urgent to avoid repeat CNS surgeries. Recent reports have shown that propranolol, a -blocker used for the treatment of hypertension and other cardiac and neurological diseases, is the best option for infantile hemangioma (IH). Propranolol could be an efficient treatment to control hemangioblastoma growth in VHL disease because of its antiangiogenic effects demonstrated in IH and the hypothetical impact on HIF levels.HeLa 9X (HRE) hypoxia responsive element cell line and primary hemangioblastoma-derived cells were subjected to propranolol treatment and cell viability and apoptosis were evaluated. HIF1- and Hif-2 expression after propranolol treatment was analyzed by western blotting. Quantitative PCR was performed to study the mRNA expression of HIF target genes. Vascular endothelial growth factor (VEGF) was measured in culture supernatants by immunoassay.Propranolol downregulated HIF-dependent transcription in HeLa 9XHRE cells. Under hypoxic conditions, propranolol decreased the expression of HIF target genes in hemangioblastoma cells, which stopped proliferating and died following long-term treatment. These results suggests that propranolol treatment promoted reduced HIF protein expression and corresponding downregulation of HIF target genes, and inhibited cell proliferation in parallel with induction of cell death by apoptosis.Our results suggest that propranolol could reduce the growth of HIF-dependent tumors and may thus be a promising treatment to delay surgery in VHL patients.


Saura Rojas J.E.,University of Granada | Horcajadas Almansa A.,University of Granada | Ros Lopez B.,Servicio de Neurocirugia
Neurocirugia | Year: 2016

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations. © 2015 Sociedad Española de Neurocirugía.


PubMed | Servicio de Neurocirugia and University of Granada
Type: Journal Article | Journal: Neurocirugia (Asturias, Spain) | Year: 2016

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations.


PubMed | Servicio de Neurocirugia, University of Florida, Hospital Italiano Of Buenos Aires and Hospital Padilla
Type: Journal Article | Journal: Surgical neurology international | Year: 2016

The aim of this study is to describe the results of 13 patients with facial hemispasm, treated with microvascular decompression.Between June 2005 and May 2014, 13 patients with facial hemispasm were operated, underwent microvascular decompression. The age, sex, duration of symptoms before surgery, and surgical finds, were all evaluated. In addition, postoperative results were also analyzed.Seven patients were women and 6 were men. The average age of the patients was 53 years. The average time between onset of symptoms and surgery ranged from 3 to 9 years. In all cases the facial hemispasm was typical, one with concomitant trigeminal neuralgia, observed in all neurovascular compression intraoperative. In decreasing order of frequency, the cause of compression was anterior inferior cerebellar artery, posterior inferior cerebellar artery, dolicomega basilar artery and dolicomega vertebral artery. The average time of postoperative follow-up after the surgery was 24 months. Complete relief from spasm occurred in 62%; 30% disappearance after 3 weeks-2 months (8% partial) and in 8% had no improvement. Regarding postoperative complications: 3 patients had facial paresis II-III in House-Brackman scale and 1 patient presented CSF leak. None of the patients in the serie had hearing loss or deafness.The microvascular decompression for facial hemispasm is a safe an effective procedure, which allows complete resolution of the disease in most cases.


Campero A.,Hospital Padilla | Ajler P.,Hospital Italiano | Campero A.,Servicio de Neurocirugia
Surgical Neurology International | Year: 2014

Background: The aim of this study is to describe the results of 36 patients with trigeminal neuralgia treated with microvascular decompression. Methods: Between June 2005 and May 2012, 36 patients with trigeminal neuralgia were operated by the first author (AC), underwent microvascular decompression. The age, sex, duration of symptoms before surgery, and surgical finds, were all evaluated. In addition, postoperative results were also analyzed. Results: Twenty-five patients were women and 11 were men. The average age of the patients was 48 years. The average time of postoperative follow-up after the surgery was 36 months. Relief from pain until now occurred in 32 patients (88%). Pain recurrence was observed in 4 patients; of those, 2 cases showed a vein compression. Conclusion: The microvascular decompression for trigeminal neuralgia is a safe an effective option. A vein compression could point out an unfavorable follow-up.


PubMed | Servicio de Neurocirugia, Hospital Italiano and Hospital Padilla
Type: Journal Article | Journal: Surgical neurology international | Year: 2014

The aim of this study is to describe the results of 36 patients with trigeminal neuralgia treated with microvascular decompression.Between June 2005 and May 2012, 36 patients with trigeminal neuralgia were operated by the first author (AC), underwent microvascular decompression. The age, sex, duration of symptoms before surgery, and surgical finds, were all evaluated. In addition, postoperative results were also analyzed.Twenty-five patients were women and 11 were men. The average age of the patients was 48 years. The average time of postoperative follow-up after the surgery was 36 months. Relief from pain until now occurred in 32 patients (88%). Pain recurrence was observed in 4 patients; of those, 2 cases showed a vein compression.The microvascular decompression for trigeminal neuralgia is a safe an effective option. A vein compression could point out an unfavorable follow-up.


PubMed | Servicio de Neurocirugia
Type: Journal Article | Journal: Global spine journal | Year: 2014

Study DesignCase report. ObjectiveThe recommended treatment of cervical subluxation is currently closed or open reduction. These treatments are better accomplished in the acute setting, when muscular and ligamentous laxity allows the required maneuvers to realign the dislocated segments. However, subsets of patients are still being treated subacutely. The majority of the literature addressing subacute subluxations reports treatment through front and back approaches, many of them performed in two, three, or even four stages. Other authors recommend days or weeks of traction to reduce the subluxation, followed by anterior or posterior approaches. Herein, we present a one-stage open posterior surgical treatment of a 2-month standing C5-C6 subluxation with jumped facets, describing a useful technique to reduce these challenging cases without the need of traction or multistage procedures. MethodsAfter opening and exposing the posterior elements, we performed a wide C5-6 bilateral foraminotomy; we then put lateral mass screws and rods from C4 to C6. Resembling the technique used in the reduction of high-grade lumbar spondylolisthesis, we used a rod reducer to bring back the C5 screw head toward the rod, thus realigning the lateral mass screw heads and reducing the subluxation. ResultsNo changes were observed in the motor evoked or somatosensory potentials during this maneuver. Following an uneventful procedure, the patient was transferred to the postanesthetic care unit and discharged 3 days later. ConclusionsThis open single-stage posterior approach dramatically reduces operating time. This technique could be added into the decision-making armamentarium for cases without disk herniation.

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