5 results on '"Bordes-Garcia, V."'
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2. Can We Make Simple In Situ Decompression of the Ulnar Nerve at the Elbow Still Easier?
- Author
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Vanaclocha V, Blanco T, Ortiz P, Lopez-Trigo J, Capilla P, Bordes-Garcia V, and Vanaclocha L
- Published
- 2017
3. Treatment of intrinsic brain tumors located in motor eloquent areas. results of a protocol based in navegation, tractography and neurophysiological monitoring of cortical and subcortical structures
- Author
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Gonzalez-Darder, J. M., Gonzalez-Lopez, P., Talamantes-Escriba, F., Garcia-March, G., Roldan-Badia, P., VICENT QUILIS QUESADA, Verdu-Lopez, F., Bordes-Garcia, V., Botella-Macia, L., Masbout, G., Cortes-Donate, V., and Belloch-Ugarte, V.
- Subjects
Monitorización neurofisiológica intraoperatoria ,Tumor cerebral intrínseco ,Intraoperative neurophysiological monitoring ,Corteza cerebral motora ,Cerebral motor cortex ,Intrinsic brain tumor ,Neuronavegación ,Craneotomía ,Neuronavigation ,Craniotomy - Abstract
Objetivos: El papel actual del tratamiento microquirúrgico de los tumores cerebrales intrínsecos se basa en alcanzar la máxima resección volumétrica del tumor minimizando la morbilidad postoperatoria. El propósito del trabajo es estudiar los beneficios de un protocolo diseñado para tratar tumores localizados en áreas elocuentes motoras, en el que se incluye la navegación y la estimulación de tractos motores subcorticales. Material y métodos: Se han incluido 17 pacientes con tumores corticales y subcorticales de área motora tratados quirúrgicamente. Para la planificación preoperatoria se fusionaron en el sistema de navegación estudios anatómicos, de resonancia funcional motora (RNM-f) y los tractos subcorticales generados por estudios de tensor de difusión (DTI). La monitorización intraoperatoria incluía el mapeo motor por estimulación cortical y subcortical directa (ECD y EsCD) e identificación del surco central por inversión de la onda N20 con electrodos corticales multipolares. La localización de los puntos con respuesta positiva a la ECD o EsCD se correlacionaba con las áreas corticales o tractos funcionales motores definidos en los estudios preoperatorios gracias al navegador. Resultados: La resección volumétrica tumoral media fue del 89.1±14.2% del volumen tumoral calculado en los estudios preoperatorios, con resección total (≥100%) en doce pacientes. En el preoperatorio había focalidad neurológica deficitaria motora en el 58.8% de los pacientes, que aumentó al 76.5% a las 24 horas de la cirugía y se redujo a los 30 días al 41.1%. Hubo una gran correlación entre los datos anatómicos y funcionales, tanto a nivel cortical como subcortical. Sin embargo, en seis casos no se pudo identificar anatómicamente el surco central y en muchos pacientes la RNM-f ofrecía datos contradictorios. Se realizaron un total de 52 ECD con respuesta motora positiva que identificaba el área motora primaria, alcanzándose una correlación positiva del 83.7%. Se realizaron un total de 55 EsCD con respuesta motora positiva que identificaban tractos corticoespinales procedentes del área motora primaria. La distancia media entre los puntos de respuesta y la ubicación de los haces en el navegador era de 7.3±3.1mm. Conclusiones: La integración de estudios anatómicos y funcionales preoperatorios e intraoperatorios permite una resección funcional que amplía de forma significativa la resección tumoral de los tumores alojados en áreas elocuentes motoras. La navegación permite integrar y reconocer la correlación entre los datos preoperatorios y los hallazgos intraoperatorios. Las áreas funcionales motoras corticales se reconocen anatómica y funcionalmente en el preoperatorio mediante estudios de RNM y RNM-f y las subcorticales con TDI y la generación de la tractografía a partir del mismo, mientras que la confirmación intraoperatoria se consigue mediante la ECD y estudio de inversión de la onda N20 para las áreas corticales y con la EsCD para las subcorticales. El tratamiento microquirúrgico guiado por navegación y con la ayuda de los estudios descritos permite resecciones tumorales medias del 90% en lesiones tumorales de áreas motoras corticales y subcorticales elocuentes con una morbilidad neurológica alta en el postoperatorio inmediato que se reduce de forma significativa a las cuatro semanas. Los estudios en curso deben definir los márgenes de seguridad para la resección funcional que tengan en consideración el 'shift' cerebral operatorio. Finalmente, queda por demostrar el beneficio de estos protocolos en intervalo libre de enfermedad, de recidiva o en la supervivencia final de los pacientes. Objectives: The role of the microsurgical management of intrinsic brain tumors is to maximize the volumetric resection of the tumoral tissue minimizing the postoperative morbidity. The purpose of our paper has been to study the benefits of an original protocol developed for the microsurgical treatment of tumors located in eloquent motor areas where the navigation and electrical stimulation of motor subcortical pathways have been implemented. Materials and methods: A total of 17 patients operated on for resection of cortical or subcortical tumors in motor areas were included in the series. Preoperative planning for multimodal navigation was done integrating anatomic studies, motor functional MRI (f-MRI) and subcortical pathways volumes generated by diffusion tensor imaging (DTI). Intraoperative neuromonitorization included motor mapping by direct cortical and subcortical electrical stimulation (CS and sCS) and localization of the central sulcus using cortical multipolar electrodes and the N20 wave inversion technique. The location of all cortical and subcortical stimulated points with positive motor response was stored in the navigator and correlated with the cortical or subcortical motor functional structures defined preoperatively. Results: The mean tumoral volumetric resection was 89.1±14.2% of the preoperative volume, with a total resection (≥100%) in twelve patients. Preoperatively a total of 58.8% of the patients had some motor deficit, increasing 24 hours after surgery to 76.5% and decreasing to 41.1% a month later. There was a great correlation between anatomic and functional data, both cortically and subcortically. However, in six cases it was not possible to identify the central sulcus and in many cases fMRI gave contradictory information. A total of 52 cortical points submitted to CS had positive motor response, with a positive correlation of 83.7%. Also, a total of 55 subcortical points had positive motor response, being in these cases 7.3±3.1mm the mean distance from the stimulated point to the subcortical tract. Conclusions: The integration of preoperative and intraoperative anatomic and functional studies allows a safe functional resection of the brain tumors located in eloquent areas, compared to the tumoral resection based on anatomic imaging studies. Multimodal navigation allows the integration and correlation among preoperative and intraoperative anatomic and functional data. Cortical motor functional areas are anatomically and functionally located preoperatively thanks to MRI and fMRI and subcortical motor pathways with TDI and tractography. Intraoperative confirmation is done with CS and N20 inversion wave for cortical structures and with sCS for subcortical pathways. With this protocol we achieved a mean of 90% of volumetric resection in cortical and subcortical tumors located in eloquent motor areas with an increase of neurological deficits in the immediate postoperative period that significantly decreased one month later. Ongoing studies will define the safe limits for functional resection taking into account the intraoperative brain shift. Finally, it must be demonstrated if this protocol has any benefit for patients concerning disease free or everall survival.
4. Olfactory groove meningiomas. Radical microsurgical treatment through the bifrontal approach
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Gonzalez-Darder, J. M., Pesudo-Martinez, J. V., Bordes-Garcia, V., VICENT QUILIS QUESADA, Talamantes-Escriva, F., Gonzalez-Lopez, P., and Masbout-Kayal, G.
- Subjects
Olfactory groove meningiomas ,Colgajo perióstico pediculado ,Vascularized periosteal flap ,Cirugía de base de cráneo ,Skull base surgery ,Bifrontal craniotomy ,Craneotomía bifrontal ,Meningioma del surco olfatorio - Abstract
Objetivos. Describir los detalles técnicos del abordaje bifrontal para el tratamiento microquirúrgico radical de los meningiomas del surco olfatorio. Revisar los factores diagnósticos a valorar en la selección del abordaje quirúrgico de estos tumores. Material y métodos. Se revisa una serie microquirúrgica de 35 tumores del surco olfatorio intervenidos por vía bifrontal. Resultados. El volumen medio de las lesiones era de 85 cc (4.4 cm de diámetro). El 65.7% presentaban edema cerebral perilesional relevante, el 80% hiperostosis en la base de implantación y el 28.6% invasión de los senos paranasales. En todos los casos se realizó una exéresis grado 1 de Simpson. Hubo un éxitus por neumonía. La estancia hospitalaria fue de 3-20 días, con un Glasgow Outcome Scale 4-5 al alta en todos los casos y seguimiento medio de 55.2 meses. Como complicaciones relevantes destacan rinolicuorrea transitoria en dos casos e hidrocefalia en otro caso. Se ha identificado una recidiva local asintomática en un paciente a los 4 años de la cirugía. Conclusiones. En nuestra experiencia la vía bifrontal ha permitido la exéresis radical de los meningiomas de suco olfatorio de gran tamaño. La disección microquirúrgica de los segmentos A2 de las arterias cerebrales anteriores es posible gracias a la existencia de un plano aracnoideo entre ellas y el tumor. La vascularización del tumor se controla abordando precozmente el tumor por la base y no se precisa embolización preoperatoria. La vía bifrontal permite un tratamiento agresivo de la hiperostosis, infiltración ósea e invasión de los senos paranasales. La reconstrucción de la fosa anterior se consigue con un colgajo perióstico pediculado. Objectives. To describe the microsurgical technique for the radical removal of olfactory groove meningiomas through the bifrontal approach. To review the diagnostic elements to be taken into account in the selection of the surgical approach to these tumours. Materials and methods. A microsurgical series of 35 olfactory groove meningiomas operated on through a bifrontal craniotomy is reviewed. Results. The mean tumoral volume was 85cc (4.4cm diameter). A relevant peritumoral brain edema was found in 65.7% of cases, hyperostosis in the implantation base in 80% and paranasal sinus invasion in 28.6%. A Sipmson grade 1 resection was achieved in every case. A patient died due to a postoperative pneumonia. Postoperative hospitalization time was between 3 and 20 days and at discharge all patients had a Glasgow Outcome Scale grade 4-5. The mean follow-up was 55.2 months. Two patients had postoperative transient rhinolicuorrhea and an additional patient developed hydrocephalus. An asymptomatic recurrence have been identified in a patient four years after surgery. Conclusions. In our experience the bifrontal approach allowed the radical removal of huge olfactory groove meningiomas. The microdissection of the anterior cerebral artery A2 segments is possible thanks to the arachnoidal plane between vessels and tumor. Tumoral blood flow is secured by the early approaching of the base of the tumor and preoperative embolization is not necessary. Bifrontal approach allows an aggressive treatment of the hyperostosis, bone infiltration and paranasal sinus invasion. Anterior fossa reconstruction is done using a vascularized periosteal flap.
5. [System of dynamic neutralization in the lumbar spine: experience on 94 cases].
- Author
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Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, and Saez D
- Subjects
- Adult, Aged, Bone Screws, Female, Humans, Internal Fixators, Male, Middle Aged, Postoperative Complications, Radiography, Treatment Outcome, Joint Instability pathology, Joint Instability surgery, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae pathology, Lumbar Vertebrae surgery, Spinal Diseases pathology, Spinal Diseases surgery
- Abstract
Objective: To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions., Material and Methods: We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work., Results: The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections., Conclusions: The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.
- Published
- 2005
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