CLAN 2022 Microvascular decompression for glossopharyngeal neuralgia. A personal serie of 118 cases (A2022 1123).pptx
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Microvascular decompression for glossopharyngeal neuralgia. A personal 118 cases serie from Latin America. Glossopharyngeal neuralgia (GPN) is a craniofacial pain syndrome described as electrical discharges in the territory of the IX cranial nerve. A very rare neurovascular compression syndrome/cranial nerve HDS. Incidence 0.2–0.7/100,000 h/year. Misdiagnosis TN (V3). The MVD/MSD is a non-destructive technique focused on nerve isolation. Information about short and long-term efficacy of MVD for GPN is scarce. In our database, from 6 years 10 months we attended 2.248 diagnosis cases of HDS, 118 cases with some type of GPN, 40 simple and 78 combined type, and 34 underwent to MVD in our clinic. Results, we reach pain relief (88%), and poor result due to residual pain, not controlled with medication (5,9%); mortality rate cero. As an effective and safe procedure, minimally invasive MSD should be the first choice as a treatment for GPN, allowing good and excellent relief of glossopharyngeal neuropathic pain in most cases. Neurologia Segura Medical Center
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Microvascular decompression for glossopharyngeal neuralgia in a single center...
Microvascular decompression for glossopharyngeal neuralgia in a single center, Neurología Segura Medical Center, Mexico.
Glossopharyngeal neuralgia (GPN) is a craniofacial pain syndrome described as electrical discharges in the territory of the IX cranial nerve.
A very rare neurovascular compression syndrome, also is called as hiperactive disfuncional syndrome of the glossopharyngeal nerve
Incidence 0.2–0.7/100 000/year.
Misdiagnosis wit the third branch for trigeminal neuralgia (V3).
Neurología Segura Medical Center
www.neurologiasegura.net
Our minimally invasive microsurgical decompression (MSD) is a non-destructive technique focused on nerve isolation. Information about short and long-term efficacy of MVD for GPN is scarce.
Our minimally invasive MSD should be the first choice as a treatment for simple and combined GPN is a very effective and safe procedure, allowing a good, very good and excellent resolution of glossopharyngeal territory pain in most cases.
Presented in the 8th World Federation of the Skull Base Societies Meeting at Rio de Janeiro, Brazil.
Neurología Segura Medical Center
www.neurologiasegura.net
Microvascular decompression for glossopharyngeal neuralgia in a single center...
Microvascular decompression for glossopharyngeal neuralgia in a single center at Word Neurosurgery Webinar Conference 2021
The purpose of this study is to describe our results of microvascular decompression (MVD) to treat glossopharyngeal neuralgia (GPN), as well as to inform the findings during this surgery and the outcomes. Method: From August 2016 to October 2021, 94 patients were diagnosed with GPN; 37 (39%) in its classic form and 57 (61%) in combination with other neuropathies. DMV was performed in 29 patients. Age, sex, time of evolution of the symptoms, intraoperative findings and post-operative results were evaluated. Result: The mean age of patients was 56.5 years old and the average time of the evolution of the symptoms was 7.5 years. Most of the patients were female (52%), and the right side was the more affected (62%). Comorbidities were presented in 52% of patients highlighting systemic arterial hypertension, diabetes mellitus and dyslipidemia. The leading cause of compression was SCA, followed by PICA, AICA and vertebral artery. Other findings included arachnoiditis (92%), mainly viscous with signs of fibrosis and/or microcalcifications. Complications were reported in 5 patients (17.2%); those included CSF fistula or facial palsy. All patients presented immediate improvement of the GPN symptoms after surgery, 20 (68.9%) reported themselves without pain, 2 (6.9%) presented with mild pain with no medication requirement, 3 (10.3%) moderate pain adequately controlled with medication, 2 (6.9%) were candidates to radiofrequency thermoablation due to residual pain, and in 2 (6.9%) patients the follow-up was lost. Conclusion: Minimally invasive MVD as a treatment for GPN is an effective and safe procedure allowing a good resolution of symptoms in most cases. Keywords: microvascular decompression, glossopharyngeal neuralgia, neuropathy
Neurología Segura Medical Center
www.neurologiasegura.net
Trigeminal
Trigeminal neuralgia (TN) is a neuropathic disorder characterized by severe, sporadic facial pain affecting the trigeminal nerve. It often feels like electric shocks in the face. A 57-year-old female presented with sudden, sharp left cheek pain triggered by touch or talking. No dental cause was found, and TN was diagnosed provisionally. The diagnosis was later confirmed by a neurologist. TN is caused by compression or demyelination of the trigeminal nerve root and treated initially with anticonvulsants like carbamazepine. If medications fail, surgical options include microvascular decompression, percutaneous nerve procedures, or radiosurgery.
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Microvascular decompression for glossopharyngeal neuralgia in a single center...
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Glossopharyngeal neuralgia (GPN) is a craniofacial pain syndrome described as electrical discharges in the territory of the IX cranial nerve.
A very rare neurovascular compression syndrome, also is called as hiperactive disfuncional syndrome of the glossopharyngeal nerve
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Misdiagnosis wit the third branch for trigeminal neuralgia (V3).
Neurología Segura Medical Center
www.neurologiasegura.net
Our minimally invasive microsurgical decompression (MSD) is a non-destructive technique focused on nerve isolation. Information about short and long-term efficacy of MVD for GPN is scarce.
Our minimally invasive MSD should be the first choice as a treatment for simple and combined GPN is a very effective and safe procedure, allowing a good, very good and excellent resolution of glossopharyngeal territory pain in most cases.
Presented in the 8th World Federation of the Skull Base Societies Meeting at Rio de Janeiro, Brazil.
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Academic production and continuous communication
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Bendtsen, L., Zakrzewska, J.M., Abbott, J., Braschinsky, M., Di Stefano, G., Donnet, A., ... & Cruccu, G. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology, 26(6), 831-49.
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Slide 4. Epidermoid cysts are slow-growing brain tumors of embryonic origin that manifest later in life.1
The anterolateral cisterns of the brainstem is its most frequent location.2
They represent approximately 1% of intracranial tumors.1
They are present in about 2% of patients presenting as a first symptom a trigeminal neuralgia.2
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Slide 5. We present our experience and philosophy on the surgical approach based on three principles:
Preserve the life of the patient.
Do not damage the nerve and vascular structures adjacent to the surgical site to avoid neurological sequelae and complications inherent to surgery.
Eliminate the cause of compressive neuropathy and relieve symptoms.
Slide 6.For this presentation we focus primarily on the anterolateral location of the brainstem of Epidermoid Cyst.
Slide 7. Our surgical technique in 10 steps.
1.Lateral decubitus positioning with head rotation
1 inch skin incision in the retromastoid region
2.Musculoskeletal plane dissection to reach the surface of the skull
3.Infra-asterional craniectomy <2cm
5. Durotomy in "<" or ">"
6. Depletion of CSF from the posterior fossa without brain retraction
7. Debulking and tumor resection
8. Treatment of the implant area
9. Hemostatic review of the microsurgical area
10.Hermetic duroplasty and soft tissues
Slide 21. Our series of EC cases in the ALCs of the brainstem is one of the largest published in Latin America and, based on the excellent long-term results obtained, we propose this minimally invasive microsurgical approach as the best treatment.
Comprehensive anterolateral cisterns of the brainstem as a 3D space concept
Non-septate but monocompartmental, non-infiltrative towards the adjacent arachnoid
Complete or subtotal excision without implant zone is the goal in the first surgery
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Objetivo: Definir el algoritmo de tratamiento de nuestros pacientes con neuralgia de trigémino clásica.
Casos y método: Entre enero 2011 a octubre 2021, 2210 pacientes fueron diagnosticados como síndrome de disfunción hiperactiva de los pares craneales, entre ellos, neuralgia del trigémino con 83% (n=1841).
Resultados: En la fase intermedia de la enfermedad, definido por el autor en otra publicación, las opciones de tratamiento quirúrgico ablativos (n=98) incluyeron, lesión térmica o termoablación por radiofrecuencia (n=74), radiación gamma o radiocirugía estereotáctica (n=24), lesión química o rizólisis con esteroides o alcoholes y lesión mecánica o compresión con balón o globo de Fogarty, según condiciones clínicas de cada paciente; mientras que el único tratamiento quirúrgico no ablativo (n=902) es la descompresión microquirúrgica del nervio trigémino en el segmento cisternal (n=839), no únicamente la descompresión microvascular definido por el autor en otra publicación y extirpación de algún tumor compresivo sobre el nervio trigémino (n=63).
Conclusión: En nuestra opinión, se propone que el manejo de la neuralgia del trigémino debe ser abordado por un equipo multidisciplinario de expertos con una visión integral y disponer de la gama de opciones terapéuticas actuales. A pesar de demostrar alivio casi inmediato, las opciones terapéuticas ablativas, presentan alto riesgo de pérdida sensorial facial y altas tasas de recurrencia. La descompresión microvascular en centros altamente especializados resuelve un elevado número de casos, siendo la descompresión microquirúrgica mínimamente invasiva el abordaje recomendado, en nuestra opinión experta. Se recomienda realizar esta cirugía en la fase final del entrenamiento del neurocirujano con experiencia
en cirugía de la base del cráneo. En América Latina, debemos fortalecer la formación de especialistas en subdisciplinas propias de la especialidad como lo exige la sociedad moderna global.
Lectura presentada en el World Neurosurgery Webinar Congress 2021 y 11th Virtual International Conference of the Neurosurgery Research Listserv
Neurología Segura Medical Center
www.neurologiasegura.net
XXXIX CLAN Guayaquil Quiste Epidermoide de Fosa Posterior (A20211120)
Este documento describe un estudio de casos de quistes epidermoides en las cisternas anterolaterales del tallo cerebral. Los quistes epidermoides son tumores cerebrales de crecimiento lento que se manifiestan comúnmente en etapas avanzadas de la vida y su localización más frecuente es en las cisternas anterolaterales del tallo cerebral. El estudio presenta los resultados quirúrgicos de 26 pacientes tratados con un abordaje microquirúrgico mínimamente invasivo con excelentes resultados a largo pl
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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International Congress for Medical Tourism 2023
Neurología Segura as International Medical Center for the treatment of the Trigeminal Neuralgia presented by Mauro Segura, CEO.
Latin American leader for the treatment of Trigeminal Neuralgia.
More than 1,200 MVD surgeries in one single Center.
FLANC Neurosurgery Reference Center.
Latin American Leader for the Treatment of Trigeminal Neuralgia.
Highly Specialized Medical Center.
Modern and Certified Hospital (Hospital Angeles Morelia)
How to become a reference center for international medical tourism, step by step,
International Quality Certifications, Multicultural work enviroment, International patients, doctors and insurences, International reference for trigeminal neuralgia, Oversea recognition of
quality, service and results of high level, Offer a unique and excellent medical service, International prestige for the scientific community, Increasing numbers of cases and surgical procedures, Strengthen alliances and brand loyalty.
Epidemiology of Trigeminal Neuralgia. It is estimated that it affects 4 to 5 cases per 100,000 people each year without racial, geographic or economic predilections.
Occurs in a female:male ratio of 3:1.
Appears after 50 years of age (90% of cases).
It affects only one side of the face. Although it can be bilateral in about 5% of cases (classic form) and up to 16% (atypical form). In Neurología Segura we have identified that patients take an average of 7 years to find specialized and expert help.
Neurología Segura as a highly specialized international medical center.
At Neurología Segura more than 100 procedures are performed per year, which positions us as a highly specialized center in the treatment of Trigeminal Neuralgia according to the World Federation of Neurosurgical Societies (WFNS).
Academic production and continuous communication
of our findings and results.
More than 30 scientific posters have been presented at medical congresses
More than 100 presentations have been made in national and international medicine forums
More than 200 national and international congresses have been attended
Collaborations in more than 30 publications in books and medical journals
More than 20 research projects in progress.
www.neurologiasegura.net
2023 03 01 4a Reunión ASEMEJA una historia de éxito
4a bReunión ASEMEJA con aval de JICA
Breve narrativa de una historia de trabajo y éxito en la creación de un centro médico de alta especialidad en latinoamérica dedicado al estudio y tratamiento de la neuralgia del trigémino en Neurología Segura posterior a intercambio académico por JICA
Neurología Segura
CMAE 2023
www.neurologiasegura.net
Asemeja 2023, hospital de alta especialidad, líder en tratamiento de neuralgia del trigemino, Mauro Segura neurocirujano, mejor neurocirujano neuralgia, neuralgia trigeminal, neurología segura, trigeminal neuralgia
MVD TECHNIQUE by AKITA NOKEN CENTER A2021 0101.pptx
The document discusses the results of a study on the impact of COVID-19 lockdowns on air pollution. Researchers found that lockdowns led to significant short-term reductions in nitrogen dioxide and fine particulate matter pollution globally as economic activities slowed. However, the impacts on greenhouse gases and long-term air quality improvements remain uncertain without permanent behavior and economic changes.
Ethiological Diversity of Secondary TN EAN.pptx
European Academy of Neurology. Study Group for Trigeminal Neuralgia at Neurologia Segura, Morelia, Mexico. 6o. Congress of the EAN Virtual 2020. European Academy of Neurology, June 2020
Etiological Diversity of Secondary Trigeminal Neuralgia
All the causes of this type of TN seen in our clinic in the last 6 years.
When we clasifiy TN by etiology we have three different groups: Classical TN includes patients that have a neurovascular contact on MRI. Secondary TN groups patients with neuropathy caused or associated to another disease and Idiopathic TN includes the patients that do not have an apparent cause for the disease.
In 2016 The AAN published in it’s journal a new classification for trigeminal neuralgia. This new classification resolved some of the confusión that could appear when trying to group patients with the disesae. The big change in this classification is the differentiation of 2 categories, the first one is clinical presentaion; patients with TN can present with sudden episodes of pain that happen scattered during the day and are usually triggered by certain activies or sensations or they can present with a more severe form of continuos persistent pain on top of the paroxismal pain attacks.
On the other hand we can also talk about 3 main types of TN based on it’s etiology. The first and most common group representing about 70% of the patients is Classical TN which includes those patients that have a neurovascular contact affecting the 5th CN and that is demonstrated through an MRI. Secondary TN includes all the patients with the disease that have pain in the distribution of the 5th CN caused by another disease. And Idiopathic TN represents the smallest group in which there is no apparent cause that explains the presence of trigeminal pain.
The European Academy of Neurology recently published a new guideline in 2020 which endorses this classification and furthermore Groups Classical TN and Idiopathic TN into a category named Primary TN when the disease process is intrinsic to the Trigeminal Nerve and Secondary when the disease starts somewhere else.
Bendtsen, L., Zakrzewska, J.M., Abbott, J., Braschinsky, M., Di Stefano, G., Donnet, A., ... & Cruccu, G. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology, 26(6), 831-49.
Cruccu, G., Finnerup, N.B., Jensen, T.S., Scholz, J., Sindou, M., Svensson, P., ... & Nurmikko, T. (2016). Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology, 87(2), 220-8.
Carranza-Renteria O, Segura-Lozano M. Evaluation of the New Classification of Trigeminal Neuralgia with a Retrospective Analysis. J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244 DOI: 10.1055/s-0039-1679829
For our study we conducted a prospective recollection of all the cases of TN seen at our hospital in Mexico from January 2014 to December 2019. All the patients were diagnosed by first doing a complete medical chart.
Neuralgia del trigemino refractaria (2022 1021)
XLII Congreso AMETD, sesiones plenarias: Intervencionismo en síndromes
dolorosos de díficil control
La neuralgia del trigémino refractaria a tratamiento farmacológico e intervencionismo es un reto médico que debe ser evaluado por un equipo de profesionales expertos en el tema de dolor facial para identificar la causa más certera del dolor en cada caso.
Neurología Segura
Mauro Segura CEO
MVD for TN secondary to meningioma IMMM A2022 10 14.pptx
Abstract from the last international meeting presentation about trigeminal neuralgia secondary to meningioma at the trigeminal porus in the skull base, a very rare anatomical location for this tumor
Mauro Segura, MD PhD
Neurología Segura
Mexico
Alternativas en recidivas de NT SCNO v corta A2022 0714.pptx
Este documento discute las alternativas para el tratamiento de recidivas de neuralgia del trigémino. La descompresión microvascular (DMV) es la opción quirúrgica principal, con una tasa de éxito superior al 89%. Sin embargo, entre un 8-14% de pacientes experimentan una recurrencia del dolor. El documento analiza las posibles causas de recidiva temprana o tardía y recomienda la reexploración con DMV como el método más seguro y efectivo para tratar la neuralgia del trigémino recurrente, siempre que se identifique evidencia
Algias faciales abordaje SCNO A2022 0714.pptx
Resumen de la participación del Dr. Mauro Segura, Director de Neurología Segura, experto en el estudio y tratamiento de la neuralgia del trigémino y otras algas faciales
XXII Congreso de la SCNO, Puerto Vallarta, México.
www.neurologiasegura.net
Dr. Mauro Alberto Segura Lozano
Neurología Segura
Quiste epidermoide de fosa posterior serie de casos SCNO A2022 0715
En el marco del Congreso de la Sociedad de Cirugía Neurológica de Occidente 2022 rodeado de un increíble grupo de líderes de opinión de la neurocirugía en Latinoamérica.
Presentamos una semblanza sobre nuestra revisión sistemática del quiste epidermoide infratentorial o de la fosa posterior
Neurología Segura Medical Center
Morelia, México
Neuralgia del trigémino, experiencia de 1,000 cirugías en Neurología Segura ...
Este documento resume la experiencia de 1000 cirugías para tratar la neuralgia del trigémino en Latinoamérica. Describe las características clínicas de la neuralgia del trigémino, incluyendo sus causas, clasificaciones, diagnóstico, tratamientos quirúrgicos y resultados. Explica que la neuralgia del trigémino puede ser primaria o secundaria a otras causas, y que el diagnóstico clínico y la resonancia magnética son fundamentales para determinar el tratamiento.
Epidermoid cyst at the 2nd Yemeni Neurosurgical Conference 2017 (A2017 0517)
On May 17th, 2017 we were invited to present our large experience on epidermoid cyst tumors located at the posterior skull base.
At that time we were reached no more than ten success epidermoid cyst operated cases by employing our minimally invasive retromastoid approach
Mauro Segura, Md, PhD
Neurologia Segura Medical Center
Organizer by John Bennet Neurosurgery TV
turismo neurologiasegura neuralgia del trigemino GASS 2016 (A2016 10)
En el marco del Congreso bianual del Grupo Angeles Servicios de Salud 2016 se presentó el abstracto del reporte de resultados en turismo médico en 24 meses celebrado en la Ciudad de México, Camino Real Polanco.
Se presenta un análisis comparativo entre las diferentes técnicas quirúrgicas y percutáneas para tratamiento del dolor facial predominantemente neuralgia del trigémino y glosofaríngeo en nuestro centro médico altamente especializado en Neurología Segura
Neurología Segura Medical Center
Neuralgia del trigémino: Una nueva clasificación terapéutica 2015
Presentado en el marco del NASB Meeting 2015 por el grupo de experto de Latinoamérica de Neurología Segura y publicado en el Segura M, et al. A New Clinical Classification of Trigeminal Neuralgia. J Neurol Surg B Skull Base 2015; 76 - P049 Journal of Neurological Surgery, Part B: Skull Base DOI: 10.1055/s-0035-1546677
181 cirugías del trigémino en el 2015 por el grupo de expertos en Latinoamérica
Neurología Segura
Global Spine Congress 2011: Evolution and Analisis de 337 operated cases of l...
En el marco del Global Spine de Barcelona se presentó el reporte preliminar del abordaje minimamente invadido conocido como hemilaminoforaminotomía y discectomía en 337 pacientes con hernia fiscal lumbar.
Resalta la experiencia y filosofía del trabajo basado en la preservación la integridad anatómica y funcional de las estructuras músculo-esqueléticas, específicamente el muro posterior o columna posterior además de las neurovasculares a nivel del foramen intervertebral, contrario a la tendencia moderna en el foro.
El trabajo fue dirigido y publicado por el Dr. Gilberto Gardea Loera, neurocirujano de columna de Delicias, México
Algias faciales en FESORMEX (A20220318)
Webinar de la FESORMEX con el Dr. ROberto Dávalos Valenzuela y Dr. Mauro Segura sobre el tema de algia facial abordaje diagnóstico y terapéutico integral y multidisciplinario, experiencia y nuevos criterios a lo largo de 20 años de experiencia en Neurología Segura como líder latinoamericano en el tratamiento de la neuralgia del trigémino
Webinar presentado ante la comunidad de médicos especialistas en cirugía craneofacial y cirugía de cabeza y cuello con formación de otorrinolaringología
Neurología Segura Medical Center
www.neurologiasegura.net
Enfrentando la Pandemia Covid 19 (A20211220)
Sesión General del Hospital Angeles Morelia por parte del equipo de Neurología Segura, líder en el estudio y tratamiento de la neuralgia del trigémino en Latinoamérica con sede en Morelia, México
Neurología Segura Medical Center
www.neurologiasegura.net
Efficacy and safety of microvascular decompression for trigeminal in patients...
This study evaluated the efficacy and safety of microvascular decompression (MVD) for treating trigeminal neuralgia in patients with morbid obesity. The study found that while MVD surgery took longer and had higher risks in obese patients, it was still effective at reducing pain. Specifically, obese patients had longer surgery/anesthesia times, more pre-existing health issues, and higher complication rates during intubation. However, obese patients still experienced significant pain relief following surgery similar to non-obese patients, with over 65% reporting an excellent outcome. The study concluded that MVD should be considered for obese patients with TN when it is the only effective treatment option, and can be performed safely in specialized medical centers.
Posterior Fossa Epidermoid Cyst at the World Neurosurgery Webinar Conference...
Slide 1. 11th Virtual International Conference of the Neurosurgery Research Listserv and the World Neurosurgery Webinar Conference 2021, presented by Mauro Segura, Neurología Segura Director, Morelia Mexico 2021
Slide 4. Epidermoid cysts are slow-growing brain tumors of embryonic origin that manifest later in life.1
The anterolateral cisterns of the brainstem is its most frequent location.2
They represent approximately 1% of intracranial tumors.1
They are present in about 2% of patients presenting as a first symptom a trigeminal neuralgia.2
The study of choice is a high definition MRI
Slide 5. We present our experience and philosophy on the surgical approach based on three principles:
Preserve the life of the patient.
Do not damage the nerve and vascular structures adjacent to the surgical site to avoid neurological sequelae and complications inherent to surgery.
Eliminate the cause of compressive neuropathy and relieve symptoms.
Slide 6.For this presentation we focus primarily on the anterolateral location of the brainstem of Epidermoid Cyst.
Slide 7. Our surgical technique in 10 steps.
1.Lateral decubitus positioning with head rotation
1 inch skin incision in the retromastoid region
2.Musculoskeletal plane dissection to reach the surface of the skull
3.Infra-asterional craniectomy <2cm
5. Durotomy in "<" or ">"
6. Depletion of CSF from the posterior fossa without brain retraction
7. Debulking and tumor resection
8. Treatment of the implant area
9. Hemostatic review of the microsurgical area
10.Hermetic duroplasty and soft tissues
Slide 21. Our series of EC cases in the ALCs of the brainstem is one of the largest published in Latin America and, based on the excellent long-term results obtained, we propose this minimally invasive microsurgical approach as the best treatment.
Comprehensive anterolateral cisterns of the brainstem as a 3D space concept
Non-septate but monocompartmental, non-infiltrative towards the adjacent arachnoid
Complete or subtotal excision without implant zone is the goal in the first surgery
Due to the rarity of the entity, we recommend that the neurosurgeon interested in treating this type of tumor be trained in laboratories with cadavers, with software for 3D virtual surgery and under the tutelage of an expert neurosurgeon to resolve contingencies that may arise during the curve learning.
Neurología Segura Medical Center
www.neurologiasegura.net
Cirugía del trigémino 1,000 casos operados en Neurología Segura CLAN Guayaqui...
Se presentaron los nuevos conceptos sobre el abordaje diagnóstico y terapéutico en pacientes con dolor craneofacial, entre ellos, la neuralgia del trigémino como el principal síndrome doloroso facial, con un alto índice de alivio permanente del dolor con una mejoría en la calidad de vida, en el marco del XXXIX Congreso Latinoamericano de Neurocirugía CLAN en Guayaquil, Ecuador.
Cirugía de la neuralgia del trigémino 1,000 en Neurología Segura
Segura, MA, Segura AF, Munguía AG.
Introducción: Se tienen reportes de dolor facial desde Hipócrates en el siglo V a.C. y de neuralgia desde el siglo I en los escritos de Areteo y Galeno. En la antigüedad no existía tratamiento, por lo que las personas optaban por quitarse la vida para terminar su sufrimiento.
Objetivo: Definir el algoritmo de tratamiento de nuestros pacientes con neuralgia de trigémino clásica.
Casos y método: Entre enero 2011 a octubre 2021, 2210 pacientes fueron diagnosticados como síndrome de disfunción hiperactiva de los pares craneales, entre ellos, neuralgia del trigémino con 83% (n=1841).
Resultados: En la fase intermedia de la enfermedad, definido por el autor en otra publicación, las opciones de tratamiento quirúrgico ablativos (n=98) incluyeron, lesión térmica o termoablación por radiofrecuencia (n=74), radiación gamma o radiocirugía estereotáctica (n=24), lesión química o rizólisis con esteroides o alcoholes y lesión mecánica o compresión con balón o globo de Fogarty, según condiciones clínicas de cada paciente; mientras que el único tratamiento quirúrgico no ablativo (n=902) es la descompresión microquirúrgica del nervio trigémino en el segmento cisternal (n=839), no únicamente la descompresión microvascular definido por el autor en otra publicación y extirpación de algún tumor compresivo sobre el nervio trigémino (n=63).
Conclusión: En nuestra opinión, se propone que el manejo de la neuralgia del trigémino debe ser abordado por un equipo multidisciplinario de expertos con una visión integral y disponer de la gama de opciones terapéuticas actuales. A pesar de demostrar alivio casi inmediato, las opciones terapéuticas ablativas, presentan alto riesgo de pérdida sensorial facial y altas tasas de recurrencia. La descompresión microvascular en centros altamente especializados resuelve un elevado número de casos, siendo la descompresión microquirúrgica mínimamente invasiva el abordaje recomendado, en nuestra opinión experta. Se recomienda realizar esta cirugía en la fase final del entrenamiento del neurocirujano con experiencia
en cirugía de la base del cráneo. En América Latina, debemos fortalecer la formación de especialistas en subdisciplinas propias de la especialidad como lo exige la sociedad moderna global.
Lectura presentada en el World Neurosurgery Webinar Congress 2021 y 11th Virtual International Conference of the Neurosurgery Research Listserv
Neurología Segura Medical Center
www.neurologiasegura.net
XXXIX CLAN Guayaquil Quiste Epidermoide de Fosa Posterior (A20211120)
Este documento describe un estudio de casos de quistes epidermoides en las cisternas anterolaterales del tallo cerebral. Los quistes epidermoides son tumores cerebrales de crecimiento lento que se manifiestan comúnmente en etapas avanzadas de la vida y su localización más frecuente es en las cisternas anterolaterales del tallo cerebral. El estudio presenta los resultados quirúrgicos de 26 pacientes tratados con un abordaje microquirúrgico mínimamente invasivo con excelentes resultados a largo pl
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2023 03 01 4a Reunión ASEMEJA una historia de éxito
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MVD for TN secondary to meningioma IMMM A2022 10 14.pptx
MVD for TN secondary to meningioma IMMM A2022 10 14.pptx
Alternativas en recidivas de NT SCNO v corta A2022 0714.pptx
Alternativas en recidivas de NT SCNO v corta A2022 0714.pptx
Quiste epidermoide de fosa posterior serie de casos SCNO A2022 0715
Quiste epidermoide de fosa posterior serie de casos SCNO A2022 0715
Neuralgia del trigémino, experiencia de 1,000 cirugías en Neurología Segura ...
Neuralgia del trigémino, experiencia de 1,000 cirugías en Neurología Segura ...
Epidermoid cyst at the 2nd Yemeni Neurosurgical Conference 2017 (A2017 0517)
Epidermoid cyst at the 2nd Yemeni Neurosurgical Conference 2017 (A2017 0517)
turismo neurologiasegura neuralgia del trigemino GASS 2016 (A2016 10)
turismo neurologiasegura neuralgia del trigemino GASS 2016 (A2016 10)
Neuralgia del trigémino: Una nueva clasificación terapéutica 2015
Neuralgia del trigémino: Una nueva clasificación terapéutica 2015
Global Spine Congress 2011: Evolution and Analisis de 337 operated cases of l...
Global Spine Congress 2011: Evolution and Analisis de 337 operated cases of l...
Efficacy and safety of microvascular decompression for trigeminal in patients...
Efficacy and safety of microvascular decompression for trigeminal in patients...
Posterior Fossa Epidermoid Cyst at the World Neurosurgery Webinar Conference...
Posterior Fossa Epidermoid Cyst at the World Neurosurgery Webinar Conference...
Cirugía del trigémino 1,000 casos operados en Neurología Segura CLAN Guayaqui...
Cirugía del trigémino 1,000 casos operados en Neurología Segura CLAN Guayaqui...
XXXIX CLAN Guayaquil Quiste Epidermoide de Fosa Posterior (A20211120)
XXXIX CLAN Guayaquil Quiste Epidermoide de Fosa Posterior (A20211120)
Recently uploaded
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.com
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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CLAN 2022 Microvascular decompression for glossopharyngeal neuralgia. A personal serie of 118 cases (A2022 1123).pptx
- 1. Mauro Segura, MD, PhD. Adriana Fernanda Segura Zenón, María Nayeli Rojas Pedroza,Yael Rodrigo Torres Torres, Alejandro GonzálezSilva, Aarón GiovanniMunguía Rodríguez. Neurología SeguraMedicalCenter,Morelia,Michoacán,México. Investigación Segura Microvascular decompression for glossopharyngeal neuralgia. A personal 118 cases serie Miami, Florida, November 22th, 2022
- 2. • Glossopharyngeal neuralgia (GPN) is a craniofacial pain syndrome described as electrical discharges in the territory of the IX cranial nerve. • A very rare neurovascular compression syndrome/cranial nerve HDS. • Incidence 0.2–0.7/100,000 h/year. • Misdiagnosis TN (V3). • The MVD/MSD is a non-destructive technique focused on nerve isolation. Information about short and long-term efficacy of MVD for GPN is scarce. Introduction info@neurologiasegura.net
- 3. January 2016 October 2022 2248 Cases of HDS 118 Cases of GPN 40 Simple 78 Combined 34 MVD Method info@neurologiasegura.net
- 5. Age at MVD x̄ = 55.5 y Evolution of symptoms x̄ = 7.9 y Results info@neurologiasegura.net
- 6. 19 cases (56%) 15 cases (44%) BMI 26.1 BMI 24.2 Results Male Female info@neurologiasegura.net
- 7. 19 cases (56%) 15 cases (44%) Right side Left side Results info@neurologiasegura.net
- 8. Results Triggers Comorbidities info@neurologiasegura.net Tongue base movement 100% Pressure 42% Cold 38% 12.5% 12.5% DM2 71% SAH 58% Negated 41% Others 33% DM2=Diabetes Mellitus SAH = Systemic Arterial Hypertension DLP= Dyslipidemia HT = Hypothyroidism DLP 8% HT 8%
- 9. Vascular and histopatological findings Culprit vessel Arachnoiditis Viscous Fibrosis Calcification PICA AICA VA info@neurologiasegura.net
- 10. Immediate transient complications Headache Dizziness Nausea Mild postoperative complications 1 CSF leak (4%) 5 Transient facial palsy (20.8%) Cough (4%) Dysphonia (4%) Complications info@neurologiasegura.net Mortality rate 0%
- 11. Complementary radiofrecuency Lost follow-up 2 cases (5.9%) Outcome No pain No medication Mild pain No medication Moderate pain Controlled with medication Residual pain Not controlled with medication 22 (64.7%) 4 (11.7%) 2 (5.9%) 4 (11.7%) Outcome info@neurologiasegura.net Pain relief (88%)
- 12. As an effective and safe procedure, minimally invasive MSD should be the first choice as a treatment for GPN, allowing good and excellent relief of glossopharyngeal neuropathic pain in most cases. Conclusion info@neurologiasegura.net
Editor's Notes
- The purpose of this study is to demonstrate the safety and efficacy of MVD to treat GPN in our medical center, as well as to inform the microsurgical findings during this surgery.