Epidermoid cyst at the 2nd Yemeni Neurosurgical Conference 2017 (A2017 0517)
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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
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2 Navegando por el hueso temporal
Navegando por el hueso temporal.
Serie de clases de neuroanatomía para estudiantes de perorado impartido por el Dr. Mauro Segura, neurocirujano de la base del cráneo experto en la cirugía del trigémino.
Enfoque microquirúrgico para abordajes de la base del cráneo de patologías comunes como son tumores de la base del cráneo, neuralgia faciales del trigémino, glosofaríngeo y espasmo hemifacial, entre otros, incluso mastoiditis crónica complicada; específicamente abordaje potroso retromastoideo o traspetroso posterior y anterior (Kawase's approach)
Neurología Segura
Líder latinoamericano para el tratamiento de la neuralgia del trigémino
1 Anatomía microquirúrgica del seno cavernoso y fosa media
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More from neurologia segura
2 Navegando por el hueso temporal
Navegando por el hueso temporal.
Serie de clases de neuroanatomía para estudiantes de perorado impartido por el Dr. Mauro Segura, neurocirujano de la base del cráneo experto en la cirugía del trigémino.
Enfoque microquirúrgico para abordajes de la base del cráneo de patologías comunes como son tumores de la base del cráneo, neuralgia faciales del trigémino, glosofaríngeo y espasmo hemifacial, entre otros, incluso mastoiditis crónica complicada; específicamente abordaje potroso retromastoideo o traspetroso posterior y anterior (Kawase's approach)
Neurología Segura
Líder latinoamericano para el tratamiento de la neuralgia del trigémino
1 Anatomía microquirúrgica del seno cavernoso y fosa media
Seno cavernoso y fosa media. Lecciones de anatomía microquirúrgica
Revisión anatómica con imágenes microquirúrgicas de la anatomía del seno cavernoso y fosa media con relación a estructuras neurovasculares, indispensable para conocer y comprender el síndrome neurológico del trigémino
Neurología Segura
Líder latinoamericano en el tratamiento de la neuralgia del trigémino
Profesor de pregrado de Medicina, cátedra de Neurología clínica 2012
Tomado del libro suplemento de Neurosurgery Dr. Albert Rhoton Jr
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
CLAN 2022 Microvascular decompression for glossopharyngeal neuralgia. A perso...
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
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
8th Congress European Academy of Neurology 2022.pptx
The document summarizes the results of a retrospective analysis of clinical and intraoperative data from 586 patients who underwent microvascular decompression (MVD) surgery to treat classical trigeminal neuralgia between 2016-2021. The most common anatomical findings were:
- Mixed arterial and venous contact with the trigeminal nerve in 65.5% of cases.
- The superior cerebellar artery (SCA) was the most common culprit artery (65.5%).
- The innominate vein was the most common culprit vein (28.5%).
- The arachnoid was found to be thickened and fibrotic in the majority of cases (85.7%).
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.
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
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
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
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1 Anatomía microquirúrgica del seno cavernoso y fosa media
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2023 03 01 4a Reunión ASEMEJA una historia de éxito
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CLAN 2022 Microvascular decompression for glossopharyngeal neuralgia. A perso...
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MVD TECHNIQUE by AKITA NOKEN CENTER A2021 0101.pptx
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8th Congress European Academy of Neurology 2022.pptx
8th Congress European Academy of Neurology 2022.pptx
MVD for TN secondary to meningioma IMMM A2022 10 14.pptx
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Quiste epidermoide de fosa posterior serie de casos SCNO A2022 0715
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Neuralgia del trigémino: Una nueva clasificación terapéutica 2015
Global Spine Congress 2011: Evolution and Analisis de 337 operated cases of l...
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Epidermoid cyst at the 2nd Yemeni Neurosurgical Conference 2017 (A2017 0517)
- 1. Neurosurgery, Skull Base Surgery
- 2. Definition Embryonic derivative originated by remains of elements of ectodermal origin during the closure of the neural tube between 3rd and 5th SDG Epidemiology 1% from all intracranial and 7% from all angle tumors, 3rd-5th decade of life Classification Diagnosis Clinical syndrome according to lesion site www.neurologiasegura.net
- 3. 10 cases 45% 23% 7% 8% 8% 8% brain tumors associated epidermoid cyst Neurinoma chordoma Metastasis Meningioma Carcinoma n=21 TIPICA 70% TIC 12% ATIPICA 3% OCC 2% EM 1% Tumors 8% Multiple Esclerosis Postraumatic Miastenia Gravis Postherpetic Arnold Chiari n=270 Distribution by etiology n=270 Trigeminal Neuralgia Syndrome Operated Cases www.neurologiasegura.net Trigeminal Neuralgia and Brain Tumors
- 4. www.neurologiasegura.net 0 13 25 38 50 ene'11 abr'11 jul'11 oct'11 ene'12 abr'12 jul'12 oct'12 ene'13 abr'13 jul'13 oct'13 ene'14 abr'14 jul'14 oct'14 ene'15 abr'15 jul'15 oct'15 treated operated 3%0% 0% 2% 5% 1% 2% 1% 3% 0% 1% 0% 60% 1% 0% 0% 5% 1% 0% 4% 4% 7% Argentina Bolivia Canada Chile Colombia Costa Rica Ecuador El Salvador España Francia Guatemala Honduras México Nicaragua Panama Paraguay Perú Puerto Rico Uruguay USA Venezuela No Esp. geography and demography from January 2010 up today Our Telemed Experience
- 5. www.neurologiasegura.net 0 30 60 90 20 10´s 20´s 30´s 40´s 50's 60´s 70´s 80´s 90´s 1 8 34 27 52 31 26 7 1 24 3 31 73 60 103 67 49 16 2 Distribution by age (decades) January 2010 - January 2015 Our Experience 54% 45% 1% DERECHO IZQUIERDO BILATERAL >70y/o = 16% 21- 30 = 3 31 - 40 = 4 41 – 50 = 1 51 – 60 = 1 >61= 1 <40y/o = 70% ECyst
- 6. TN Clinical Course 24% 29% 22% 8% 17% Timing n=776 <3 3 to 6 7 to 10 11 to 14 >15 YEARS 0 15 30 45 60 1 2 3 4 5 6 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18 … Advanced Non pharmacological response • Pharmacological phase Chronic Complex Complicated All Trigeminal Neuralgia www.neurologiasegura.net
- 7. Imaging diagnosis CT Lobulated low-density intracranial lesion with or without calcifications MRi Heterogeneous T1-T2 hypo-hyperintense multilobed extra-axial lesion Histopathological analysis
- 13. Our surgical and non surgical trigeminal neuralgia cases n=776 Tumor removal microsurgical resection (8%) - E. Cyst 10 cases Microvascular decompression (23%) Percutaneous ablative procedures – Radiofrequency gangliolysis (9%) – Glycerol rhizolysis (1%) – Ganglion balloon compression (<1%) Stereotactic radiosurgery (3,2%) – GK/CK – LINAC-based Peripheral ablative procedures – Peripheral branch neurectomy – Alcohol neurolysis Open destructive procedures – Partial sensory rhizotomy – Subtemporal ganglionectomy (Frazier-Spiller procedure) – Trigeminal bulbar nucleus thermoablation (<1%) 5 43 116 280 Our Surgical Trigeminal Neuralgia www.neurologiasegura.net
- 14. Our Complications from all MVD Author Year n= CSF V VII VIII Death Inf Rec Breeze 1982 52 2% 17% 15% 11% 0 Van Loveren 1982 23 13% 9% Apfelbaum 1983 406 1% 3% 1% Kolluri 1984 72 11% 19% 0 Piatt 1984 103 2% 1% 1% 8% 1% Zorman 1984 125 4% 2% 3% 0 Bederson 1989 166 4% 3% 5% 5% 0 Klun 1992 220 0 0.5% 0.5% 4.5% Sun 1994 61 7% 3% 6% 0 Barker 1996 1204 0.2% 1% 0.5% 1% 0.2% Kondo 1997 281 7% Revuelta 2006 668 nd nd nd nd nd 0,2% Segura 2015 270 1.48% 0.37% 0.74% 0.74% 0 1.48% 0.74% 11% 4% Trigeminal Neuralgia
- 15. XIX CONGRESO DE LA SOCIEDAD DE CIRUGIA NEUROLOGICA DE OCCIDENTE Homenaje Dr. Edgar Nathal-Vera 20 al 23 de Julio de 2016 Isla Navidad, México
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- % total (%permanent) BSAER monitoring in 1980’s