Categoría: Publicaciones

Siringomielia no secundaria a Chiari. Actualización en fisiopatología y manejo.

Autores: J. Giner - C. Pérez López - B. Hernández - Á. Gómez de la Riva - A. Isla - J.M. Roda

Abstract: Son muchos los conocimientos y publicaciones existentes sobre la siringomielia relacionada con la malformación de Chiari, pero existe poca difusión de este cuadro cuando no se presenta en relación con dicha malformación. Ello es importante ya que es una entidad propia que precisa de un conocimiento y manejo específico. Presentamos esta revisión con el objetivo de dar a conocer las ideas más aceptadas y difundidas a día de hoy al respecto de la fisiopatología, manejo y otros aspectos de la siringomielia no secundaria a malformación de Chiari.

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Evolution of Patients With Immediate Complete Facial Paralysis Secondary to Acoustic Neuroma Surgery.

Autores: Adriana Pardo-Maza - Luis Lassaletta - Teresa González-Otero - José Maria Roda - Susana Moraleda - Álvaro Arbizu - Javier Gavilán.

Abstract: —Objective: To study the evolution of patients with immediate complete facial paralysis after acoustic neuroma surgery in different scenarios and assess different facial reanimations techniques.

Methods: This study included 50 patients with complete facial paralysis immediately after acoustic neuroma surgery. Data were analyzed into 4 groups according to the need and type of reconstruction of the facial nerve, either none, immediate, or on a deferred basis. All patients had intraoperative facial nerve monitoring, and facial nerve function was evaluated according the House-Brackmann (HB) scale.

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Bases Anatomicas y Hemodinamicas del complejo de la arteria comunicante anterior.

Autores: J. Egea - E. Parada - V. Gomez-Rangel - I. Buendia - P. Negredo - E. Montell - R. Ruhí - J. Vergés - J.M. Roda - A.G. Garcia - M.G. Lopez

Abstract: —High molecular weight (HMW) glycosaminoglycanes of the extracellular matrix have been implicated in tissue repair.

Stroke is the third leading cause of death, behind cardiovascular diseases and cancer, and is a leading cause of serious, long-term disability. Although treatments for ischemic stroke have been rigorously investigated for two decades, up to now there is only one approved pharmacological treatment, the intravenous thrombolytic recombinant tissue plasminogen activator (rt-PA) (Jahan and Vinuela,2009). Despite the fact that thrombolytic rt-PA hasdemonstrated efficacy in treating patients withthrombotic stroke, the short time window, the risk ofhemorrhage and the requirement for computedtomography scan before the initiation of treatmentreduces the number of patients (around 4%) actuallyreceiving the drug; consequently, other approaches totreat stroke are urgently needed.

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NF2 gene alterations may have a clinical impact in non-NF2 vestibular schwannomas

Autores: Luis Lassaletta - Miguel Torres-Martın - Carolina Pen˜a-Granero - Jose Maria Roda - Santiago Santa-Cruz-Ruiz - Javier S. Castresana - Javier Gavilan - Juan A. Rey

Abstract:It has been suggested that NF2 mutations might correlate with clinical expression of VS in NF2 patients. The aim of this study was to analyze the impact of genetic alterationsin theNF2gene on epidemiologic, clinical, and radiologicfeatures of patients with sporadic VS. The association betweencigarette consumption and the molecular genetic findings wasalso studied.

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ITH33/IQM9.21 is a novel compound belonging to a family of glutamic acid derivatives...

Autores: Lorrio S, Gómez-Rangel V, Negredo P, Egea J, Leon R, Romero A, Dal-Cim T, Villarroya M, Rodriguez-Franco MI, Conde S, Arce MP, Roda JM, García AG, López MG.

Abstract: ITH33/IQM9.21 is a novel compound belonging to a family of glutamic acid derivatives, synthesized under the hypothesis implying that multitarget ligands may provide more efficient neuroprotection than single-targeted compounds.

In rat hippocampal slices, oxygen plus glucose deprivation followed by re-oxygenation (OGD/Reox) elicited 42% cell death. At 1 μM, ITH33/IQM9.21 mitigated this damage by 26% and by 55% at 3 μM. OGD/Reox also elicited mitochondrial depolarization, overproduction of reactive oxygen species (ROS), enhanced expression of nitric oxide synthase (iNOS) and reduction of GSH levels. These changes were almost fully prevented when 3 μM ITH33/IQM9.21 was present during slice treatment with OGD/Reox. In isolated hippocampal neurons, ITH33/IQM9.21 reduced [Ca(2+)](c) transients induced by a high K(+) depolarizing solution or glutamate. In a photothrombotic model of stroke in mice, intraperitoneal injection of ITH33/IQM9.21 at 1.25 mg/kg, 2.5 mg/kg or 5 mg/kg given before and during 2 days after stroke induction, reduced infarct volume by over 45%. Furthermore, when the compound was administered 1 h post-stroke, a similar effect was observed. In conclusion, these in vitro and in vivo results suggest that ITH33/IQM9.21 exhibits neuroprotective effects to protect the vulnerable neurons at the ischemic penumbra by an effective and multifaceted mechanism, mediated by reduction of Ca(2+) overload, providing mitochondrial protection and antioxidant actions.

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Instituto Teófilo Hernando, Universidad Autónoma de Madrid, Madrid, Spain; Departamento de Farmacología y Terapéutica, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid, Spain.

Autores: Del Río L, Lassaletta L, Díaz-Anadón A, Alfonso C, Roda J.M., Gavilán J.

Department of Otolaryngology, La Paz University Hospital, Idipaz Research Institute, Madrid, Spain

Abstract: OBJECTIVE: This study on patients undergoing surgery for vestibular schwannoma investigated tumour (i) the effect of pre-operative factors on tinnitus, (ii) the effect of translabyrinthine or hearing preservation surgical approaches on tinnitus, and (iii) the effect of postoperative tinnitus status on the patient's quality of life (QOL).

METHODOLOGY: Seventy-nine patients who underwent vestibular schwannoma (VS) excision between 2001 and 2005 were selected. Postoperative tinnitus status was evaluated using a standard questionnaire for tinnitus, and QOL was measured using the Glasgow Benefit Inventory (GBI).

RESULTS: Overall, 58% of patients noted tinnitus before tumour removal. Pre-operative tinnitus was not associated with age, gender, tumour size, or hearing thresholds. The total percentage of patients suffering postoperative tinnitus was 64%. Hearing preservation approaches showed no difference in terms of changes in tinnitus compared to the translabyrinthine approach. Twenty-one patients (30%) reported better QOL, 40 patients (56%) reported worse QOL, and 10 patients (14%) reported the same QOL. A significant association was found between tinnitus worsening as measured by GBI score and QOL.
CONCLUSIONS:

Most patients do not report significant changes in their tinnitus status after surgery. Tinnitus evolution is unpredictable and not related to the type of surgical approach. Thus, tinnitus should not be used as a criterion for selecting the surgical approach. Tinnitus worsening appears to influence QOL following surgery for VS.

Human Cadaver brain infusion skull model for neurosurgical training.

Autores: J.Olabe Goxencia - Javier Olabe - J.M. Roda - Vidal Sancho

Abstract: Microsurgical technique and anatomical knowledge require extensive laboratory training. Human cadaver models are especially valuable as they supply a good microsurgical training environment simultaneously providing authentic brain anatomy. We developed the “skull infusion model” as an extension of our previous “brain infusion model” taking it a step further maintaining simplicity but enhancing realism ...

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Functional recovery after hematic administration of allogenic mesenchimal stem cells in acute schemic stroke in rates.

Autores: M. Gutierrez-Fernandez - B. Rodriguez-Frutos - J. Alvarez-Grech - M.T. vallejo-Cremades - M. Exposito-Alcaide - J. Merino - J.M. Roda - E. Diez-Tejedor

Abstract: The majority of neuroprotective treatments for cerebral ischemia have been efficacious in experimental studies but have failed their clinical trials. Only i.v. thrombolysis (rtPA) hasbeen shown to be effective; however its narrow therapeutictime window makes it a treatment for a reduced percentageof patients (Hacke et al., 2008). In the past, protective ther-apies have been directed towards saving neural cells. Stroke-induced damage compromises the integrity of the neurovas-cular unit (Lo et al., 2003) through various pathophysiologicmechanisms. Angiogenesis, neurogenesis and synaptogen-esis are interrelated mechanisms that promote brain plasticityand help to repair the neurovascular unit and recover neuro-logical function (Gutierrez et al., 2009). Endogenous brainplasticity can be stimulated by rehabilitation, stimulationand/or administration of trophic factors and cell therapy.

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Microsurgical cerebral aneurysm training porcine model

Autores: Jon Olabe - Javier Olabe - J.M. Roda

Abstract: The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1–2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones.

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¿Como reparar el daño cerebral isquémico?. Utilidad de los modelos experimentales en la búsqueda de respuestas.

Autores: R. Prieto Arribas, J.M. Pascual-Garvi, F. Gonzalez-LLanos, J.M. Roda

Abstract: "Las neuronas son las misteriosas mariposas del alma, cuyo batir de las alas quien sabe si esclarecerán algun dia el secreto de la vida mental". Santiagfo Ramón y Cajal (1852-1934).

Existe una polémica creciente en torno a la utilidad clínica de los modelos experimentales de isquemia cerebral, alimentada por la discrepancia observada entre los estudios experimentales y los ensayos clínicos respecto a la eficacia de las terapias que tratan de aminorar o revertir el daño isquémico cerebral. Más de dos décadas de intenso trabajo que abarcan miles de estudios experimentales y cientos de estudios clínicos con un coste global de billones de dólares parecen baldíos, al no haberse hallado ninguna terapia efectiva capaz de aminorar el daño isquémico cerebral, a excepción de la terapia trombolítica con factor activador del plasminógeno, que se estima aplicable a tan sólo un 5% de los pacientes admitidos y diagnosticados de un ictus en la urgencia hospitalaria. ¿Debemos por ello concluir que los modelos experimentales de isquemia cerebral son irrelevantes para el dise no y ensayo de terapias farmacológicas ...

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