Management of Brain Tumors in Eloquent Areas with Awake Patient
By José Luis Navarro-Olvera, Gustavo Parra-Romero, Stephani Dalila Heres-Becerril, David Trejo-Martínez, José D. Carrillo Ruiz, Kleber Gonzalez Echeverría and Gustavo Aguado-Carrillo
This chapter aims to provide an overview of the transdisciplinary work of the Neurosurgeon, Neuroanesthesiologist and Neuropsychologist before, during and after the resection of a neoplasm in eloquent areas with the patient conscious under the 3A anesthesia modality (asleep, awake, asleep). The diagnostic approach and the logistics to carry out this procedure and achieve better results will be shown. At present there is growing evidence regarding the benefits of surgery in awake patients, with application in the treatment of epilepsy, abnormal movements and oncological surgery. The benefits of awake craniotomy are increased lesion removal, with improved survival benefit, whilst minimizing damage to eloquent cortex and resulting postoperative neurological dysfunction. Other advantages include a shorter hospitalization time, hence reduced cost of care, and a decreased incidence of postoperative complications. This approach has allowed to achieve a higher degree of resection with less morbidity and a higher quality of life.
Part of the book: Frontiers in Clinical Neurosurgery
Neurosurgical Spasticity Treatment: From Lesion to Neuromodulation Procedures
By José Damián Carrillo-Ruíz, Jesús Quetzalcoatl Beltran, José Rodrigo Carrillo-Márquez, José Luis Navarro-Olvera, Luis García, Francisco Villegas-López and Francisco Velasco
Spasticity is one of the most important and residual signs after pyramidal and para-pyramidal catastrophic lesions after diverse neurological insults, including stroke, brain and spine trauma and post-radiation; infection and immunological diseases affecting nervous system, between others. Spasticity is normally a compensatory motor mechanism that could ameliorate the patients´ disability. Nevertheless, disastrous spasticity is described when the extremities force is diminished in the affected limbs, or when is impossible to wake o to take objects, maximum when hand or foot deformity is exposed. The objective of this chapter is centered in the neurosurgical treatment of spasticity, including brain lesions with specific targets and the spine with its different modalities. This review shows not only the basic aspects in these techniques, but also the option of infusion pumps and deep brain stimulation. To close, a proposal is stablished to determinate the possible path to treat the spasticity in the future.
Part of the book: Frontiers in Clinical Neurosurgery
Rare Brain Tumors with Infrequent Clinical Manifestations: Illustrative Cases
By José Luis Navarro-Olvera, Armando Armas-Salazar, José Damián Carrillo-Ruiz, Jesús Q . Beltrán, Gustavo Parra-Romero and Gustavo Aguado-Carrillo
This chapter describes the epidemiology, clinical and neuroimaging features, histological characteristics, surgical approach, outcomes, and prognostic factors of different cases of very rare intracranial tumors, associated with complex clinical syndromes. Highlighting the important aspects in the diagnosis and management that were considered relevant through the experience of our center. Here we included an intracranial Rosai-Dorfman disease manifested as an apparent multiple meningiomatosis, a choroid plexus papilloma clinically manifested as a hemifacial spasm originated by a compression of the facial colliculus, and a neuroenteric cyst associated with Klippel-Feil syndrome. This type of tumor presents a challenge to the neurosurgeon, originating various questions about its management. In this chapter, we present the experience we had with these pathologies to establish the most appropriate management decisions.
Part of the book: Brain Tumors
Usefulness of Intraoperative 2D-Ultrasound in the Resection of Brain Tumors
By José Luis Navarro-Olvera, Armando Armas-Salazar, Jesús Q. Beltrán, Gustavo Aguado-Carrillo, Fiacro Jiménez-Ponce, Edgar Abarca-Rojano and José Damián Carrillo-Ruiz
The surgical approach to brain tumors often uses preoperative images to visualize the characteristics of pathology, guiding the surgical procedure. However, the usefulness of preoperative images during the surgical procedure is altered by the changes in the brain during the surgery because of craniotomy, inflammation, tumor resection, cerebrospinal fluid (CSF) drainage, among others. For this reason, there is a need to use intraoperative imaging evaluation methods that allow the surgeon to consider these changes, reflecting the real-time anatomical disposition of the brain/tumor. Intraoperative ultrasound (iUS) has allowed neurosurgeons to guide the surgical procedure without exposing the patient to ionizing radiation or interrupting the procedure. Technological advances have made it possible to improve image quality, have smaller probes, and facilitate the use of the equipment, in addition to the introduction of new imaging modalities, such as three-dimensional images, enhanced with contrast, among others, expanding the available options. In the context of these advances, the objective of this chapter was to review the current status of the usefulness and challenges of iUS for brain tumor resection through an in-depth review of the literature and the discussion of an illustrative case.
Part of the book: Central Nervous System Tumors
Motor Recovery in Different Types of Brachial Plexus Injury Surgeries View all chapters
By Armando Armas-Salazar, Fátima Ximena Cid-Rodríguez, José Luis Navarro-Olvera, Edgar Abarca-Rojano, Noé Tellez-León, María de la Luz Montes-Castillo, Ana Isabel García-Jerónimo and José Damián Carrillo-Ruiz
Brachial plexus injuries (BPI) affect mostly the young population. The management of these injuries is complex and there are many surgical options for treatment. To evaluate the patient motor component, the British Medical Research Council motor grading scale (BMRC), range-of-motion (ROM), disability of the arm, shoulder, and hand questionnaire (DASH), and push and pull dynamometer are the main clinical assessment tools that provide information about the clinical status regarding motor function. The purpose of this chapter is to show the motor recovery on interventions that are available as surgical alternatives for the management of BPI, through a systematic review of the literature.
Part of the book: Advances in Spine Surgery [Working title]