https://repositorio.fleni.org.ar/xmlui/handle/123456789/276 2026-04-01T21:33:10Z 2026-04-01T21:33:10Z Cervio, Andrés Eduardo Ruella, Mauro Domecq, Lucila Fraire, Jazmín Azul Marengo, Ricardo Mormandi, Rubén https://repositorio.fleni.org.ar/xmlui/handle/123456789/1332 2025-03-28T16:16:50Z 2025-02-07T00:00:00Z

Petroclival Meningiomas: Experience in Argentinian Center Cervio, Andrés Eduardo; Ruella, Mauro; Domecq, Lucila; Fraire, Jazmín Azul; Marengo, Ricardo; Mormandi, Rubén Introduction: Petroclival meningiomas are challenging tumors located in a critical region at the skull base. These tumors often present with specific clinical manifestations due to their proximity to vital structures such as cranial nerves (CN) and major blood vessels. Management often requires a multidisciplinary approach and due to its complexity and risks, some studies even propose stereotactic radiosurgery (SRS) as an alternative to surgery. This study aims to demonstrate our experience in the treatment of petroclival meningiomas. Materials and Methods: Single-center, retrospective study of a cohort of 64 surgical patients operated for petroclival meningioma in a third-level center in Buenos Aires, Argentina, between 2010 and 2023. Medical records, imaging studies, and surgical protocols were reviewed. Patients with an age greater than 18 years old, a mean follow-up of at least 6 months and adequate pre- and postoperative contrast-enhanced volumetric MRI were included. Results: A total of 53 patients met the inclusion criteria with a mean age of 52 years (range 25–78), a predilection for female sex (73.58%) and a mean follow-up of 54.6 months (range 6–182). Headaches, facial numbness, hypoacusis and gait impairment were the most frequent symptoms at consultation. Dysphagia and dysphonia were seen in 22.6%. Preoperative mean KPS was 86. Regarding tumor characteristics, mean tumor volume was 24.8 cm3 (range 1.8–67.3) with brainstem compression seen in 92.45% of cases. Calcifications were noticed in 16.98% of tumors. A complete cleft sign was identified in 24% and partial in 37.7% of cases, with signs of brainstem edema in 18.87%. Retrosigmoid approach was the main route chosen for tumor resection (56.6%) followed by presigmoid (35.85%) and frontotemporal approach (7.5%). A Gross-total-resection was achieved in 22.64% and Near-Total in 33.96%, with a Simpson I-III resection rate of 64.15%. Residual tumor was managed with postoperative gamma-knife in 52.8% of cases. Mean hospital-stay was 9.9 days. Most frequent complications seen were new postoperative CN deficit (75%) and meningitis (11.32%) of which 3.7% were infectious. CSF leak was seen in 3.7% of patients and more serious complications such as vasospasm, ischemia or hematomas were seen in 3.7% respectively with two patients needing surgery for management. There were no postoperative deaths. Mean early postoperative KPS and at last follow-up were 78.8 and 84.15 respectively with a mean GOS at last follow-up of 4.56. A total of 22.64% of patients needed discharge to a rehabilitation center, and improvement in CN deficits were totally seen in 28.3% and partial in 52.83% of cases. Conclusion: Surgical resection of petroclival meningiomas is considered the mainstay of treatment. However, due to the complex anatomy and potential for neurological deficits, careful preoperative planning and precise intraoperative techniques are paramount for good outcomes. Leaving a residual tumor in favor of minimizing the risk of permanent postoperative morbidity is often needed, with the aid of postoperative advanced SRS techniques. Further research is needed to enhance patient care.

2025-02-07T00:00:00Z Cervio, Andrés Eduardo Ruella, Mauro Fraire, Jazmín Azul Domecq, Lucila Mormandi, Rubén Marcó Del Pont, Francisco Marengo, Ricardo https://repositorio.fleni.org.ar/xmlui/handle/123456789/1331 2025-06-05T15:22:14Z 2025-02-07T00:00:00Z

“Skull Base Chondrosarcoma” Analyzing a Rare Pathology Cervio, Andrés Eduardo; Ruella, Mauro; Fraire, Jazmín Azul; Domecq, Lucila; Mormandi, Rubén; Marcó Del Pont, Francisco; Marengo, Ricardo Introduction: Chondrosarcomas are malignant tumors that develop from cells derived from chondrocytes. They constitute ~20% of cancers of the skeletal system and affect people between 40 and 70 years old. Only 2% are located at the skull base and the petroclival location is the most common. Symptoms vary depending on the location of the tumor. Materials and Methods: Retrospective, monocentric study of a cohort of patients operated on for skull base chondrosarcomas at our institution in the past 10 years. Their clinical, imaging, and surgical characteristics were analyzed. Bibliographic research was performed to compare with other series, management and results. Results: Eleven patients were included. The average age of 45.6 years (range: 23–72) and predilection for the male sex (8:3). The average follow-up was 51 months (range 8–138). The most common symptoms were cranial nerve involvement, and the most common topography was parasellar. An endoscopic endonasal approach (EAA) was performed in 8 patients and 5 underwent craniotomy. One patient underwent reoperation and 67% were treated with postoperative radiotherapy/radiosurgery. The outcome was favorable with a mean KPS of 90. Conclusion: Chondrosarcomas are rare tumors of the CNS and involve the skull base even more. Surgical resection is the gold standard for treatment as they are usually resistant to adjuvant. Thorough preoperative evaluation of images, appropriate selection of the approach as well as neuroanatomical knowledge are of vital importance. Endoscopic endonasal resection has been reported only in exceptional cases.

2025-02-07T00:00:00Z Jaimovich, Sebastián Gastón Tcherbbis Testa, Victoria Pampin, Sergio Jaimovich, Roberto https://repositorio.fleni.org.ar/xmlui/handle/123456789/1128 2024-06-12T17:24:39Z 2023-09-16T00:00:00Z

Transtubular micro-endo-assisted approach for intraventricular and deep-seated brain lesions Jaimovich, Sebastián Gastón; Tcherbbis Testa, Victoria; Pampin, Sergio; Jaimovich, Roberto OBJECTIVE: Intraventricular and deep-seated brain lesions present a surgical challenge due to their accessibility, illumination, and relationship to neural and vascular structures. To minimize tissue damage and its complications caused by access and brain retraction, several minimally invasive endoscopic approaches have been developed; but none replace contemporary microsurgical technique. We present a transtubular micro-endo-assisted approach as an alternative to maximize the benefts and minimize the difculties of pure endoscopic approaches and contemporary microsurgical techniques. MATERIAL AND METHODS: Through a 2-3 cm craniotomy and a minimal corticotomy, we introduce a tubular retractor guided by neuronavigation, which allows controlled movements and protects the surrounding parenchyma. We performed a retrospective and observational analysis including medical records, radiological fndings, surgical treatment and outcome. RESULTS: This approach with microsurgical endoscopic-assisted technique was applied to 56 patients. Where this minimally invasive approach avoids excessive brain retraction and its complications. It combines bimanual microsurgical technique, using standard microsurgical instruments, and neuroendoscopy, allowing better, wider and angled vision and illumination. This tubular retractor system displaces brain parenchyma, causing less tissue damage. At the end, a smaller corticotomy is observed. CONCLUSION: The transtubular micro-endo-assisted approach combines the advantages of contemporary surgical techniques, improving their weaknesses. It is a safe technique, allowing treatment of solid, bleeding and larger intraventricular and/or deep-seated lesions.

2023-09-16T00:00:00Z Campos, Manuel Alonso, Mario Cendes, Fernando Cukiert, Arthur Sandoval Bonilla, Bayron Paglioli, Eliseu Buitrago, Cesar Cáceres, Adrián Bartuluchi, Marcelo Sánchez, Federico https://repositorio.fleni.org.ar/xmlui/handle/123456789/1127 2024-06-12T17:25:01Z 2023-09-16T00:00:00Z

Pediatric epilepsy surgery in Latin-America Campos, Manuel; Alonso, Mario; Cendes, Fernando; Cukiert, Arthur; Sandoval Bonilla, Bayron; Paglioli, Eliseu; Buitrago, Cesar; Cáceres, Adrián; Bartuluchi, Marcelo; Sánchez, Federico OBJECTIVE: The classical concept is that pediatric epilepsy surgery (PES) is still underused in developing countries. Accurate information about the amount of PES programs and procedures in Latin-American is still lacking. MATERIAL AND METHODS: We included information from 80 epilepsy surgical programs from 18 Latin American countries. We tabulated the duration of each program, types of surgery (curative, palliative, and diagnostic), and procedures in the pediatric population. Then, we estimated the number of procedures per capita for each country. RESULTS: We registered a total of 25,333 procedures. Temporal lobe resection was the most frequent procedure (42,3%), followed by extratemporal resection (27,1%), callosotomy (8,7%), VNS (8,4%), hemispherectomy (5%), DBS (0,7%) and other procedures (0,2%). An invasive presurgical evaluation was performed in 7,5% of cases, including 827 patients with SEEG. The pediatric population was 36,3% of the cases. The estimated ES per capita was between 1 per 207,571 habitants (Colombia) to 1 per 3,353,333 habitants (Honduras), with an overall Latin-American average of 1 case per 484,248 inhabitants. CONCLUSION: Latin America performs all epilepsy surgical procedures except laser ablation or responsive cortical stimulation (RNS). The wide diference in the procedures per country depends on the amount of PES centers, resources, medical training, and governmental investment in health. There is an unmet need to improve ES access, especially in low-income Latin American countries and an evident need to standardize the access and complexity of epilepsy surgery procedures across the Latin American region which can be attained with increased awareness by stakeholders as well as development of educational resources and logistics which enable these techniques to be available to a broader range of patients, particularly during infancy.

2023-09-16T00:00:00Z