Rodrigo Ramos-Zúñiga M.D. Ph.D. | Universidad de Guadalajara (original) (raw)

Papers by Rodrigo Ramos-Zúñiga M.D. Ph.D.

970-32-5021-9, Mar 28, 2008

Neurosurgery and Global Health, 2022

Stem cell biology and regenerative medicine, 2024

Gaceta Medica De Mexico, Dec 12, 2023

World Neurosurgery, Mar 1, 2012

To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure an... more To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure and permit regeneration by fibroblasts in an experimental in vivo model. In the in vitro phase, BChS was elaborated and the following characteristics were evaluated: pore size, thickness, water absorption capacity, tensile strength, strain, and toughness. In the second in vivo phase, 27 durectomized New Zealand rabbits were randomly assigned into three duraplasty groups with autologous dura, collagen matrix (CM), or BChS. In all groups, fluid leakage pressure was measured at 10, 21, or 180 days. Histology response to regeneration was evaluated through hematoxylin and eosin stain. BChS was standardized to obtain bilayer scaffoldings with a nonporous layer and a porous layer. The pore size was 10 μm, total thickness was 400 μm, strain was 57.8%, and tensile strength was 5.5 gr/mm(2). The physical characteristics of BChS allowed dural closure without cerebrospinal fluid (CSF) leak. There were no differences in fluid leakage pressures between the BChS, dura, and CM groups. Histologic analysis showed fibroblast migration with adequate dural regeneration. BChS is an ideal alternative for a watertight dural closure because it can be sutured, and it induces organized regeneration with fibroblasts without evidence of fibrosis.

Cirugia Y Cirujanos, 2011

Minimally Invasive Neurosurgery, Oct 1, 2006

Cerebrovascular disease is a common occurrence in adults with immediate as well as long-term neur... more Cerebrovascular disease is a common occurrence in adults with immediate as well as long-term neurological effects. Sequelae are disabling for patients and lead to a greater demand for healthcare infrastructure and search for treatment options. The acute phase in a cerebellar infarction may become complicated with transient obstructive hydrocephalus, subsequent intracranial hypertension, and the need for surgical management. Although many patients respond well to medical treatment, clinical findings and neuroimaging methods must be considered to determine whether the hydrocephalus can be surgically treated in a timely fashion. A series of cases is presented and a proposal is made for adding endoscopic third ventriculostomy to the available treatment armamentarium. Fourteen patients with cerebellar strokes and their clinical course are reported. Six required surgery for hydrocephalus management. Three of the cases had an endoscopic third ventriculostomy without complications, the rest were managed conservatively. As an average, patency was re-established in the aqueduct three months post ictus. Management of obstructive hydrocephalus in the acute phase of a cerebellar stroke must be individualized. In cases with transient obstructive hydrocephalus, endoscopic third ventriculostomy is a good surgical treatment option that avoids the risks of a long-term ventricular shunt.

Healthcare, Jun 12, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Archivos de neurociencias (México, D.F.), 2006

Pituitary adenomas make up to 10-15% of all intracranial tumors. Pos-mortem exams have found them... more Pituitary adenomas make up to 10-15% of all intracranial tumors. Pos-mortem exams have found them in up to 20% of the general population. They represent 25% of all intracranial tumors operated on. After seeing a patient with evidence of recent growth of a pituitary adenoma we set up to investigate how long does it take for an adenoma to grow and to summarize the most important concepts in pituitary adenoma pathogenesis. Discussion: a brief description is made of the clinical case that motivated the review. Following is described how, in spite of the demonstrated monoclonality of pituitary adenomas, up to 30% of them could be polyclonal and how 60% of recurrent tumors are of different clonality to the original tumor. The most notably involved oncogenes are gsp, gip2, D-type Cyclins and PTTG while the most frequently tumor suppressor genes found to be inactivated are MEN-1, CNC, IFS, VHL (which cause familiar syndromes associated with pituitary adenomas) Rb and CDK-1 (in isolated tumores). The roll of hypothalamic, pituitary and target organ hormones in pituitary oncogenesis is also reviewed. Conclusion: pituitary adenomas are the most frequent intracranial tumor but their pathogenesis is understood only partially. It is difficult to know the time it takes for a pituitary adenoma to grow. We present a case with evidence of recent growth and review the current knowledge in pituitary pathogenesis.

Revista Mexicana de Neurociencia, 2008

RESUMEN Introducción: La mayor accesibilidad a la información de carácter médico en distintos med... more RESUMEN Introducción: La mayor accesibilidad a la información de carácter médico en distintos medios de comunicación, aunado a la acertada apertura al modelo de co-responsabilidad en la relación médico-paciente y el mismo ejercicio de sus derechos, han propuesto nuevos planteamientos y dilemas en el manejo de la información técnica. Desarrollo: Se ha fundamentado como un sano ejercicio la segunda opinión profesional, dentro de las prerrogativas del paciente en la práctica clínica, en muchos casos en los que se considera necesaria la segunda opinión profesional para la toma de decisiones diagnósticas o terapéuticas. El contenido y la forma como se transmita esta información tienen relevancia desde el punto de vista bioético y se encuentra también sujeta a lineamientos normativos, legales y de respeto profesional. No sólo se sustenta en la necesidad de hacer prevalecer la búsqueda de la mejor alternativa para el paciente y su calidad de vida; sino también por la necesidad de hacerlo de una forma tal, que cumpla los criterios bioéticos universales, dentro de un plano de respeto y elemental cortesía profesional. Conclusiones: La segunda opinión médica es un ejercicio que contribuye a la calidad de la atención médica. Ésta debe hacerse siempre atendiendo a los lineamientos bioéticos y de respeto profesional. Palabras clave: ética, bioética, salud, educación médica, interconsulta médica, conflictos de interés.

Minimally Invasive Neurosurgery, Sep 1, 1999

The trans-supraorbital approach represents the advantage of combining the keyhole principle and s... more The trans-supraorbital approach represents the advantage of combining the keyhole principle and skull base surgery. In cadaveric work the author shows the anatomic fields visualized with this procedure, advantages and potential surgical applications. The experimental surgical procedure was performed on 8 adult skulls and on 3 cadavers with intact cerebral structures. First, a 2 cm supraorbital approach for endoscopic exploration was used. The basic anatomic landmarks and corresponding dimensions of the microsurgical field were recorded and then compared with those from the trans-supraorbital approach, after removing the orbital arch and other parts of the orbital ceiling. This technique offers a 0.5 cm average increase in surgical field from the craniotomy. The surgical distance that results is shorter (about 2 cm), as well as the length of the surgical instruments required. A better microscope illumination in the deep fields, and the possibility of access to the intraorbital region, the superior orbital fissure, the optic foramen, and the cavernous sinus through the clinoid space are also obtained, with minimal cerebral retraction and similar advantages as through the pterional trans-sylvian approach. The author concludes that by extending the craniotomy and decreasing the surgical distance, the microsurgical field is more convenient for microscope-assisted surgery without totally relying on the endoscope, and with minimal brain retraction. It also provides multiple options to approach vascular and tumor lesions found in these microsurgical corridors, combining principles of minimal invasion and skull-base surgery.

Archives of Medical Research, 2021

Beyond the strict biological scenarios inherent to the virus, other consequences exist that requi... more Beyond the strict biological scenarios inherent to the virus, other consequences exist that require attention due to the duration and evolving alternate implications of the pandemic in our society. The relevance of other “curves” in the Covid-19 Pandemic, related with Non Covid diseases, socio-economic issues, the wear and tear on the medical and social service infrastructure, and the physical and mental deterioration in the human resources, need a special focus in the global strategies in the management of Covid-19 pandemic. Civil rights and legal implications, are another issue to have in mind in the decisions, because these guidelines must not be the cause of social discrimination or stigma in the society. This bioethics approach is particularly targeted to those who are primarily responsible for decision making in matters with an impact on public health.

World Neurosurgery, Jun 1, 2018

Strategies in traumatic brain injury and alcohol consumption: A professional's survey. OBJETIVE: ... more Strategies in traumatic brain injury and alcohol consumption: A professional's survey. OBJETIVE: Traumatic Brain Injury (TBI) associated to alcohol consumption is a global public health problem. It is important to identify and rethink the strategies to approach this challenge for health institutions from a professional perspective. METHODS: An online survey, created with google forms, was sent to professional neurosurgeons in Mexico and Latin America. Participation was voluntary, and the responses were anonymous and confidential. Data were captured after a month and subjected to descriptive statistical analysis using Fisher's method and Chi Square. RESULTS: 83 questionnaires were answered by certified neurosurgeons with a rate of response of 52.9%. It was found that 78% of hospitals have no specific management guidelines for patients with TBI and alcohol intoxication. In 90% of cases no triage strategies are defined for the case and in the hospital admission there are no specific identified strategies for extraordinary surveillance of risks in these patients profile (p= 0.062). CONCLUSION: These finding confirm a lack of systematic strategies for management of patients with TBI and associated comorbidity of alcohol intoxication in acute phase, so it is important to define specific management guidelines to improve treatment efficacy and limit complications in patients with this profile.

Revista De Neurologia, 2000

INTRODUCTION Brain death has been a topic of great interest for clinicians throughout the history... more INTRODUCTION Brain death has been a topic of great interest for clinicians throughout the history of Neurosciences. There are so many different ideas about this topic that it has been necessary to constantly define further the criteria and medical decisions applicable in this field. Also about this matter there are a set of cultural, philosophical and religious aspects as well as autonomous principles in the people involved in such an event. Questions and dilemmas are still present in the individuality of every case and especially in terms of management of information and circumstances that define brain death. DEVELOPMENT This essay tries to analyze the medical and historical issues around death and its relation to the context of brain death as such. There are also a series of reflections supported by the current bioethical thoughts that are identified with a cultural framework that is crucial to acknowledge the way in which the doctor, the family and society approach an event such as brain death. In spite of all the development of diagnostic technology and the extremes of the futility and extreme cruelty of treatments; there are still open questions that require to be looked into with objective criteria and scientific rigor. CONCLUSION We should not put aside bioethical principles that are inherent to human quality and dignity that touch the sensitivity of those who give out the information and those who receive it within this process of interaction between the medical staff and the family.

Revista De Neurologia, Jan 16, 2009

970-32-5021-9, Mar 28, 2008

Neurosurgery and Global Health, 2022

Stem cell biology and regenerative medicine, 2024

Gaceta Medica De Mexico, Dec 12, 2023

World Neurosurgery, Mar 1, 2012

To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure an... more To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure and permit regeneration by fibroblasts in an experimental in vivo model. In the in vitro phase, BChS was elaborated and the following characteristics were evaluated: pore size, thickness, water absorption capacity, tensile strength, strain, and toughness. In the second in vivo phase, 27 durectomized New Zealand rabbits were randomly assigned into three duraplasty groups with autologous dura, collagen matrix (CM), or BChS. In all groups, fluid leakage pressure was measured at 10, 21, or 180 days. Histology response to regeneration was evaluated through hematoxylin and eosin stain. BChS was standardized to obtain bilayer scaffoldings with a nonporous layer and a porous layer. The pore size was 10 μm, total thickness was 400 μm, strain was 57.8%, and tensile strength was 5.5 gr/mm(2). The physical characteristics of BChS allowed dural closure without cerebrospinal fluid (CSF) leak. There were no differences in fluid leakage pressures between the BChS, dura, and CM groups. Histologic analysis showed fibroblast migration with adequate dural regeneration. BChS is an ideal alternative for a watertight dural closure because it can be sutured, and it induces organized regeneration with fibroblasts without evidence of fibrosis.

Cirugia Y Cirujanos, 2011

Minimally Invasive Neurosurgery, Oct 1, 2006

Cerebrovascular disease is a common occurrence in adults with immediate as well as long-term neur... more Cerebrovascular disease is a common occurrence in adults with immediate as well as long-term neurological effects. Sequelae are disabling for patients and lead to a greater demand for healthcare infrastructure and search for treatment options. The acute phase in a cerebellar infarction may become complicated with transient obstructive hydrocephalus, subsequent intracranial hypertension, and the need for surgical management. Although many patients respond well to medical treatment, clinical findings and neuroimaging methods must be considered to determine whether the hydrocephalus can be surgically treated in a timely fashion. A series of cases is presented and a proposal is made for adding endoscopic third ventriculostomy to the available treatment armamentarium. Fourteen patients with cerebellar strokes and their clinical course are reported. Six required surgery for hydrocephalus management. Three of the cases had an endoscopic third ventriculostomy without complications, the rest were managed conservatively. As an average, patency was re-established in the aqueduct three months post ictus. Management of obstructive hydrocephalus in the acute phase of a cerebellar stroke must be individualized. In cases with transient obstructive hydrocephalus, endoscopic third ventriculostomy is a good surgical treatment option that avoids the risks of a long-term ventricular shunt.

Healthcare, Jun 12, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Archivos de neurociencias (México, D.F.), 2006

Pituitary adenomas make up to 10-15% of all intracranial tumors. Pos-mortem exams have found them... more Pituitary adenomas make up to 10-15% of all intracranial tumors. Pos-mortem exams have found them in up to 20% of the general population. They represent 25% of all intracranial tumors operated on. After seeing a patient with evidence of recent growth of a pituitary adenoma we set up to investigate how long does it take for an adenoma to grow and to summarize the most important concepts in pituitary adenoma pathogenesis. Discussion: a brief description is made of the clinical case that motivated the review. Following is described how, in spite of the demonstrated monoclonality of pituitary adenomas, up to 30% of them could be polyclonal and how 60% of recurrent tumors are of different clonality to the original tumor. The most notably involved oncogenes are gsp, gip2, D-type Cyclins and PTTG while the most frequently tumor suppressor genes found to be inactivated are MEN-1, CNC, IFS, VHL (which cause familiar syndromes associated with pituitary adenomas) Rb and CDK-1 (in isolated tumores). The roll of hypothalamic, pituitary and target organ hormones in pituitary oncogenesis is also reviewed. Conclusion: pituitary adenomas are the most frequent intracranial tumor but their pathogenesis is understood only partially. It is difficult to know the time it takes for a pituitary adenoma to grow. We present a case with evidence of recent growth and review the current knowledge in pituitary pathogenesis.

Revista Mexicana de Neurociencia, 2008

RESUMEN Introducción: La mayor accesibilidad a la información de carácter médico en distintos med... more RESUMEN Introducción: La mayor accesibilidad a la información de carácter médico en distintos medios de comunicación, aunado a la acertada apertura al modelo de co-responsabilidad en la relación médico-paciente y el mismo ejercicio de sus derechos, han propuesto nuevos planteamientos y dilemas en el manejo de la información técnica. Desarrollo: Se ha fundamentado como un sano ejercicio la segunda opinión profesional, dentro de las prerrogativas del paciente en la práctica clínica, en muchos casos en los que se considera necesaria la segunda opinión profesional para la toma de decisiones diagnósticas o terapéuticas. El contenido y la forma como se transmita esta información tienen relevancia desde el punto de vista bioético y se encuentra también sujeta a lineamientos normativos, legales y de respeto profesional. No sólo se sustenta en la necesidad de hacer prevalecer la búsqueda de la mejor alternativa para el paciente y su calidad de vida; sino también por la necesidad de hacerlo de una forma tal, que cumpla los criterios bioéticos universales, dentro de un plano de respeto y elemental cortesía profesional. Conclusiones: La segunda opinión médica es un ejercicio que contribuye a la calidad de la atención médica. Ésta debe hacerse siempre atendiendo a los lineamientos bioéticos y de respeto profesional. Palabras clave: ética, bioética, salud, educación médica, interconsulta médica, conflictos de interés.

Minimally Invasive Neurosurgery, Sep 1, 1999

The trans-supraorbital approach represents the advantage of combining the keyhole principle and s... more The trans-supraorbital approach represents the advantage of combining the keyhole principle and skull base surgery. In cadaveric work the author shows the anatomic fields visualized with this procedure, advantages and potential surgical applications. The experimental surgical procedure was performed on 8 adult skulls and on 3 cadavers with intact cerebral structures. First, a 2 cm supraorbital approach for endoscopic exploration was used. The basic anatomic landmarks and corresponding dimensions of the microsurgical field were recorded and then compared with those from the trans-supraorbital approach, after removing the orbital arch and other parts of the orbital ceiling. This technique offers a 0.5 cm average increase in surgical field from the craniotomy. The surgical distance that results is shorter (about 2 cm), as well as the length of the surgical instruments required. A better microscope illumination in the deep fields, and the possibility of access to the intraorbital region, the superior orbital fissure, the optic foramen, and the cavernous sinus through the clinoid space are also obtained, with minimal cerebral retraction and similar advantages as through the pterional trans-sylvian approach. The author concludes that by extending the craniotomy and decreasing the surgical distance, the microsurgical field is more convenient for microscope-assisted surgery without totally relying on the endoscope, and with minimal brain retraction. It also provides multiple options to approach vascular and tumor lesions found in these microsurgical corridors, combining principles of minimal invasion and skull-base surgery.

Archives of Medical Research, 2021

Beyond the strict biological scenarios inherent to the virus, other consequences exist that requi... more Beyond the strict biological scenarios inherent to the virus, other consequences exist that require attention due to the duration and evolving alternate implications of the pandemic in our society. The relevance of other “curves” in the Covid-19 Pandemic, related with Non Covid diseases, socio-economic issues, the wear and tear on the medical and social service infrastructure, and the physical and mental deterioration in the human resources, need a special focus in the global strategies in the management of Covid-19 pandemic. Civil rights and legal implications, are another issue to have in mind in the decisions, because these guidelines must not be the cause of social discrimination or stigma in the society. This bioethics approach is particularly targeted to those who are primarily responsible for decision making in matters with an impact on public health.

World Neurosurgery, Jun 1, 2018

Strategies in traumatic brain injury and alcohol consumption: A professional's survey. OBJETIVE: ... more Strategies in traumatic brain injury and alcohol consumption: A professional's survey. OBJETIVE: Traumatic Brain Injury (TBI) associated to alcohol consumption is a global public health problem. It is important to identify and rethink the strategies to approach this challenge for health institutions from a professional perspective. METHODS: An online survey, created with google forms, was sent to professional neurosurgeons in Mexico and Latin America. Participation was voluntary, and the responses were anonymous and confidential. Data were captured after a month and subjected to descriptive statistical analysis using Fisher's method and Chi Square. RESULTS: 83 questionnaires were answered by certified neurosurgeons with a rate of response of 52.9%. It was found that 78% of hospitals have no specific management guidelines for patients with TBI and alcohol intoxication. In 90% of cases no triage strategies are defined for the case and in the hospital admission there are no specific identified strategies for extraordinary surveillance of risks in these patients profile (p= 0.062). CONCLUSION: These finding confirm a lack of systematic strategies for management of patients with TBI and associated comorbidity of alcohol intoxication in acute phase, so it is important to define specific management guidelines to improve treatment efficacy and limit complications in patients with this profile.

Revista De Neurologia, 2000

INTRODUCTION Brain death has been a topic of great interest for clinicians throughout the history... more INTRODUCTION Brain death has been a topic of great interest for clinicians throughout the history of Neurosciences. There are so many different ideas about this topic that it has been necessary to constantly define further the criteria and medical decisions applicable in this field. Also about this matter there are a set of cultural, philosophical and religious aspects as well as autonomous principles in the people involved in such an event. Questions and dilemmas are still present in the individuality of every case and especially in terms of management of information and circumstances that define brain death. DEVELOPMENT This essay tries to analyze the medical and historical issues around death and its relation to the context of brain death as such. There are also a series of reflections supported by the current bioethical thoughts that are identified with a cultural framework that is crucial to acknowledge the way in which the doctor, the family and society approach an event such as brain death. In spite of all the development of diagnostic technology and the extremes of the futility and extreme cruelty of treatments; there are still open questions that require to be looked into with objective criteria and scientific rigor. CONCLUSION We should not put aside bioethical principles that are inherent to human quality and dignity that touch the sensitivity of those who give out the information and those who receive it within this process of interaction between the medical staff and the family.

Revista De Neurologia, Jan 16, 2009

Señalización neural I y II. Membrana celular y concentraciones iónicas Permeabilidad de la membr... more Señalización neural I y II.

Membrana celular y concentraciones iónicas
Permeabilidad de la membrana
Mecanismos de transporte a través de la membrana
- Transporte activo
- Transporte pasivo
- Transporte especializado
Canales y transportadores básicos
- Generalidades
- Propiedades de los canales iónicos relevantes
- Rol biológico de los canales iónicos
- Enfermedades relacionadas con canales iónicos (canalipatías)
- Proteínas transportadoras

Propiedades eléctricas y potenciales de membrana
- Potenciales de membrana
- Potencial de acción

Las fibras nerviosas y su capacidad de conducción
- Mielina
- Sinapsis
- Neurotransmisores
- Unión neuromuscular
- Agonismo y antagonismo

The development of Neurosciences in the last few years has changed a set of paradigms in the prod... more The development of Neurosciences in the last few years has changed a set of paradigms in the production of knowledge, from which new scenarios have arisen in the understanding of the structure and function of the human nervous system, as well as in some of the most relevant diseases involved. Nonetheless, the impact of all the scientific information on this topic has played a limited role in the proposals in the diagnostic, therapeutic, rehabilitation and social reintegration fields, when the effect on the daily life of patients that have a neurological impairment is considered. Thus, the emergence of transl-ational science is an alternative for a more direct and pragmatic link that allows the connection between basic research and applied research, and in the short term will achieve results that can be promoted in the communities. In addition, this process involves an interaction with technological development and transfer following a global knowledge management model. Every discipline in the neurological sciences field poses different critical challenges to tend to the new epidemiologic profiles. emerging in areas such as neurodevelopment disturbances found in the pediatric population, trauma and addictions in the young, as well as neurodegenerative diseases in older adults. This model reviews the demands from society, expecting more compelling results from the scientific community, particularly in creating strategies that actually change the natural course of neurologic diseases from the bench to the bedside. Core tip: The society of knowledge has expanded with information produced all over the world. But unfortunately, only a small part of such knowledge has had an impact on decision-making pertaining health, and on the ability to solve specific problems in a given population. Translational Neurosciences represent an innovative proposal for a direct line between basic research, applied research, technology transfer and knowledge management for the resolution of a specific problem in the neurological sciences, either in diagnosis, therapy, rehabilitation or social integration. This design requires commitment with education and training of human resources in Neuro-sciences from a proactive and innovative viewpoint. Ramos-Zúñiga R. Challenge of the translational neuroscience.

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