Eduardo Lamas - Academia.edu (original) (raw)

Papers by Eduardo Lamas

Research paper thumbnail of Extradural hemorrhage in the posterior fossa in neonates

Research paper thumbnail of Chronic adult hydrocephalus due to uncommon causes

Acta Neurochirurgica, 1980

The authors report on four unusual cases of chronic adult hydrocephalus extracted from a large pe... more The authors report on four unusual cases of chronic adult hydrocephalus extracted from a large personal series of patients with hydrocephalic dementia. A syndrome resembling that of normal pressure hydrocephalus was due to the following aetiologies in these patients: Paget's disease of the skull, unruptured cerebral arteriovenous malformation, colloid cyst of the third ventricle, and cerebromeningeal cysticercosis. All these patients exhibited disturbances in cerebrospinal fluid dynamics at the time of study, and were considerably improved by CSF shunting. The value of the continuous CSF pressure monitoring and the constant infusion test in selecting patients with chronic hydrocephalus for shunt therapy is emphasized.

Research paper thumbnail of Outcome from severe head injury related to the type of intracranial lesion: A computerized tomography study

Journal of Neurosurgery, 1983

The influence of the type of intracranial lesion on the final outcome in a consecutive series of ... more The influence of the type of intracranial lesion on the final outcome in a consecutive series of 277 severely head-injured patients was analyzed. Patients were studied with computerized tomography (CT) and underwent continuous measurement of intracranial pressure. They received identical treatment according to a standardized protocol. Outcome of patients with either epidural hematoma (38 cases), subdural hematoma (56 cases), brain contusion (87 cases), or diffuse brain damage (96 cases) was rather heterogeneous, and serial CT scanning allowed the authors to outline eight consistent anatomical patterns in the whole series which have stronger prognostic significance than the four major lesion categories mentioned above. Patients with pure extracerebral hematoma (19 cases), single brain contusion (45 cases), general brain swelling (41 cases), and normal CT scans (28 cases) had a significantly better outcome than patients developing acute hemispheric swelling after operation for a large extracerebral hematoma (27 cases), patients with multiple brain contusion, either unilateral or bilateral (74 cases), and patients with diffuse axonal injury (43 cases). These anatomical patterns are interesting because, in addition to having clinical and physiopathological significance, they provide useful prognostic information and facilitate improved therapeutic decision-making in severely head-injured patients.

Research paper thumbnail of Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment

Neurosurgery, 1984

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spina... more The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.

Research paper thumbnail of Normal computerized tomography scans in severe head injury: Prognostic and clinical management implications

Journal of Neurosurgery, 1986

The authors analyze the clinical course of 46 severely head-injured patients who had completely n... more The authors analyze the clinical course of 46 severely head-injured patients who had completely normal computerized tomography (CT) scans through the immediate posttraumatic period (1 to 7 days after trauma). These patients represent 10.2% of a consecutive series of 448 cases of severe head injuries and two-thirds of the cases showing a normal CT scan on admission (the other one-third of the cases developed new pathology). The usual course in these 46 patients after the initial coma was toward progressive neurological improvement, and 35 patients (76%) achieved a functional level of survival. Nine patients (19.5%) remained comatose for several weeks and developed severe disability. There were two fatalities due to medical complications. The final outcome was more closely related to the duration of coma (the longer the duration the worse the result) than to the initial Glasgow Coma Scale (GCS) score. In fact, 26% of the patients in the lower GCS score ranges (3 to 4 points) made a good recovery and 46% developed moderate disability only. These findings indicate that the grim prognostic significance of deep posttraumatic coma is tempered in the presence of a normal scan. However, the absence of CT abnormalities in severely head-injured patients cannot be equated with a good prognosis because in one-fifth of the cases serious permanent disability develops. Sustained elevation of the intracranial pressure (ICP) was not seen in these patients, indicating that ICP monitoring may be omitted in cases with a normal scan. However, since one-third of the patients with a normal admission scan developed new pathology within the first few days of injury, a strategy for control scanning is recommended. Control CT scans performed more than 6 months after injury showed a significantly higher incidence of brain atrophy in patients developing permanent disability than in those who made a good recovery.

Research paper thumbnail of Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma

Journal of Neurosurgery, 1988

taken directly from CT scan to the operating room (30 patients). The remaining 25 had no splenic ... more taken directly from CT scan to the operating room (30 patients). The remaining 25 had no splenic injury on CT scan, which was confirmed surgically. CT scan was correctly indicative of splenic injury in 28 of 30 operated cases and in 16 nonoperated cases. Overall acccuracy was 97%, specificity was 100%, and sensitivity was 93%. The authors conclude that CT is an accurate technique to determine the extent of splenic injury; CT classification has a high correlation with anatomic findings; and early operation with severe class II and all class III injuries may optimize splenic salvage, thus reducing late splenectomy and hospitalization.

Research paper thumbnail of Bilateral dural arteriovenous fistula in the region of the cavernous sinus

Neuroradiology, 1978

The case of a patient with a fistula between the left internal carotid artery and the cavernous s... more The case of a patient with a fistula between the left internal carotid artery and the cavernous sinus, and another fistula between the right external carotid artery and the cavernous sinus, is reported. The clinical symptomatology, which was of spontaneous onset, was unilateral and consisted of exophthalmos and injection of the conjunctiva on the left side. Almost complete remission occurred after angiography.

Research paper thumbnail of Dural posterior fossa AVM producing raised sagittal sinus pressure: Case report

Journal of Neurosurgery, 1977

A patient with raised intracranial pressure secondary to a dural arteriovenous malformation (AVM)... more A patient with raised intracranial pressure secondary to a dural arteriovenous malformation (AVM) of the posterior fossa is presented. Direct shunting of arterial blood into the transverse sigmoid sinus caused a considerable increase of the sagittal sinus pressure (SSP) and elevation of intracranial pressure (ICP). Both ICP and SSP returned to normal values following obliteration of the dural AVM by selective embolization.

Research paper thumbnail of Comparison of the Clinical Presentation of Symptomatic Arteriovenous Malformations (Angiographically Visualized) and Occult Vascular Malformations

Neurosurgery, 1992

The authors compared the clinical presentations of angiographically apparent arteriovenous malfor... more The authors compared the clinical presentations of angiographically apparent arteriovenous malformations (AVMs) and angiographically occult vascular malformations (AOVMs) of the brain in 188 consecutive patients treated when computed tomography and magnetic resonance were available. There were 133 patients (70.7%) with AVMs and 55 patients (29.2%) with AOVMs. AOVMs tended to occur more frequently in male patients and in the posterior fossa and to present earlier clinically than AVMs, but differences were not significant. One distinctive feature was the greater size of AVMs, as compared with AOVMs. Presentation by hemorrhage occurred in 64.3% of the patients with AVMs and in 61.8% of those with AOVMs. Malformations of both types located in the posterior fossa presented with hemorrhage more frequently (84.2% of AVMs and 78.5% of AOVMs) than similar lesions lying above the tentorium (60.8% of AVMs and 56% of AOVMs). Bleeding was more severe in patients with AVMs than in those with AOVMs, as indicated by the higher mortality associated with hemorrhage (7.5 vs. 3.6% of the cases) and the more frequent and marked decrease in the level of consciousness observed at admission (34 vs. 16.2% of drowsy or comatose patients). Brain hematomas caused by AVMs were on average bigger than those caused by AOVMs (58.8 and 20% of large hematomas, respectively), and intraventricular and subarachnoid hemorrhages were also more common and profuse in patients with AVMs. However, AOVMs bled subsequently more times than AVMs (61.7 vs. 15.6%), before they were diagnosed and treated, leading to a higher nonoperative morbidity (16.3 vs. 13.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Posttraumatic cerebral hemispheric swelling: Analysis of 55 cases studied with computerized tomography

Journal of Neurosurgery, 1988

The authors have analyzed the clinical course and intracranial pressure (ICP) changes in 55 sever... more The authors have analyzed the clinical course and intracranial pressure (ICP) changes in 55 severely head-injured patients presenting with bulk enlargement of one cerebral hemisphere within a few hours after trauma. These patients represent 10.5% of a series of 520 patients with severe head injury studied with computerized tomography (CT). Cerebral hemispheric swelling has the highest mortality rate and the shortest survival period after trauma in all series of severe head injury. In this series, it was associated with an ipsilateral subdural hematoma of variable size in 47 patients (85%) or with a large epidural hematoma in five patients (9%); in three patients (5.4%) it occurred as an isolated lesion. Evacuation of an associated extracerebral hematoma, which was performed within 4 hours after injury in only 20% of cases, scarcely changed the patients' preoperative neurological status. The high incidence of arterial hypotension and/or hypoxemia at admission (47% of cases) and the severity of the clinical presentation (82% of patients scored 5 points or less on the Glasgow Coma Scale, 74% had unilateral or bilateral mydriasis, and 80% had an initial ICP above normal) correlated with a very poor final outcome (87% mortality). Only one of the 11 patients with normal initial ICP continued to have normal pressure throughout the course. High-dose thiopental failed to control severe intracranial hypertension in 24 patients (51%) who had a fulminant, malignant course. A transient decrease in ICP elevation was achieved in 15 patients (31.4%) and definitive control in eight patients (17%), among whom were the seven survivors in this series. In the authors' experience, once ICP is controlled, barbiturate administration should not be discontinued until a control CT scan shows complete disappearance of the mass effect.

Research paper thumbnail of Multiple intracranial arterial occlusions (moyamoya disease) in patients with neurofibromatosis one case report with autopsy

Acta Neurochirurgica, 1978

The authors report two cases of multiple intracranial arterial occlusive disease occurring in pat... more The authors report two cases of multiple intracranial arterial occlusive disease occurring in patients affected by neurofibromatosis. Clinicoradiological presentation was, in both cases, typical of the so-called Moyamoya disease. Special emphasis on the anatomopathological necropsy findings in the second case is made, because, to the authors' knowledge, this is the first reported case in the literature.

Research paper thumbnail of OBSERVATIONS ON 82 PATIENTS WITH EXTRADURAL HEMATOMA

Journal of Computer Assisted Tomography, 1981

A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1... more A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1980 is presented. Forty-one patients were managed before the advent of computerized tomography (CT) and the other 41 after this neuroradiological method was available. Mortality and disability rates which were 29.2% and 31.7% during the pre-CT period decreased to 12.1% and 19.5%, respectively, with the aid of CT scanning. This technique allowed a more rapid and accurate diagnosis of the hematomas than angiography, and defined better the presence and the evolutional changes of the associated cerebral lesions. As a consequence, surgery has been more effectively planned and executed during the CT era.

Research paper thumbnail of Neurocutaneous melanosis

Acta Neurochirurgica, 1977

A case of neurocutaneous melanosis in a 15 year old male is described. A primary malignant mening... more A case of neurocutaneous melanosis in a 15 year old male is described. A primary malignant meningeal melanoma caused the death of the patient in six months. The skin lesions were benign. The literature is reviewed, and the nature of the disease and its relationship with other phakomatoses is discussed.

Research paper thumbnail of Intraventricular morphine for control of pain in terminal cancer patients

Journal of Neurosurgery, 1983

... Address reprint requests to: Ramiro D. Lobato, MD, Servicio Neurocirugia, Ciudad Sanitaria “1... more ... Address reprint requests to: Ramiro D. Lobato, MD, Servicio Neurocirugia, Ciudad Sanitaria “1° de Octubre,” C/Andalucía, Km 5,4, Madrid, Spain. DOI: 10.3171/jns.1983.59.4.0627. Figures and Tables. ... 24. Kerr FWL: Neuroanatomical substrates of nociception in the spinal cord. ...

Research paper thumbnail of Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

Journal of Neurosurgery, 1990

Research paper thumbnail of Spinal metastatic disease: analysis of factors determining functional prognosis and the choice of treatment

Neurosurgery, 1984

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spina... more The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.

Research paper thumbnail of Post-traumatic diffuse axonal brain injury. Analysis of 78 patients studied with Computed Tomography

Acta Neurochirurgica, 1986

A group of 78 severe head injury patients showing computerized tomography (CT) findings of the so... more A group of 78 severe head injury patients showing computerized tomography (CT) findings of the so-called “diffuse axonal injury” is analyzed. These patients represent 20% of the authors' series of severe head injury. Twenty-three patients showed small intraparenchymal haemorrhages in the CT scan study, 15 intraventricular haemorrhage and 40 patients had both intraparenchymal and intraventricular haemorrhages. Signs of brainstem haemorrhagic contusion were seen in 29 (38%) patients. Generalized brain swelling superimposed on the above findings was present in 75% of the cases. Raised intracranial pressure, which was found in 50% of the patients, correlated with the presence of ventriculocisternal collapse in the CT scan and an unfavourable outcome. Only 4 patients in this series made a good recovery, 13 developed a moderate disability, 11 a severe disability, 12 became vegetative and 38 (49%) died. The prognosis with this post-traumatic lesion is the worst in the authors' severe head injury series after excluding cases with subdural haematoma.

Research paper thumbnail of Giant cerebral arteriovenous malformation producing a noncommunicating hydrocephalus

Surgical Neurology, 1981

The case of a woman with a large, mixed, cerebral arteriovenous malformation mainly involving the... more The case of a woman with a large, mixed, cerebral arteriovenous malformation mainly involving the posterior fossa and producing a noncommunicating hypertensive hydrocephalus is reported. Relief of ventricular enlargement by means of a cerebrospinal fluid shunt unexpectedly resulted in stupor and Parinauds' syndrome. These complications were completely relieved by ligating the shunt. The vascular and mechanical factors involved in the production of hydrocephalus in this patient are discussed.

Research paper thumbnail of Intraventricular hemorrhage in severe head injury

Journal of Neurosurgery, 1983

A series of 30 patients suffering posttraumatic intraventricular hemorrhage (IVH) after closed he... more A series of 30 patients suffering posttraumatic intraventricular hemorrhage (IVH) after closed head injury is reviewed. Clotted blood and a mixture of blood and cerebrospinal fluid could be distinguished by computerized tomography (CT). Posttraumatic IVH was associated with diffuse brain lesions in most cases; intracerebral lesions with contusion, and subdural hematomas coexisted with posttraumatic IVH in eight and four instances, respectively. In two more cases, no CT abnormality other than IVH was noted. All patients in this series were in deep coma at the time of CT examination, and only seven survived. The early clinical findings, the site of ventricular hematoma, and the final outcome are analyzed.

Research paper thumbnail of Outcome in children with severe head injuries

Childs Nervous System, 1985

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (... more We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.

Research paper thumbnail of Extradural hemorrhage in the posterior fossa in neonates

Research paper thumbnail of Chronic adult hydrocephalus due to uncommon causes

Acta Neurochirurgica, 1980

The authors report on four unusual cases of chronic adult hydrocephalus extracted from a large pe... more The authors report on four unusual cases of chronic adult hydrocephalus extracted from a large personal series of patients with hydrocephalic dementia. A syndrome resembling that of normal pressure hydrocephalus was due to the following aetiologies in these patients: Paget's disease of the skull, unruptured cerebral arteriovenous malformation, colloid cyst of the third ventricle, and cerebromeningeal cysticercosis. All these patients exhibited disturbances in cerebrospinal fluid dynamics at the time of study, and were considerably improved by CSF shunting. The value of the continuous CSF pressure monitoring and the constant infusion test in selecting patients with chronic hydrocephalus for shunt therapy is emphasized.

Research paper thumbnail of Outcome from severe head injury related to the type of intracranial lesion: A computerized tomography study

Journal of Neurosurgery, 1983

The influence of the type of intracranial lesion on the final outcome in a consecutive series of ... more The influence of the type of intracranial lesion on the final outcome in a consecutive series of 277 severely head-injured patients was analyzed. Patients were studied with computerized tomography (CT) and underwent continuous measurement of intracranial pressure. They received identical treatment according to a standardized protocol. Outcome of patients with either epidural hematoma (38 cases), subdural hematoma (56 cases), brain contusion (87 cases), or diffuse brain damage (96 cases) was rather heterogeneous, and serial CT scanning allowed the authors to outline eight consistent anatomical patterns in the whole series which have stronger prognostic significance than the four major lesion categories mentioned above. Patients with pure extracerebral hematoma (19 cases), single brain contusion (45 cases), general brain swelling (41 cases), and normal CT scans (28 cases) had a significantly better outcome than patients developing acute hemispheric swelling after operation for a large extracerebral hematoma (27 cases), patients with multiple brain contusion, either unilateral or bilateral (74 cases), and patients with diffuse axonal injury (43 cases). These anatomical patterns are interesting because, in addition to having clinical and physiopathological significance, they provide useful prognostic information and facilitate improved therapeutic decision-making in severely head-injured patients.

Research paper thumbnail of Spinal Metastatic Disease: Analysis of Factors Determining Functional Prognosis and the Choice of Treatment

Neurosurgery, 1984

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spina... more The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.

Research paper thumbnail of Normal computerized tomography scans in severe head injury: Prognostic and clinical management implications

Journal of Neurosurgery, 1986

The authors analyze the clinical course of 46 severely head-injured patients who had completely n... more The authors analyze the clinical course of 46 severely head-injured patients who had completely normal computerized tomography (CT) scans through the immediate posttraumatic period (1 to 7 days after trauma). These patients represent 10.2% of a consecutive series of 448 cases of severe head injuries and two-thirds of the cases showing a normal CT scan on admission (the other one-third of the cases developed new pathology). The usual course in these 46 patients after the initial coma was toward progressive neurological improvement, and 35 patients (76%) achieved a functional level of survival. Nine patients (19.5%) remained comatose for several weeks and developed severe disability. There were two fatalities due to medical complications. The final outcome was more closely related to the duration of coma (the longer the duration the worse the result) than to the initial Glasgow Coma Scale (GCS) score. In fact, 26% of the patients in the lower GCS score ranges (3 to 4 points) made a good recovery and 46% developed moderate disability only. These findings indicate that the grim prognostic significance of deep posttraumatic coma is tempered in the presence of a normal scan. However, the absence of CT abnormalities in severely head-injured patients cannot be equated with a good prognosis because in one-fifth of the cases serious permanent disability develops. Sustained elevation of the intracranial pressure (ICP) was not seen in these patients, indicating that ICP monitoring may be omitted in cases with a normal scan. However, since one-third of the patients with a normal admission scan developed new pathology within the first few days of injury, a strategy for control scanning is recommended. Control CT scans performed more than 6 months after injury showed a significantly higher incidence of brain atrophy in patients developing permanent disability than in those who made a good recovery.

Research paper thumbnail of Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma

Journal of Neurosurgery, 1988

taken directly from CT scan to the operating room (30 patients). The remaining 25 had no splenic ... more taken directly from CT scan to the operating room (30 patients). The remaining 25 had no splenic injury on CT scan, which was confirmed surgically. CT scan was correctly indicative of splenic injury in 28 of 30 operated cases and in 16 nonoperated cases. Overall acccuracy was 97%, specificity was 100%, and sensitivity was 93%. The authors conclude that CT is an accurate technique to determine the extent of splenic injury; CT classification has a high correlation with anatomic findings; and early operation with severe class II and all class III injuries may optimize splenic salvage, thus reducing late splenectomy and hospitalization.

Research paper thumbnail of Bilateral dural arteriovenous fistula in the region of the cavernous sinus

Neuroradiology, 1978

The case of a patient with a fistula between the left internal carotid artery and the cavernous s... more The case of a patient with a fistula between the left internal carotid artery and the cavernous sinus, and another fistula between the right external carotid artery and the cavernous sinus, is reported. The clinical symptomatology, which was of spontaneous onset, was unilateral and consisted of exophthalmos and injection of the conjunctiva on the left side. Almost complete remission occurred after angiography.

Research paper thumbnail of Dural posterior fossa AVM producing raised sagittal sinus pressure: Case report

Journal of Neurosurgery, 1977

A patient with raised intracranial pressure secondary to a dural arteriovenous malformation (AVM)... more A patient with raised intracranial pressure secondary to a dural arteriovenous malformation (AVM) of the posterior fossa is presented. Direct shunting of arterial blood into the transverse sigmoid sinus caused a considerable increase of the sagittal sinus pressure (SSP) and elevation of intracranial pressure (ICP). Both ICP and SSP returned to normal values following obliteration of the dural AVM by selective embolization.

Research paper thumbnail of Comparison of the Clinical Presentation of Symptomatic Arteriovenous Malformations (Angiographically Visualized) and Occult Vascular Malformations

Neurosurgery, 1992

The authors compared the clinical presentations of angiographically apparent arteriovenous malfor... more The authors compared the clinical presentations of angiographically apparent arteriovenous malformations (AVMs) and angiographically occult vascular malformations (AOVMs) of the brain in 188 consecutive patients treated when computed tomography and magnetic resonance were available. There were 133 patients (70.7%) with AVMs and 55 patients (29.2%) with AOVMs. AOVMs tended to occur more frequently in male patients and in the posterior fossa and to present earlier clinically than AVMs, but differences were not significant. One distinctive feature was the greater size of AVMs, as compared with AOVMs. Presentation by hemorrhage occurred in 64.3% of the patients with AVMs and in 61.8% of those with AOVMs. Malformations of both types located in the posterior fossa presented with hemorrhage more frequently (84.2% of AVMs and 78.5% of AOVMs) than similar lesions lying above the tentorium (60.8% of AVMs and 56% of AOVMs). Bleeding was more severe in patients with AVMs than in those with AOVMs, as indicated by the higher mortality associated with hemorrhage (7.5 vs. 3.6% of the cases) and the more frequent and marked decrease in the level of consciousness observed at admission (34 vs. 16.2% of drowsy or comatose patients). Brain hematomas caused by AVMs were on average bigger than those caused by AOVMs (58.8 and 20% of large hematomas, respectively), and intraventricular and subarachnoid hemorrhages were also more common and profuse in patients with AVMs. However, AOVMs bled subsequently more times than AVMs (61.7 vs. 15.6%), before they were diagnosed and treated, leading to a higher nonoperative morbidity (16.3 vs. 13.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Research paper thumbnail of Posttraumatic cerebral hemispheric swelling: Analysis of 55 cases studied with computerized tomography

Journal of Neurosurgery, 1988

The authors have analyzed the clinical course and intracranial pressure (ICP) changes in 55 sever... more The authors have analyzed the clinical course and intracranial pressure (ICP) changes in 55 severely head-injured patients presenting with bulk enlargement of one cerebral hemisphere within a few hours after trauma. These patients represent 10.5% of a series of 520 patients with severe head injury studied with computerized tomography (CT). Cerebral hemispheric swelling has the highest mortality rate and the shortest survival period after trauma in all series of severe head injury. In this series, it was associated with an ipsilateral subdural hematoma of variable size in 47 patients (85%) or with a large epidural hematoma in five patients (9%); in three patients (5.4%) it occurred as an isolated lesion. Evacuation of an associated extracerebral hematoma, which was performed within 4 hours after injury in only 20% of cases, scarcely changed the patients' preoperative neurological status. The high incidence of arterial hypotension and/or hypoxemia at admission (47% of cases) and the severity of the clinical presentation (82% of patients scored 5 points or less on the Glasgow Coma Scale, 74% had unilateral or bilateral mydriasis, and 80% had an initial ICP above normal) correlated with a very poor final outcome (87% mortality). Only one of the 11 patients with normal initial ICP continued to have normal pressure throughout the course. High-dose thiopental failed to control severe intracranial hypertension in 24 patients (51%) who had a fulminant, malignant course. A transient decrease in ICP elevation was achieved in 15 patients (31.4%) and definitive control in eight patients (17%), among whom were the seven survivors in this series. In the authors' experience, once ICP is controlled, barbiturate administration should not be discontinued until a control CT scan shows complete disappearance of the mass effect.

Research paper thumbnail of Multiple intracranial arterial occlusions (moyamoya disease) in patients with neurofibromatosis one case report with autopsy

Acta Neurochirurgica, 1978

The authors report two cases of multiple intracranial arterial occlusive disease occurring in pat... more The authors report two cases of multiple intracranial arterial occlusive disease occurring in patients affected by neurofibromatosis. Clinicoradiological presentation was, in both cases, typical of the so-called Moyamoya disease. Special emphasis on the anatomopathological necropsy findings in the second case is made, because, to the authors' knowledge, this is the first reported case in the literature.

Research paper thumbnail of OBSERVATIONS ON 82 PATIENTS WITH EXTRADURAL HEMATOMA

Journal of Computer Assisted Tomography, 1981

A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1... more A consecutive, unselected series of 82 patients with epidural hematoma treated between 1973 and 1980 is presented. Forty-one patients were managed before the advent of computerized tomography (CT) and the other 41 after this neuroradiological method was available. Mortality and disability rates which were 29.2% and 31.7% during the pre-CT period decreased to 12.1% and 19.5%, respectively, with the aid of CT scanning. This technique allowed a more rapid and accurate diagnosis of the hematomas than angiography, and defined better the presence and the evolutional changes of the associated cerebral lesions. As a consequence, surgery has been more effectively planned and executed during the CT era.

Research paper thumbnail of Neurocutaneous melanosis

Acta Neurochirurgica, 1977

A case of neurocutaneous melanosis in a 15 year old male is described. A primary malignant mening... more A case of neurocutaneous melanosis in a 15 year old male is described. A primary malignant meningeal melanoma caused the death of the patient in six months. The skin lesions were benign. The literature is reviewed, and the nature of the disease and its relationship with other phakomatoses is discussed.

Research paper thumbnail of Intraventricular morphine for control of pain in terminal cancer patients

Journal of Neurosurgery, 1983

... Address reprint requests to: Ramiro D. Lobato, MD, Servicio Neurocirugia, Ciudad Sanitaria “1... more ... Address reprint requests to: Ramiro D. Lobato, MD, Servicio Neurocirugia, Ciudad Sanitaria “1° de Octubre,” C/Andalucía, Km 5,4, Madrid, Spain. DOI: 10.3171/jns.1983.59.4.0627. Figures and Tables. ... 24. Kerr FWL: Neuroanatomical substrates of nociception in the spinal cord. ...

Research paper thumbnail of Percutaneous microcompression of the gasserian ganglion for trigeminal neuralgia

Journal of Neurosurgery, 1990

Research paper thumbnail of Spinal metastatic disease: analysis of factors determining functional prognosis and the choice of treatment

Neurosurgery, 1984

The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spina... more The authors surveyed 31 surgical and radiotherapy series comprising over 2300 patients with spinal metastases to determine the influence of factors such as tumor biology and topography, pretreatment neurological status, the presence of a myelographic block, the progression rate of symptoms, and the general medical condition of the patient on both the functional prognosis and the choice of treatment. Both life expectancy and the functional results after therapy are mainly dependent on tumor biology, which in turn determines radiosensitivity. The remaining factors seem to have only complementary predictive power. Because radiotherapy has been found to be as effective as operation plus radiotherapy in the management of the majority of patients with spinal metastases, it is very important to improve the selection of surgical candidates (less than 42% of the total cases) to prevent unnecessary surgery-related morbidity and mortality. Factors considered important in the selection of therapy are the location of the tumor within the spinal canal, the neurological status at the time of treatment, and the systemic condition of the patient.

Research paper thumbnail of Post-traumatic diffuse axonal brain injury. Analysis of 78 patients studied with Computed Tomography

Acta Neurochirurgica, 1986

A group of 78 severe head injury patients showing computerized tomography (CT) findings of the so... more A group of 78 severe head injury patients showing computerized tomography (CT) findings of the so-called “diffuse axonal injury” is analyzed. These patients represent 20% of the authors' series of severe head injury. Twenty-three patients showed small intraparenchymal haemorrhages in the CT scan study, 15 intraventricular haemorrhage and 40 patients had both intraparenchymal and intraventricular haemorrhages. Signs of brainstem haemorrhagic contusion were seen in 29 (38%) patients. Generalized brain swelling superimposed on the above findings was present in 75% of the cases. Raised intracranial pressure, which was found in 50% of the patients, correlated with the presence of ventriculocisternal collapse in the CT scan and an unfavourable outcome. Only 4 patients in this series made a good recovery, 13 developed a moderate disability, 11 a severe disability, 12 became vegetative and 38 (49%) died. The prognosis with this post-traumatic lesion is the worst in the authors' severe head injury series after excluding cases with subdural haematoma.

Research paper thumbnail of Giant cerebral arteriovenous malformation producing a noncommunicating hydrocephalus

Surgical Neurology, 1981

The case of a woman with a large, mixed, cerebral arteriovenous malformation mainly involving the... more The case of a woman with a large, mixed, cerebral arteriovenous malformation mainly involving the posterior fossa and producing a noncommunicating hypertensive hydrocephalus is reported. Relief of ventricular enlargement by means of a cerebrospinal fluid shunt unexpectedly resulted in stupor and Parinauds' syndrome. These complications were completely relieved by ligating the shunt. The vascular and mechanical factors involved in the production of hydrocephalus in this patient are discussed.

Research paper thumbnail of Intraventricular hemorrhage in severe head injury

Journal of Neurosurgery, 1983

A series of 30 patients suffering posttraumatic intraventricular hemorrhage (IVH) after closed he... more A series of 30 patients suffering posttraumatic intraventricular hemorrhage (IVH) after closed head injury is reviewed. Clotted blood and a mixture of blood and cerebrospinal fluid could be distinguished by computerized tomography (CT). Posttraumatic IVH was associated with diffuse brain lesions in most cases; intracerebral lesions with contusion, and subdural hematomas coexisted with posttraumatic IVH in eight and four instances, respectively. In two more cases, no CT abnormality other than IVH was noted. All patients in this series were in deep coma at the time of CT examination, and only seven survived. The early clinical findings, the site of ventricular hematoma, and the final outcome are analyzed.

Research paper thumbnail of Outcome in children with severe head injuries

Childs Nervous System, 1985

We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (... more We present a series of 56 children who suffered severe head injuries, with a Glasgow Coma Score (GCS) of less than 8. The cases were classified according to the type of morphologic lesion on computed tomography (CT) scan. Intracranial pressure (ICP) was monitored in all children in this series. A protocol that included artificial ventilation and other measures of treatment for intracranial hypertension was applied. Results were analyzed according to age, type of lesion, and ICP. The usefulness of the ICP recording and of obtaining a correct classification of lesions using the CT scan is emphasized.