Examinando por Autor "Quiñones Hinojosa, Alfredo"

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    Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex : A Systematic Review
    (2018-08) Leon Ariza, Daniel S.; Leon Ariza, Juan S.; Nangiana, Jasvinder; Vargas Grau, Gabriel; Leon Sarmiento, Fidias E.; Quiñones Hinojosa, Alfredo
    The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. Methods A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. Results A total of 575 patients were included in this study. TCR was found in 8.9% of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06; F = 0.3912809), covaried with age (P = 0.012; F = 9.302), and inversely correlated to each other (r = −0.27). Conclusions TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.
  • Publicación
    Acceso abierto
    Ventricular Volume Dynamics During the Development of Adult Chronic Communicating Hydrocephalus in a Rodent Model
    (2018-12) Vivas Buitrago, Tito; Pinilla Monsalve, Gabriel; Jusué Torres, Ignacio; Oishi, Kumiko; Robison, Jamie; Crawford, Joshua A.; Pletnikov, Mikhail; Xu, Jiadi; Baledént, Olivier; Lokossou, Armelle; Hung, Alice L.; Blitz, Ari M.; Lu, Jennifer; Herzka, Daniel A.; Guerrero Cazares, Hugo; Oishi, Kenichi; Mori, Susumu; Quiñones Hinojosa, Alfredo; Rigamonti, Daniele
    Introduction The pathophysiology of normal-pressure hydrocephalus and the correlation with its symptomatology is not well understood. Objective To monitor and evaluate the enlargement patterns of the ventricular system for each ventricle and its correlation with the presenting symptoms. Methods Bilateral kaolin injection into the subarachnoid space overlying the cranial convexities was done in 18 adult rats. Magnetic resonance imaging was performed on an 11.7-T scanner 15, 60, 90, and 120 days after injection. Volumes of the ventricular system were measured for each ventricle and correlated with biweekly behavioral findings. Results There was a progressive increase in the ventricular volume for the lateral ventricles since day 15 in the kaolin-injected animals. There was a nonsignificant trend in volume growth for the third ventricle, but its enlargement was synchronous with the lateral ventricles. No significant change for the fourth ventricle. No symptoms were detected in the first 60 days. Association was found between the ventricular volume and locomotor changes. In addition, the odds of locomotor symptoms increased by 3% for every additional cubic millimeter of volume in the left (P < 0.001) and right (P = 0.023) ventricles, and for the total magnetic resonance imaging volume by 1% (P = 0.013). Conclusions Expansion of the lateral ventricles maintained similar proportions over time, accompanied by a synchronous third ventricular expansion with less proportion and a nonsignificant fourth enlargement. Lateral ventricles enlarged most in those animals that were to develop late locomotor deterioration. Further research using this animal model combined with different radiologic imaging techniques, such as diffusion tensor imaging and perfusion studies, is recommended.