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Neurosurgery of Adults
Professor and consultant: Dr. Salvat, Jorge
Department Chief: Dr. Salaberry, Juan Carlos
1. General neurosurgery
2. Summary of Services
3. Professionals
4. Technology
5. Academic activities
6. Consultations
1. General neurosurgery
The General Neurosurgery section is responsible for the management of patients with pathologies of neurosurgical resolution such as:
* 1. Skull traumatisms
* 2. Hydrocephalia
1. Skull Traumatisms
(more information in the "images" section of the department)
The traumatic brain lesion is defined as the result of the application of an external force on the skull with subsequent primary and secondary damage. Statistics of developed countries report roughly 200-300 cases of skull traumatisms of diverse severity each 100,000 people per year. In childhood, 25% of traumatic deaths are produced by cerebral lesions.
The most frequent causes of skull traumatism are:
A - Automobile accidents
B - Firearm wounds
C - Falls
The primary cerebral damage of skull traumatism is produced by the initial impact, so that the only preventive measures are those tending to diminish the frequency of accidents. The secondary cerebral damage occurs as a result of the pressure exerted on the still healthy brain tissue by fractured bony segments, haematomas and cerebral oedema produced by the blow. On this potential damage, one can act medically, either surgically, by evacuating haematomas, bruises and fractures and by administering intravenous medications intended to normalise intracranial pressure. Because the skull is a rigid bony structure, any space-occupying intracranial lesion will generate an increase in intracranial pressure at the expense of the compression of healthy brain tissue. Therefore, it is necessary to monitor intracranial pressure. For this purpose, there are intracerebral catheters, which connected to computer-assisted systems, continuously display the value of intracranial pressure, thus allowing correction of remaining metabolic variables to ensure appropriate cerebral oxygenation.
The prognosis of skull traumatisms depends on their intensity, on the severity of lesions, on the possibility
of surgical resolution and on the values of intracranial pressure. Patients who survive traumatic brain lesions enter programmes of physical and psychic rehabilitation tending to optimise their functionality.
2. Hydrocephalia
The Central Nervous System possesses the ventricular system, made up by the lateral ventricles, the III and IV ventricles communicating with one another and full of cerebrospinal fluid. This liquid is continually produced and reabsorbed at cerebral level. When for different causes the circulation of the cerebrospinal fluid is affected, hydrocephalia develops.
The more common causes of hydrocephalia include the alteration of liquid reabsorption due to bleeding or infections, obstruction of the circulation due to tumorous lesions or to excessive secretion of liquid on the part of some tumours. Although hydrocephalia is a pathology that prevails in childhood, there is a picture that may present in mature age and whose symptomatology includes:
- Gait alteration (short steps, instability, repeated falls)
- Urinary dysfunction (urinary urgency and incontinence)
- Memory alterations (apathy, indifference, memory disorders)
Quite often confused with a picture of senile illness, Parkinson's or Alzheimer's disease, this disorder was discovered by Hakim-Adams in 1965. The diagnosis is carried out based on clinical symptoms, magnetic resonance or computed tomography imaging and specific studies such as radio-isotope cisternography. Diagnoses to be ruled out include neurocognitive pathologies, Parkinson and Alzheimer syndromes and multi-infarct dementia. The treatment consists in shunting the surplus cerebrospinal fluid, by means of a valve system, to the abdomen or the systemic circulation.
2. Services
The Department of Adult Neurosurgery at FLENI Institute is divided into different sections specialised in the different neurosurgical pathologies.
* Neuro-oncology Section
The Neuro-oncology Section offers comprehensive treatment to patients with tumours of the Central Nervous System. Specialists in oncological surgery work jointly with radiotherapists and oncologists, as well as with physical rehabilitation therapists and neuropsychologists.
* Vascular Neurosurgery Section
The Vascular Section is responsible for the management of patients with aneurysms, cerebral malformations and cerebrovascular accidents.
* Spine Pathology Centre
The Spine Pathology Centre offers comprehensive treatment to patients with traumatic, degenerative and
infectious disorders of the spine.
* Stereotactic Neurosurgery Section / Gamma-Knife
Stereotactic radiosirgery uses small radiation doses directed to a specific area of the brain in order to treat lesions located in cerebral areas of difficult surgical access. In turn, stereotactic surgical biopsies allow in turn making diagnoses of deep cerebral lesions.
* Endovascular Neurosurgery Section
Interventionist Neuroradiology carries out diagnostic studies and therapeutic procedures in patients with vascular lesions of the Central Nervous system.
* Functional Neurosurgery Section
It offers specific surgical treatments to patients with chronic pains and spasticity refractory to medical treatment, including implantation of medication pumps and medullary stimulation.
* Epilepsy Surgery Centre
It includes neurosurgeons, neurologists, neurophysiologists and neuropsychologists specialised in the surgical treatment of epilepsy.
* Peripheral Nerve and Plexus Neurosurgery Section
The Peripheral Nerve Neurosurgery Section includes the treatment of traumatic and tumorous lesions, as well as for peripheral nerve entrapment.
* Oto-neurosurgery Section
In charge of patients with vestibular schwannomas and neurofibromatosis
* Neuro-anaesthesiology Section
3. Medical Staff
Consultor: Dr. Jorge Salvat
Service Chief: Dr. Juan Carlos Salaberry
Telephone: 5777-3200
Name / Specialty / Extension
Dr. Jorge Salvat / Neurosurgeon / 2301
Dr. Juan Salaberry / Neurosurgeon / 2303
Dr. Santiago Condomí Alcorta / Neurosurgeon / 2303
Dr. Osvaldo Fernández Boan / Neurosurgeon / 2303
Dr. Andrés Cervio / Neurosurgeon / 2303
Dr. Pablo Marino / Neuro-Orthopaedist / 2303
Dr. Natalia Roura / Neuro-Orthopaedist / 2303
Dr. Hugo Pomata / Neurosurgeon / 2500
Dr. Julio Antico / Radiotherapist, Neurosurgeon
Dr. Eduardo Tenca / Radiotherapist, Neurosurgeon
Dr. Vicente Diamante / Otorhinolaryngologist / 2700
Dr. Federico Demonty / Anaesthesiologist / 1936
Dr. Adriana Pérez / Anaesthesiologist / 1936
Dr. Leonardo Masri / Anaesthesiologist / 1936
For consultations on neurosurgical pathology, contact:
Tel.: 011-5777- 3200
Extension 2701/2702
4. Technology
(more information in the "images" section of the department)
The Department of Neurosurgery at FLENI Institute has a highly specialised surgery area made up by 4 independent surgery rooms, equipped with the state-of-the-art technology necessary to perform any neurosurgical procedure of high complexity.
. Surgical equipment
- Microscopes
Surgical microscopes include a Leica Model Wild M695 (A) and a Leica OMH.
- Bipolar Coagulators
Soring MBC 501 Coagulator and Aesculap GN 640 Coagulator.
- Ultrasonic Aspirator
- Endoscope
The Karl Storz endoscope includes rigid endoscopes with 0º, 30º and 70º lenses and a flexible endoscope to perform endoscopic procedures such as third ventriculostomy.
- Neuronavigator
FLENI Institute has an Elekta Neuronavigator to carry out high complexity neurosurgical procedures where it is necessary to determine the precise localization of the lesion to be removed and of the adjacent cerebral areas that should be spared to avoid producing neurological damage.
The neuronavigator is very useful for the neurosurgeon, since it allows the accurate localization of the lesion to be removed, as well as the identification of the vital adjacent structures that should be spared. The procedure begins in the morning of surgery with the placement of 8 small electrodes at the level of the patient's forehead. Next, a fast sequence of resonance imaging is carried out to determine the relationship between the intracranial structures and such electrodes. Later on, general anaesthesia is given. Once the patient is asleep and placed in surgery position, the neuronavigator is informed of the patient's position in space by means of an infrared detection system. Thus, during the entire surgery the monitor of the neuronavigator will show the resonance image corresponding to the operation area. The advantages of this new technology are the performance of smaller approaches, with less postoperative complications and shorter hospitalisation time, the identification of tumorous limits, the correct localization of deep lesions and the performance of diverse measurements such as tumorous volumetry.
5. Academic Activities
- A. Papers presented at Congresses
- B. Publications
- C. Awards
A. Papers presented at Congresses
* National Congresses and Symposia
- Metástasis de ependimoma en glándula hipofisiaria. 12* Semana de Congreso del Sistema Nervioso Central. Mar del Plata, 22-25 de Mayo de 1995
- Neurinomas Trigeminales. XXXV Congreso Argentino de la Asociación Argentina de Neurocirugía. Paraná-Entre Ríos, 15-17 de agosto de 1998
- Lesión ósea intracraneana. Congreso de la Sociedad de Neurocirugía de la provincia de Buenos Aires. Neuropinamar 98. Pinamar, 4-6 de diciembre de 1998
- Evolución atípica de los Glioblastomas Multiformes. XXXV Congreso Argentino de la Asociación Argentina de Neurocirugía. Paraná-Entre Ríos, 15-17 de agosto de 1998
- Resonancia Magnética Funcional y Neuronavegación en Neurocirugía. Congreso de la Sociedad de Neurocirugía de la provincia de Buenos Aires. Neuropinamar 2000. Pinamar, 30 de noviembre al 2 de Diciembre de 2000
- Lesiones calcificadas intracraneanas. Congreso Argentino de Neurocirugía- Neuropinamar 2001. Pinamar, 5-8 de diciembre de 2001
- Meningiomas de fosa posterior. Congreso Argentino de Neurocirugía- Neuropinamar 2001. Pinamar, 5-8 de diciembre de 2001
- Absceso cerebral y fístula arterio-venosa pulmonar. Congreso Argentino de Neurocirugía- Neuropinamar 2001. Pinamar, 5-8 de diciembre de 2001
- Meduloblastomas del adulto. Congreso Argentino de Neurocirugía- Neuropinamar 2001. Pinamar, 5-8 de diciembre de 2001
* International Congresses and Symposia
- Uso profiláctico de Difenilhidantoína en procedimientos neuroquirúrgicos de pacientes no epilépticos. Existe alguna diferencia con relación al tiempo y vía de administración?. VI World Conference on Clinical Pharmacology and Therapeutics, Buenos Aires, 4-6 de agosto de 1996
- Multiple Bone Metastasis of Glioblastoma Multiforme. Third Congress of the European Association for Neuro-Oncology. Versailles-France, 13-16 de septiembre de 1998
- Osteoplastía por regeneración con hueso autólogo en los abordajes de fosa posterior. XXVIII Congreso Latinoamericano de Neurocirugía. XLI Congreso de la Sociedad Chilena de Neurocirugía. Santiago de Chile, 10-15 de Octubre de 1998
- Primary Brain Sarcoma. XXXI World Congress of the International College of Surgeons. Buenos Aires, 15-19 de Noviembre de 1998
- Cordotomía ántero-lateral en el tratamiento del dolor por cáncer. II Simposium Internacional de Neurocirugía Estereotáctica. I Simposium Internacional de Neurocirugía Funcional. Córdoba, 30-31 de marzo de 2000
- Infusión continua de Baclofén en el Tratamiento de la Espasticidad. XXIX Congreso Latinoamericano de Neurocirugía. Fortaleza-Brasil, 11-16 de junio de 2000
- Síndrome de Ollier y Condrosarcoma de la Base de Cráneo. XXIX Congreso Latinoamericano de Neurocirugía. Fortaleza-Brasil, 11-16 de junio de 2000
- Cavernomas Intracraneales. XXIX Congreso Latinoamericano de Neurocirugía. Fortaleza-Brasil, 11-16 de junio de 2000
- Metastasis of adenocarcinoma within a hemangioblastoma of the posterior fossa. III International Skull Base Congress. Foz do Iguassu- Brasil, 7-11 de noviembre de 2000
- Continuous Intrathecal Baclofen Infusion for Control of Severe Spasticity. World Society for Stereotactic and Functional Neurosurgery. 11-14 september 2001, Adelaide, Australia
- Use of Neuronavigation in Intracranial Surgery. 12th World Congress of Neurosurgery. 16-20 september 2001, Sydney, Australia
- Continuous Intrathecal Baclofen Infusion for Control of Severe Spasticity. 12th World Congress of Neurosurgery. 16-20 september 2001, Sydney, Australia
B. Publications
* National
- Linfoma T primario cerebral. Revista Argentina de Neurocirugía 12: 23-29; 1998
- Fístula arteriovenosa cortical cerebral. Revista Argentina de Neurocirugía 12 : 29-33; 1998
- Osteoplastía por Regeneración con Hueso Autólogo en los Abordajes de Fosa Posterior. Revista Argentina de Neurocirugía 12: 147-150, 1998
- Carcinomatosis Leptomeníngea. Archivos de Neurología, Neurocirugía y Neuropsiquiatría 4: 54-57, 2000
- Condrosarcoma de Base de Cráneo y enfermedad de Ollier. Neurocirugía Vol 52: 54-57, 2001
* International
- Use of Antiepileptic Drugs in Nontraumatic Neurosurgical Procedures. Is There Any Best Route and Time of Administration? Clinical Neuropharmacology 20: 438-441; 1997
Bone Metastases from Secondary Glioblastoma Multiforme. A Case Report. J Neuro-Oncology 52: 141-148, 2001
C. Awards
1- Premio "Julio Aranovich". Uso profiláctico de Epamín en procedimientos neuroquirúrgicos de pacientes no epilépticos. Existe alguna diferencia en el tiempo y vía de administración?. Congreso 12* Semana del Sistema Nervioso Central. Mar del Plata, 22-25 de Mayo de 1996
2- Premio "Dr. Tomás Insausti". Utilidad de la Electrocorticografía para Definir Área Epileptogénica en Pacientes Epilépticos Sometidos a Cirugía.
23* Congreso Argentino de Neurociencias. Mar del Plata, 5-7 de Junio de 1998
Mención Accésit. Lesión ósea intracraneana. Congreso de la Sociedad de Neurocirugía de la provincia de Buenos Aires. Pinamar, 4-6 de diciembre de 1998
6. Consultations
For consultations on neurosurgical pathology, contact:
Department of Adult Neurosurgery
FLENI Institute
Montañeses 2325 (1428)
Tel.: 011-5777- 3200
Extension 2701/ 2702
e-mail: acervio@fleni.org.ar
Medical Team:
Dr. Cervio Andrés (P)
Dr. Condomí Alcorta Santiago (P)
Dr. Diamante Vicente Guillermo (A)
Dr. Fernández Boan Osvaldo (A)
Dr. Marino Pablo (P)
Dr. Salaberry Juan Carlos (Chief)
Dr. Salvat Jorge Máximo (Professor and Consultant)
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