Novel neurosurgery performed in Holguín, Cuba hospital.

• July 24, 2020
• By Lourdes Pichs Rodríguez
• Hits: 1461
Нові нейрохірургії виконані в Гольгуїні, лікарні Куби

To perform the resection, the patient had to undergo a very wide craniotomy, which consists of removing a part of the skull to access the brain parenchyma where the lesion is observed.

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Realizan novedosa neurocirugía en hospital de Holguín

Hospital Clínico Quirúrgico Lucía Iñiguez Landín

Neurosurgery in Holguín is back in the news with the first resection of a glioma in the left temporal lobe with intraoperative neurophysiological monitoring (MIO) performed in eastern Cuba on a 48-year-old patient suffering from a lesion that is more aggressive to the system central nervous, who was operated on Friday 17 by a multidisciplinary team at the Lucía Íñiguez Landín hospital.(Haga click arriba)

 
The novel surgical procedure, based on the use of various techniques to remove the seven by seven centimeters malignant tumor, was performed on Erides Almarales, resident in the municipality of Báguanos, by young neurosurgeons, who had the assistance of the specialist in Clinical Neurophysiology and DrC Arquímedes Montoya and his work and technology team, from the Dr. Juan Bruno Zayas General Hospital, in Santiago de Cuba. (Click images to enlarge)

Monitoring allowed the tumor to be resected, knowing how to delimit between healthy and diseased tissue.


Regarding the operative act, Dr. Freddy Varona Fernández, main neurosurgeon, explained that after analyzing the peculiarities of the glioma, as well as size and location, it was decided to "jointly use the fluorescein protocol - a drug that pigments the most vascularized and damaged areas- with microscopic surgery and neurophysiological monitoring, which allows us to differentiate, through the brain's electrical pattern, the healthy tissue of the patient ”.

The also Head of the "Lucia" Neurosurgery Service specified that both in the preoperative period, started the day before surgery, and during the more than four hours of the intervention and in the postoperative period, they had the cooperation of Professor Montoya, who together He encouraged his team to guide the motor and sensory areas through neuromonitoring to avoid damaging them during the resection of the lesion.





Doctor Freddy Varona through the microscope accurately visualizes the lesion.


Both agreed that in this type of operation the coordinated and professional participation of all participants is decisive, and in which the role of anesthesiologists is essential. "We were suggested to use a total intravenous anesthesia (TIVA), to use multiple drugs with low doses, to prevent the patient from having an anesthetic block, in the cerebral cortex that did not allow its registration, therefore we all had to work in unison , using very low doses of medication, so as not to block the cerebral cortex and in this way allow the neurophysiologist to do the examination and this, in turn, would guide us as to what areas of surgery we might be working on. "
For his part, Dr. José Miguel Pastor Rojas, another of the acting neurosurgeons, specified that "this elective major surgery was very well planned jointly between our team and that of Professor Santiago, to agree to introduce a novel treatment here, just done up to now in the International Center for Neurological Restoration (Ciren), in Havana, since other similar ones, but in the spinal column, have been carried out in the province of Santiago de Cuba and in the Octavio de la Concepción de la Pedraja pediatric hospital, from Holguín.

Neurosurgeons Freddy and José Miguel, on the left and right, respectively, explain how they performed the surgical act.
 

The patient evolves well one week after his operation, he only maintains motor aphasia (difficulty in emitting the words), which can improve in the course of the days; understands everything that is said to him, follows the orders that the specialists give him and recovers in the Neurosurgery Room, after his stay in the Intensive Care Unit.
The Team Leader acknowledged that “this coordinated action made it easier for the patient's electrical pattern to remain stable, which, when compared to that performed in the postoperative period, showed the same behavior, that is, the invasive action did not cause any new injury to that already established by the tumor. "

Dr. Freddy Varona interacts with the patient to assess his postoperative status. Photos: Carlos Rafael and Courtesy of Doctors Freddy and José Miguel


For the Lucía Íñiguez clinical surgical hospital and, especially, for the medical team that is the protagonist of this event, also made up of neurosurgeon Klaudia García, from the pediatric Octavio de la Concepción de la Pedraja; the anesthesiologist Sandra Chía Martínez, nursing staff and other professionals, materializing this risky procedure constitutes a very high satisfaction, achieved in times of great pressure due to the effects of the economic, commercial and financial blockade of the United States against the country and of great tension in post-COVID-19 times.

Dr. Varona pointed out that tumor surgeries in the central nervous system, in general, are expensive, and if these complex techniques are added to them, they exceed 100 thousand or 120 thousand dollars, but in Cuba for all nationals the treatment Surgical, such as medicated and hospitalization are free, without distinction.