RESUMEN
Focal adhesion kinase (FAK) is a key signaling molecule regulating cell adhesion, migration, and survival. FAK localizes into focal adhesion complexes formed at the cytoplasmic side of cell attachment to the ECM and is activated after force generation via actomyosin fibers attached to this complex. The mechanism of translating mechanical force into a biochemical signal is not understood, and it is not clear whether FAK is activated directly by force or downstream to the force signal. We use experimental and computational single-molecule force spectroscopy to probe the mechanical properties of FAK and examine whether force can trigger activation by inducing conformational changes in FAK. By comparison with an open and active mutant of FAK, we are able to assign mechanoactivation to an initial rupture event in the low-force range. This activation event occurs before FAK unfolding at forces within the native range in focal adhesions. We are also able to assign all subsequent peaks in the force landscape to partial unfolding of FAK modules. We show that binding of ATP stabilizes the kinase domain, thereby altering the unfolding hierarchy. Using all-atom molecular dynamics simulations, we identify intermediates along the unfolding pathway, which provide buffering to allow extension of FAK in focal adhesions without compromising functionality. Our findings strongly support that forces in focal adhesions applied to FAK via known interactions can induce conformational changes, which in turn, trigger focal adhesion signaling.
Asunto(s)
Adenosina Trifosfato/química , Proteínas Aviares/química , Proteína-Tirosina Quinasas de Adhesión Focal/química , Simulación de Dinámica Molecular , Desplegamiento Proteico , Adenosina Trifosfato/metabolismo , Animales , Proteínas Aviares/genética , Proteínas Aviares/metabolismo , Pollos , Activación Enzimática , Proteína-Tirosina Quinasas de Adhesión Focal/genética , Proteína-Tirosina Quinasas de Adhesión Focal/metabolismo , Adhesiones Focales/enzimología , Adhesiones Focales/genética , Mecanotransducción Celular/genética , Dominios Proteicos , Relación Estructura-ActividadRESUMEN
BACKGROUND AND PURPOSE: The purpose of this study was to assess nationwide incidence and outcomes of aneurysmal subarachnoid hemorrhage (aSAH). The Swiss SOS (Swiss Study on Subarachnoid Hemorrhage) was established in 2008 and offers the unique opportunity to provide this data from the point of care on a nationwide level. METHODS: All patients with confirmed aneurysmal subarachnoid hemorrhage admitted between January 1, 2009 and December 31, 2014, within Switzerland were recorded in a prospective registry. Incidence rates were calculated based on time-matched population data. Admission parameters and outcomes at discharge and at 1 year were recorded. RESULTS: We recorded data of 1787 consecutive patients. The incidence of aneurysmal subarachnoid hemorrhage in Switzerland was 3.7 per 100 000 persons/y. The number of female patients was 1170 (65.5%). With a follow-up rate of 91.3% at 1 year, 1042 patients (58.8%) led an independent life according to the modified Rankin Scale (0-2). About 1 in 10 patients survived in a dependent state (modified Rankin Scale, 3-5; n=185; 10.4%). Case fatality was 20.1% (n=356) at discharge and 22.1% (n=391) after 1 year. CONCLUSIONS: The current incidence of aneurysmal subarachnoid hemorrhage in Switzerland is lower than expected and an indication of a global trend toward decreasing admissions for ruptured intracranial aneurysms. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03245866.
Asunto(s)
Hemorragia Subaracnoidea/epidemiología , Hemorragia Subaracnoidea/terapia , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Roto/epidemiología , Aneurisma Roto/mortalidad , Aneurisma Roto/terapia , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Vida Independiente , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores Sexuales , Hemorragia Subaracnoidea/mortalidad , Análisis de Supervivencia , Suiza/epidemiología , Resultado del TratamientoRESUMEN
Echo chambers and opinion polarization recently quantified in several sociopolitical contexts and across different social media raise concerns on their potential impact on the spread of misinformation and on the openness of debates. Despite increasing efforts, the dynamics leading to the emergence of these phenomena remain unclear. We propose a model that introduces the dynamics of radicalization as a reinforcing mechanism driving the evolution to extreme opinions from moderate initial conditions. Inspired by empirical findings on social interaction dynamics, we consider agents characterized by heterogeneous activities and homophily. We show that the transition between a global consensus and emerging radicalized states is mostly governed by social influence and by the controversialness of the topic discussed. Compared with empirical data of polarized debates on Twitter, the model qualitatively reproduces the observed relation between users' engagement and opinions, as well as opinion segregation in the interaction network. Our findings shed light on the mechanisms that may lie at the core of the emergence of echo chambers and polarization in social media.
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Comunicación , Difusión de la Información , Modelos Teóricos , Red Social , HumanosRESUMEN
The subtemporal approach provides a narrow operative corridor to the crus cerebrum and adjacent structures of the crural, interpeduncular, and ambient cistern. Addition of a zygomatic osteotomy widens this narrow corridor and spares retraction of the temporal lobe. We investigate and compare the morphometric parameters of the subtemporal approach with versus without zygomatic osteotomy. On each side of four cadaveric heads, a temporal craniotomy was performed to gain access to the crus cerebrum and adjacent subarachnoid cisterns using a subtemporal approach. Operative corridor width and corridor working angle were measured with and without brain retraction on each specimen side. Next, a zygomatic osteotomy was performed followed by full downward reflection of the temporalis muscle and further drilling of the squamous part of the temporal bone. Lastly, operative corridor width and corridor working angle were measured again for comparison. The subtemporal operating corridor was (mean/SD): 5.8/2.6 mm without retraction, 11.4/4.3 mm with retraction, and 13.5/6.5° working angle. After addition of a zygomatic osteotomy, the operative corridor was 8/9.2/4.3 mm without retraction, 14.7/4.5 mm with retraction, 31.8/3.1° working angle. Zygomatic osteotomy significantly increased the operative corridor working angle of the subtemporal approach. Furthermore, we demonstrate a direct approach into the interpeduncular fossa. Clin. Anat. 32:710-714, 2019. © 2019 Wiley Periodicals, Inc.
Asunto(s)
Mesencéfalo/anatomía & histología , Cigoma/anatomía & histología , Cadáver , Craneotomía/métodos , Humanos , Mesencéfalo/cirugía , Procedimientos Neuroquirúrgicos/métodos , Osteotomía/métodos , Lóbulo Temporal/anatomía & histología , Lóbulo Temporal/cirugía , Cigoma/cirugíaRESUMEN
The spiking activity of single neurons can be well described by a nonlinear integrate-and-fire model that includes somatic adaptation. When exposed to fluctuating inputs sparsely coupled populations of these model neurons exhibit stochastic collective dynamics that can be effectively characterized using the Fokker-Planck equation. This approach, however, leads to a model with an infinite-dimensional state space and non-standard boundary conditions. Here we derive from that description four simple models for the spike rate dynamics in terms of low-dimensional ordinary differential equations using two different reduction techniques: one uses the spectral decomposition of the Fokker-Planck operator, the other is based on a cascade of two linear filters and a nonlinearity, which are determined from the Fokker-Planck equation and semi-analytically approximated. We evaluate the reduced models for a wide range of biologically plausible input statistics and find that both approximation approaches lead to spike rate models that accurately reproduce the spiking behavior of the underlying adaptive integrate-and-fire population. Particularly the cascade-based models are overall most accurate and robust, especially in the sensitive region of rapidly changing input. For the mean-driven regime, when input fluctuations are not too strong and fast, however, the best performing model is based on the spectral decomposition. The low-dimensional models also well reproduce stable oscillatory spike rate dynamics that are generated either by recurrent synaptic excitation and neuronal adaptation or through delayed inhibitory synaptic feedback. The computational demands of the reduced models are very low but the implementation complexity differs between the different model variants. Therefore we have made available implementations that allow to numerically integrate the low-dimensional spike rate models as well as the Fokker-Planck partial differential equation in efficient ways for arbitrary model parametrizations as open source software. The derived spike rate descriptions retain a direct link to the properties of single neurons, allow for convenient mathematical analyses of network states, and are well suited for application in neural mass/mean-field based brain network models.
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Potenciales de Acción/fisiología , Modelos Neurológicos , Red Nerviosa/fisiología , Plasticidad Neuronal/fisiología , Neuronas/fisiología , Transmisión Sináptica/fisiología , Adaptación Fisiológica/fisiología , Animales , Simulación por Computador , Humanos , Modelos Estadísticos , Dinámicas no LinealesRESUMEN
Increased thermal or mechanical stability of DNA duplexes is desired for many applications in nanotechnology or -medicine where DNA is used as a programmable building block. Modifications of pyrimidine bases are known to enhance thermal stability and have the advantage of standard base-pairing and easy integration during chemical DNA synthesis. Through single-molecule force spectroscopy experiments with atomic force microscopy and the molecular force assay we investigated the effect of pyrimidines harboring C-5 propynyl modifications on the mechanical stability of double-stranded DNA. Utilizing these complementary techniques, we show that propynyl bases significantly increase the mechanical stability if the DNA is annealed at high temperature. In contrast, modified DNA complexes formed at room temperature and short incubation times display the same stability as non-modified DNA duplexes.
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ADN/química , Pirimidinas/química , Secuencia de Bases , ADN/síntesis química , Microscopía de Fuerza Atómica , Datos de Secuencia Molecular , TemperaturaRESUMEN
While nanophotonic devices are unfolding their potential for single-molecule fluorescence studies, metallic quenching and steric hindrance, occurring within these structures, raise the desire for site-specific immobilization of the molecule of interest. Here, we refine the single-molecule cut-and-paste technique by optical superresolution routines to immobilize single fluorescent molecules in the center of nanoapertures. By comparing their fluorescence lifetime and intensity to stochastically immobilized fluorophores, we characterize the electrodynamic environment in these nanoapertures and proof the nanometer precision of our loading method.
RESUMEN
It is widely believed that diversity arising from different skills enhances the performance of teams, and in particular, their ability to learn and innovate. However, diversity has also been associated with negative effects on the communication and coordination within collectives. Yet, despite the importance of diversity as a concept, we still lack a mechanistic understanding of how its impact is shaped by the underlying social network. To fill this gap, we model skill diversity within a simple model of collective learning and show that its effect on collective performance differs depending on the complexity of the task and the network density. In particular, we find that diversity consistently impairs performance in simple tasks. In contrast, in complex tasks, link density modifies the effect of diversity: while homogeneous populations outperform diverse ones in sparse networks, the opposite is true in dense networks, where diversity boosts collective performance. Our findings also provide insight on how to forge teams in an increasingly interconnected world: the more we are connected, the more we can benefit from diversity to solve complex problems.
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Comunicación , AprendizajeRESUMEN
The ability of humans to create and disseminate culture is often credited as the single most important factor of our success as a species. In this Perspective, we explore the notion of 'machine culture', culture mediated or generated by machines. We argue that intelligent machines simultaneously transform the cultural evolutionary processes of variation, transmission and selection. Recommender algorithms are altering social learning dynamics. Chatbots are forming a new mode of cultural transmission, serving as cultural models. Furthermore, intelligent machines are evolving as contributors in generating cultural traits-from game strategies and visual art to scientific results. We provide a conceptual framework for studying the present and anticipated future impact of machines on cultural evolution, and present a research agenda for the study of machine culture.
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Evolución Cultural , Hominidae , Humanos , Animales , Cultura , AprendizajeRESUMEN
Intensity fluctuations between an ON-state and an OFF-state, also called blinking, are common to all luminescent objects when studied at the level of individuals. We studied blinking of three dyes from a homologous series (Cy3, Cy5, Cy7). The underlying radical anion states were induced by removing oxidants (i.e. oxygen) and by adding the reductant ascorbic acid. We find that for different conditions with distinct levels of oxidants in solution the OFF-state lifetime always increases in the order Cy3Asunto(s)
Carbocianinas/química
, Oxidación-Reducción
, Oxígeno/química
, Espectrometría de Fluorescencia
, Temperatura
RESUMEN
Giant pituitary adenomas (GPAs), defined as >/=40 mm in one extension, present a challenging subgroup of pituitary adenomas in terms of radical tumor removal and complication rates. The potential impact of intraoperative magnetic resonance imaging (iMRI) is investigated in a consecutive series and the results compared to the literature. From November 2004 until February 2005, six (five male) patients were operated for GPAs via an iMRI-guided transsphenoidal approach in the PoleStar N20. Clinical, endocrinological, and neuroradiological outcomes (at 3 months and yearly postoperative over 4 years) were assessed. Mean age was 46 years (range, 34-60). All patients presented with preoperative visual field defects, five with pituitary failure. Five adenomas were clinically nonfunctioning, one was producing GH and TSH. Preoperative imaging showed invasion of the cavernous sinus in all and extension to the interventricular foramen in two patients (one with occlusive hydrocephalus). Resection was total in four and subtotal (small cavernous sinus remnants) in two patients, leading to transsphenoidal reoperation in one patient. Visual acuity and fields improved in all six patients. The patient with occlusive hydrocephalus developed a postoperative cerebrospinal fluid leak (subsequently revised), two patients developed temporary, one permanent central diabetes insipidus, and one of them transient hyponatremia. Compared to the preoperative situation, endocrine status in the long-term follow-up (mean, 25 months) remained unchanged in four and worsened in two. Two patients were considered not to require hormone replacement therapy. IMRI supports transsphenoidal resections of GPAs because residual adenoma and related risk structures are easily detected and localized intraoperatively, extending the restricted visual access of the microscope beyond mere surface anatomy to a three-dimensional view. More radical removal of adenomas in a single surgical session combined with low complication rates are accomplished. This may add to a favorable clinical and endocrinological outcome in GPAs.
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Adenoma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Hipofisarias/cirugía , Hueso Esfenoides/cirugía , Cirugía Asistida por Computador/métodos , Adenoma/patología , Adulto , Enfermedades del Sistema Endocrino/etiología , Oftalmopatías/etiología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Neoplasias Hipofisarias/patología , Complicaciones Posoperatorias/epidemiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Consensus algorithms on networks have received increasing attention in recent years for various applications, ranging from distributed decision making to multivehicle coordination. In particular, second-order consensus models take into account the Newtonian dynamics of interacting physical agents. For this model class, we uncover a mechanism inhibiting the formation of collective consensus states via rather small time-periodic coupling modulations. We treat the model in its spectral decomposition and find analytically that, for certain intermediate coupling frequencies, parametric resonance is induced on a network level-at odds with the expected emergence of consensus for very short and long coupling time scales. Our formalism precisely predicts those resonance frequencies and links them to the Laplacian spectrum of the static backbone network. The excitation of the system is furthermore quantified within the theory of parametric resonance, which we extend to the domain of networks with time-periodic couplings.
RESUMEN
PURPOSE: Atlantoxial fusion with screw rod constructs traditionally requires subperiostal dissection of the C1/C2 muscle attachments, which may lead to postoperative axial neck pain and intraoperative blood loss. We evaluate a potentially less invasive, muscle splitting approach for atlantoaxial fusion in a cadaver model. METHODS: A technical feasibility study was performed in a human cadaveric specimen with standard surgical instruments and an operating microscope. Surgically relevant anatomical structures as well as final exposure of the C1, C1/C2 and C2 screw entry points are demonstrated. RESULTS: Following a midline skin incision, blunt mobilization and downward retraction of the trapezius and splenius capitis muscle is followed by a longitudinal split of the semispinalis capitis muscle. At the lower border of the rectus capitis posterior major and the obliquus capitis inferior muscle the entry points for C1 lateral mass, C1/C2 transarticular and C2 pedicle screw are exposed. CONCLUSION: Minimal invasive splitting of the semispinalis capitis muscle allows adequate exposure of the screw entry points of C1, C1/C2 and C2 while preserving the intrinsic muscles of the back at the craniocervical junction.
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Vértebra Cervical Axis/cirugía , Atlas Cervical/cirugía , Disección/métodos , Músculos Paraespinales/cirugía , Fusión Vertebral/métodos , Cadáver , Vértebras Cervicales , Estudios de Factibilidad , Humanos , Masculino , Tornillos PedicularesRESUMEN
STUDY DESIGN: A laboratory cadaveric study. OBJECTIVE: We aimed to demonstrate the feasibility of a posterior oblique approach, sharing the same advantages as the transpsoas technique while minimizing the risk of lumbar plexus or psoas muscle injuries. SUMMARY OF BACKGROUND DATA: The transpsoas approach for interbody fusion and corpectomy offers advantages over posterior and anterior approaches. However, possible risks include traumatization of the psoas muscle or lumbar plexus. METHODS: All lumbar disk spaces and vertebral bodies were exposed by a posterior oblique approach from left and right on a human cadaveric specimen. The exposure obtained and a step-by-step documentation of the procedure is outlined in detail. RESULTS: We were able to achieve wide exposure of all lumbar disk spaces and vertebral bodies above the L5/S1 disk space. Only the psoas muscle was retracted, and the lumbar plexus nerves were easily visualized and gently retracted. Sharp dissection was only required around the tip of the transverse processes. CONCLUSIONS: A posterior oblique approach seems to be less invasive than the transpsoas approach. Exposure of the anterior column structures above the iliac crest is comparable. The oblique approach offers direct access to the lumbar plexus and the extraforaminal segments of the nerve roots.
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Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Plexo Lumbosacro/cirugía , Fusión Vertebral/métodos , Anciano , Cadáver , Estudios de Factibilidad , Femenino , HumanosRESUMEN
BACKGROUND: The combined anterior transpetrosal and subtemporal/transcavernous (atsta) approach to the petroclival junction provides a wide exposure facilitating resection of large tumor lesions such as petroclival mengiomas, chondrosarcomas, or chordomas. In this article we provide technical instructions on the approach with anatomical consideration and a literature review of previous applications of this approach. METHODS: The combined approach was performed in two cadaveric specimen and relevant anatomical aspects were studied. Additionally, the authors performed a review of the literature focusing on indications, neurologic outcome, and complications associated with the technique. RESULTS: A combined atsta approach offers a wide exposure of the crus cerebrum, pons, basal temporal lobe, cranial nerves III to VII/VIII, posterior cerebral artery (PCA), superior cerebellar artery (SCA), basilar artery (BA), anterior inferior cerebellar artery (AICA), and posterior communicating artery (Pcom). It has been successfully applied with acceptable morbidity and mortality rates, mainly for (spheno-) petroclival meningiomas. CONCLUSION: The combined approach studied here is a useful skull base approach to the petroclival junction and can be applied to treat large or complex pathologies of the region. Detailed anatomical knowledge is essential.
RESUMEN
OBJECTIVE: The cervical carotid segment is used routinely as donor site for high-flow bypass procedures. The horizontal petrous segment would offer a shorter graft distance, complete graft protection intracranially, and avoid the need for surgical neck exposure. In a morphometric cadaveric study, we aimed to investigate variations of the petrous carotid anatomy, especially the incidence of bony dehiscence of the roof of the horizontal petrous carotid segment canal, which may facilitate exposure of the vessel and thereby potentially lower the morbidity of high-flow bypass procedures. METHODS: A subtemporal approach was used to expose the horizontal petrous internal carotid artery (ICA) on each side of 4 alcohol-embedded, silicone-injected human cadaver heads to perform a morphometric analysis of the vessel segment and surrounding bony anatomy. RESULTS: The following measurements were obtained of the horizontal petrous ICA (millimeters): long axis mean 9.6 (standard deviation [SD] 4.4, MIN 4.2, MAX 19.5), diameter mean 4.9 (SD 0.6, MIN 4, MAX 5.7), thickness of canal roof mean 2.1 (SD 1.7, MIN 0, MAX 5), and distance from temporal squama mean 22.5 (SD 6, MIN 17, MAX 35). Dehiscence of the bony roof of the horizontal petrous carotid canal was found in 25% of specimen investigated. CONCLUSIONS: A dehiscent bony roof of the horizontal petrous carotid canal potentially facilitates exposure of the vessel for high-flow bypass procedures and was observed in 25% of specimens. This feature could be identified on preoperative high-resolution imaging and thus aid in patient selection.
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Arteria Carótida Interna/anatomía & histología , Arteria Carótida Interna/cirugía , Hueso Petroso/anatomía & histología , Hueso Petroso/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Cadáver , Arteria Carótida Interna/patología , Humanos , Hueso Petroso/patologíaRESUMEN
Mechanosensitive proteins are key players in cytoskeletal remodeling, muscle contraction, cell migration and differentiation processes. Smooth muscle myosin light chain kinase (smMLCK) is a member of a diverse group of serine/threonine kinases that feature cytoskeletal association. Its catalytic activity is triggered by a conformational change upon Ca2+/calmodulin (Ca2+/CaM) binding. Due to its significant homology with the force-activated titin kinase, smMLCK is suspected to be also regulatable by mechanical stress. In this study, a CaM-independent activation mechanism for smMLCK by mechanical release of the inhibitory elements is investigated via high throughput AFM single-molecule force spectroscopy. The characteristic pattern of transitions between different smMLCK states and their variations in the presence of different substrates and ligands are presented. Interaction between kinase domain and regulatory light chain (RLC) substrate is identified in the absence of CaM, indicating restored substrate-binding capability due to mechanically induced removal of the auto-inhibitory regulatory region.
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Quinasa de Cadena Ligera de Miosina/metabolismo , Fosforilación , Procesamiento Proteico-Postraduccional , Miosinas del Músculo Liso/metabolismo , Estrés Mecánico , Humanos , Microscopía de Fuerza Atómica , Imagen Individual de MoléculaRESUMEN
Strep-Tactin, an engineered form of streptavidin, binds avidly to the genetically encoded peptide Strep-tag II in a manner comparable to streptavidin binding to biotin. These interactions have been used in protein purification and detection applications. However, in single-molecule studies, for example using atomic force microscopy-based single-molecule force spectroscopy (AFM-SMFS), the tetravalency of these systems impedes the measurement of monodispersed data. Here, we introduce a monovalent form of Strep-Tactin that harbours a unique binding site for Strep-tag II and a single cysteine that allows Strep-Tactin to specifically attach to the atomic force microscope cantilever and form a consistent pulling geometry to obtain homogeneous rupture data. Using AFM-SMFS, the mechanical properties of the interaction between Strep-tag II and monovalent Strep-Tactin were characterized. Rupture forces comparable to biotin:streptavidin unbinding were observed. Using titin kinase and green fluorescent protein, we show that monovalent Strep-Tactin is generally applicable to protein unfolding experiments. We expect monovalent Strep-Tactin to be a reliable anchoring tool for a range of single-molecule studies.
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Técnicas Biosensibles/métodos , Microscopía de Fuerza Atómica/métodos , Oligopéptidos/química , Mapeo de Interacción de Proteínas/métodos , Estreptavidina/química , Sitios de Unión , Técnicas de Sonda Molecular , Unión Proteica , Ingeniería de Proteínas/métodos , Estreptavidina/genética , Estreptavidina/ultraestructuraRESUMEN
Since the atomic force microscope (AFM) has evolved into a general purpose platform for mechanical experiments at the nanoscale, the need for a simple and generally applicable localization of the AFM cantilever in the reference frame of an optical microscope has grown. Molecular manipulations like in single molecule cut and paste or force spectroscopy as well as tip mediated nanolithography are prominent examples for the broad variety of applications implemented to date. In contrast to the different kinds of superresolution microscopy where fluorescence is used to localize the emitter, we, here, employ the absorbance of the tip to localize its position in transmission microscopy. We show that in a low aperture illumination, the tip causes a significant reduction of the intensity in the image plane of the microscope objective when it is closer than a few hundred nm. By independently varying the z-position of the sample slide, we could verify that this diffraction limited image of the tip is not caused by a near field effect but is rather caused by the absorbance of the transmitted light in the low apex needle-like tip. We localized the centroid position of this tip image with a precision of better than 6 nm and used it in a feedback loop to position the tip into nano-apertures of 110 nm radius. Single-molecule force spectroscopy traces on the unfolding of individual green fluorescent proteins within the nano-apertures showed that their center positions were repeatedly approached with very high fidelity leaving the specific handle chemistry on the tip's surface unimpaired.
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Microscopía de Fuerza Atómica/instrumentación , Microscopía de Fuerza Atómica/métodos , Nanotecnología/instrumentación , Nanotecnología/métodos , Diseño de Equipo , Proteínas Fluorescentes Verdes/química , Microscopía Electroquímica de Rastreo , Desplegamiento ProteicoRESUMEN
Spinal dural arteriovenous fistulas are the most common type of spinal arteriovenous malformations. Treatment options consist of microsurgical exclusion and/or endovascular embolization. We retrospectively identified all patients who benefited from surgical treatment at our tertiary center between January 2001 and December 2008. Clinical and imaging data were collected from patient files, including pre- and post-operative formal neurological examination, complete spine MRI and spinal digital subtraction angiography. Of our 30 patients, 25 were men and five were women with a median age of 62 years (range 24-76). The average delay between symptom onset and clinical diagnosis was 27 months (range 1-90). Complete cure of the fistula was obtained in all patients in a single surgical session with no procedural complications and no surgical morbidity. After a mean follow-up period of 32 months (range 14-128), 25 patients (83%) had improved, four were stable and one worsened. Despite recent advances in endovascular techniques and materials, there is a subgroup of patients for which surgery remains the best treatment option. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications.