Dr. Leonardo Rangel Castilla

Dr. Leonardo Rangel Castilla Neurocirujano con subespecialidades en el área cerebrovascular, endovascular, tumores, y columna. C

SKULL BASE TUMORS A MOST READ OVERVIEW OF MOST COMPLEX VBRAIN TUMORS Link for Free: https://www.sciencedirect.com/topics...
29/03/2026

SKULL BASE TUMORS

A MOST READ

OVERVIEW OF MOST COMPLEX V
BRAIN TUMORS

Link for Free: https://www.sciencedirect.com/topics/medicine-and-dentistry/skull-base-tumor

Aim
To present a review of the contemporary surgical management of skull base tumors.

Background
Over the last two decades, the treatment of skull base tumors has evolved from observation, to partial resection combined with other therapy modalities, to gross total resection and no adjuvant treatment with good surgical results and excellent clinical outcomes.

Materials and methods
The literature review of current surgical strategies and management of skull base tumors was performed and complemented with the experience of Barrow Neurological Institute.

Results
Skull base tumors include meningiomas, pituitary tumors, sellar/parasellar tumors, vestibular and trigeminal schwannomas, esthesioneuroblastomas, chordomas, chondrosarcomas, and metastases. Surgical approaches include the modified orbitozygomatic, pterional, middle fossa, retrosigmoid, far lateral craniotomy, midline suboccipital craniotomy, and a combination of these approaches. The selection of an appropriate surgical approach depends on the characteristics of the patient and the tumor, as well as the experience of the neurosurgeon.

Conclusion
Modern microsurgical techniques, diagnostic imaging, intraoperative neuronavigation, and endoscopic technology have remarkably changed the concept of skull base surgery. These refinements have extended the boundaries of tumor resection with minimal morbidity.

28/03/2026

VENOUS INFARCTION 🪢
HEMORRHAGIC STROKE 🧠

The majority of brain bleed (hemorrhage) comes from arterial side, rarely the origin is a vein. And when it does, it has a progressive course starting with headaches, altered mental status and a major neurological deficit, it is a true emergency, and the underlying cause is venous hypertension from thrombus formation in the venous sinuses, patients have a hypercoagulable state.

This is a 75-year-old female with progressive headaches, blurry vision, that progressed over two weeks to a hemorrhage. The patient was taken for emergent decompressive craniotomy to save her live.

Once the patient was stable, a cerebral angiogram was done, observing acute thrombus formation within both transverse sinuses. Direct aspiration of blood cloths was done “cleaning the pipes” to establish venous blood flow. Patient was anticoagulated and had a slow positive recovery.


🌐 San Luis Potosí, México
📧 lrcastilla@hotmail.com
☎️ Office 4444 23 31 01

MEDICAL ILLUSTRATIONS📕 📚 🎨 Medical illustrations are far more important than they might seem at first—they’re a core par...
26/03/2026

MEDICAL ILLUSTRATIONS
📕 📚 🎨

Medical illustrations are far more important than they might seem at first—they’re a core part of how medicine is taught, understood, and practiced.

The human body is incredibly complicated. Medical illustrations break down structures like organs, nerves, and blood vessels into clear, visual representations that are easier to understand than text alone.

In fields like Anatomy and Physiology, visuals help students remember details more effectively. Seeing a labeled diagram often sticks better than reading a description.

Doctors use illustrations to explain conditions and procedures to patients. For example, showing a diagram of a brain 🧠 aneurysm can help a patient better understand what’s happening in their body and why treatment is needed.

Illustrations help healthcare professionals visualize normal vs. abnormal structures. This is especially useful when studying diseases like Cancer, Cardiovascular disease, Neurological disease.

They are essential in surgical planning
Surgeons often rely on detailed visual guides to prepare for procedures. Illustrations can highlight key structures, risks, and steps before entering the operating room.

They bridge language barriers
Visuals can communicate ideas across different languages and literacy levels, making healthcare more accessible worldwide.

They are used in research and publications
Scientific papers often include illustrations to clearly present findings, especially when describing new techniques or discoveries.

STAY TUNED‼️‼️

NEUROCARDIOLOGY (Oxford Ed) Book coming soon ‼️

VIDEO ATLAS OF PEDIATRIC NEUROENDOVASCULAR (Thieme Ed) Book coming soon ‼️

VENOUS INFARCTION HEMORRHAGIC STROKE The majority of brain bleed (hemorrhage) comes from arterial side, rarely the origi...
19/03/2026

VENOUS INFARCTION

HEMORRHAGIC STROKE

The majority of brain bleed (hemorrhage) comes from arterial side, rarely the origin is a vein. And when it does, it has a progressive course starting with headaches, altered mental status and a major neurological deficit, it is a true emergency, and the underlying cause is venous hypertension from thrombus formation in the venous sinuses, patients have a hypercoagulable state.

This is a 75-year-old female with progressive headaches, blurry vision, that progressed over two weeks to a hemorrhage. The patient was taken for emergent decompressive craniotomy to save her live.

Once the patient was stable, a cerebral angiogram was done, observing acute thrombus formation within both transverse sinuses. Direct aspiration of blood cloths was done “cleaning the pipes” to establish venous blood flow. Patient was anticoagulated and had a slow positive recovery.

1. CT scan showing removal of skull to save patients life. Done by Dr Cristobal Vallejo .cristobalvallejo
2. Surgery showing hemorrhage during life-saving procedure. Done by Dr Cristobal Vallejo .cristobalvallejo
3. Angiography showing thrombus (blood clot) within both transverse sinuses
4. Angiography showing thrombus (blood clot) within both transverse sinuses
5. Angiography showing collaterals finding new route for drainage
6. Catheters in the cerebral sinuses and veins removing thrombus
7. Catheters in the cerebral sinuses and veins removing thrombus
8. Catheters in the cerebral sinuses and veins removing thrombus
9. Multiple thrombus

17/03/2026

An intrathecal baclofen (ITB) pump is a surgically implanted device that delivers baclofen directly into the spinal fluid to treat severe spasticity, reducing muscle stiffness with fewer side effects than oral medication. It is used for chronic spasticity from conditions like cerebral palsy, multiple sclerosis, or spinal cord injuries.

Una bomba de baclofeno intratecal (terapia ITB) es un dispositivo implantable que suministra baclofeno directamente al líquido cefalorraquídeo para tratar la espasticidad grave de origen cerebral o medular. Reduce la rigidez muscular y mejora la funcionalidad con menos efectos secundarios que la vía oral, siendo ideal para pacientes que no toleran fármacos orales.



www.drleonardorangel.com

🌐 San Luis Potosí, México
📧 lrcastilla@hotmail.com
☎️ Office 4444 23 31 01

10/03/2026

Another case of Glioblalstoma, a malignat tumor of the Brain. Gross total resection resection prior to chemotherapy and radiotherapy. Patient on his 70s with rapidly progressive dementia-like symptoms.

Dr. Leonardo Rangel Castilla
Neurosurgeon | Cerebrovascular | Endovascular

🏥 Hospital Lomas de San Luis, Consultorio 108
📍San Luis Potosí S.L.P.
📲 444 323 3101

TopMedicoMx

BRAIN 🧠 ANEURYSMMINIMALLY INVASIVE ENDOVASCULAR SURGERYPATIENT AWAKE1 HOUR SURGERY LESS THAN 24 HOURS IN THE HOSPITAL  O...
04/03/2026

BRAIN 🧠 ANEURYSM

MINIMALLY INVASIVE ENDOVASCULAR SURGERY

PATIENT AWAKE

1 HOUR SURGERY

LESS THAN 24 HOURS IN THE HOSPITAL

OUTPATIENT PROCEDURE

Ophthalmic Artery Aneurysm

Young 35 year-old gentleman who was found to have a brain aneurysm in a MRI obtained for headache work-up. After discussing pros and cons patient decided to have it treated.

Under conscious sedation, patient awake, through an endovascular approach, right femoral artery accces, a flow diverter (SILK PLUS) was placed along the segment of the carotid artery with the aneurysm.

1. 3D view of the OPHTHALMIC aneurysm of the carotid artery
2. Lateral view of the aneurysm
3. Delivering micro catheter
4. Flow diverter stent placement
5. Flow diverter stent placement
6. Flow diverter stent placed

NICK HOPKINS WINTER SYMPOSIUM🧠 ⛷️ 🎿 🏔️  🥃 Once again, another Jackson Hole meeting full of great lectures, beautiful Mou...
01/03/2026

NICK HOPKINS WINTER SYMPOSIUM

🧠 ⛷️ 🎿 🏔️ 🥃

Once again, another Jackson Hole meeting full of great lectures, beautiful Mountain Views, and exciting ski. Delight to see mentors and friends from residency and fellowships, feel the great camaraderie that has built over the years. This type of small meetings is where small ideas turn into great projects.

1. Camaraderie at its best
2. Robert Spetzler
3. Michael Lawton
4. Adnan Siddiqui
5. Gavin Britz
6. Amir Dehdashti
7. Talking about Pediatric Brain Aneurysm
8. Talking outflow diversion
9. Program
10. Program
11. Spetzer talk on Prof Yasargil
12. Lawton talk on spinal AVMs
13. Ski
14. Ski
15. At Dan Barrows house
16. Snowmobile
17. Snowmobile
18. Jackson Hole
19. Rams 🐏
20. Black Fox 🦊

CHRONIC SUBDURAL HEMATOMATREATED WITH MIDDLE MENINGEAL EMBOLIZATION More and more Neurological diseases are now treated ...
24/02/2026

CHRONIC SUBDURAL HEMATOMA
TREATED WITH MIDDLE MENINGEAL EMBOLIZATION

More and more Neurological diseases are now treated with endovascular techniques (catheter through a groin puncture)

Regularly Chronic Subdural hematomas have been treated with burrhole or craniotomy and drainage. The hypothesis is that Chronic subdural hematomas form a neovascular membrane. This membrane feeds the hematoma continously. By embolizing the middle Meningeal artery the neovascular membrane no longer feeds the hematoma and it eventually disappears.
These patients are typically older and fragile individuals and open brain surgery may bring secondary complications therefore an endovascular alternative is ideal.

1. Right external carotid artery injection demonstrating meningeal artery branches and Neovascular formation, lateral view
2. Right chronic subdural hematoma on an older patient with mild headache. Patient has minimal symptoms because she still can tolerate the hematoma, sooner or later she will not.
3. Right external carotid artery injection demonstrating meningeal artery branches and Neovascular formation, AP view
4. Embolic cast
5. Embolic cast
6. Embolic cast
7. Right external carotid artery injection demonstrating occlusion of the meningeal artery and no more blood supply, lateral view
8. Right external carotid artery injection demonstrating occlusion of the meningeal artery and no more blood supply, AP view

RARE DISEASE ‼️‼️CEREBRAL PROLIFERATIVE ANGIOPATHY LESS THAN 100 cases reported in the ENTIRE WORLD ‼️Cerebral prolifera...
22/02/2026

RARE DISEASE ‼️‼️

CEREBRAL PROLIFERATIVE ANGIOPATHY

LESS THAN 100 cases reported in the ENTIRE WORLD ‼️

Cerebral proliferative angiopathy (CPA) is a rare, distinct vascular malformation characterized by a diffuse network of abnormal blood vessels (nidus) that are intermingled with normal, functioning brain parenchyma. Often found in children and young adults, CPA typically presents with epilepsy, headache, or ischemic deficits, largely driven by chronic ischemia and angiogenesis, rather than hemorrhage. 

Key Aspects of Proliferative Angiopathy
* Distinct Pathophysiology: Unlike classic arterio-venous malformations (AVMs) which have a well-defined nidus, CPA is considered a disease of disorganized angiogenesis (new vessel growth) triggered by chronic perinidal ischemia.
* Imaging Features: Angiography shows a diffuse, “cloud-like” vascular blush, lack of a single dominant feeding artery, transdural (meningeal) blood supply, and significant cortical venous drainage.
* Clinical Presentation: Patients often present with intractable seizures, chronic progressive headaches, or stroke-like deficits. Hemorrhage is less common than in traditional AVMs.
* Prognosis: The condition is often progressive, but in many cases, it can remain stable with supportive care. 

This 45 year old male patient presented with progressive right side inferior quadrantonopsia, therefore treatment is mandatory. We will consider indirect bypass (revascularization).

1. MRA diffuse vascular angiogenesis
2. AP Angiography left ICA diffuse vascular lesions classic of CPA
3. Lateral Angiography left ICA diffuse vascular lesions classic of CPA
4. AP Angiography left vertebral diffuse vascular lesions classic of CPA
5. Lateral Angiography left vertebral diffuse vascular lesions classic of CPA
6. AP Angiography right ICA diffuse vascular lesions classic of CPA
7. MRI with enhancing diffuse pattern
8. Cerebral blood flow severely diminished at the left occipital region explaining patients visual symptoms

LARGE ARTERIOVENOUS MALFORMATION 🧠An arteriovenous malformation, a tangle of blood vessels that creates irregular connec...
21/02/2026

LARGE ARTERIOVENOUS MALFORMATION
🧠

An arteriovenous malformation, a tangle of blood vessels that creates irregular connections between arteries and veins that can weaken and burst. If an AVM in the brain bursts, it can cause bleeding in the brain, which can lead to a stroke or brain damage.
We present a 60 year old with a ruptured AVM of the left occipital lobe and ventricle, the AVM was originally diagnosed when she was 23 and was told to do nothing because “AVM RARELY BLEED”,. All these years she had constant debilitating headaches (probably microbleeds).

The AVM had arterial supply from branches of the PCA. She underwent endoscopic surgery vacation of the hemorrhage and ENDOVASCULAR EMBOLIZATION with almost complete obliteration. Planning on surgical resection of the AVM in the next following weeks.

AVM EMBOLIZATION ❤️‼️

1. Lateral angiography AVM
2. AP angiography AVMS
3. Occipital artery (external carotid ) feeding the AVM
4. Embolization
5. Embolization
6. Embolization
7. Embolization
8. Almost near complete Embolization
9. Almost near complete Embolization
10. CT scan with large IV hemorrhage
11. CT scan after endoscopic evacuation by .cristobalvallejo

embolizarion arteriovenousmalformation

Dirección

Hospital Lomas De San Luis, Avenida Palmira 600 Consultorio 108
San Luis Potosí
78250

Notificaciones

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