Dr. Leonardo Rangel Castilla

Casa
Mexico
San Luis Potosí
Dr. Leonardo Rangel Castilla

Neurocirujano con subespecialidades en el área cerebrovascular, endovascular, tumores, y columna. C

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

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

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

18/02/2026

MALIGNANT BRAIN TUMOR
GLIOBLASTOMA MULTIFORME (GBM)

GLIOBLASTOMA is the most malignant type of brain tumors, it occurs in older patients (55 years or older, however it has been seen in younger people), symptoms are related to the affected area of the brain including headaches, nausea, vomiting, visual symptoms, fatigue, seizures, weakness, lenguage problems, etc.
The diagnosis is confirmed with contrast MRI of the brain. A large ring enhancing mass with surrounding edema and mass effect.

Treatment is a combination of surgery (Gross total ressection ideally) follow by chemotherapy and radiotherapy. Life expectancy with no treatment is less than 6 months after diagnosis and up to several years with adequate surgery and good response to therapy. The very first surgery is crucial and it can make a big difference.

Novel alternatives if tumor recurrence:
* Radiosurgery
* Endovascular chemotherapy
* Endovascular radiotherapy
* Intrathecal chemotherapy (Ommaya reservoir)
* Second- line chemotherapy after molecular analysis

13/02/2026

EMBO FOR CURE 🧠

AVM EMBOLIZATION

An arteriovenous malformation, also known as an AVM, is a tangle of blood vessels that creates irregular connections between arteries and veins. Because the tangled blood vessels in an AVM do not form properly, they 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 23 year old with a ruptured AVM of the right temporal lobe, located at the lower part of the lobe causing an unusual subdural tentorial hemorrhage,. The AVM had arterial supply from branches of the MCA. After recovering from the hemorrhage. He underwent ENDOVASCULAR EMBOLIZATION with complete obliteration.

EMBO FOR CURE

AVM EMBOLIZATION ❤️‼️

1. 3D AVM reconstruction
2. CT scan showing blood along the tentorium
3. CT scan showing blood along the tentorium
4. CTA reconstruction showing AVM , feeders and draining vein.
5. Micro injection
6. Microcatheter in the AVM
7. Embolization
8. Liquid embolic in the AVM
9. and 10 angiography post Embolization, no AVM visible

12/02/2026

FACIAL HYPERVASCULAR LESION

This is a 13 year old boy who had growing vascular malformation of his left face (nose, cheek, lip) causing enlargement of nose and upper lip, he will have recurrent massive nosebleeds. He underwent 2 sessions of endovascular Embolization of large arterial feeders mostly from external carotid artery and ophthalmic artery. (Photos published with patients mother permission).

1. Patient at 8 years old
2. Patient at 11 years old
3. Patient of 13 years old
4. angiography of the carotid artery showing hypervascular lesion at the entire face
5. Partial Embolization through internal maxillary artery
6. Ophthalmic artery
7. Embolization of the distal portion of the ophthalmic feeding the malformation, CAREFUL protection of the central retina artery is a most to prevent blindness
8. Facial feeders
9. Complete obliteration
10. Embolic material

11/02/2026

Vascular malformation of the face.

Dr. Leonardo Rangel Castilla
Neurosurgeon | Cerebrovascular | Endovascular

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

TopMedicoMx

23/01/2026

Conocimiento, experiencia, y tecnología son lo que llevan a excelentes resultados.

World-class Neurosurgery in San Luis Potosí, México

ORIEN coming soon

20/01/2026

Este video no busca miedo: busca conciencia, atención y empatía. Compartimos este video con la autorización de los padres de Sofi.

Es la historia de Sofía, una niña de 11 años a la que le diagnosticaron un tumor cerebral (craneofaringioma).

Síntomas que parecían “normales”, señales que muchas veces se minimizan, y una realidad que cambia por completo cuando el diagnóstico llega.

Cada segundo de este video importa.
Cada reproducción ayuda a generar conciencia.
Cada compartido puede hacer que alguien actúe a tiempo.

❤️ Dale like para que llegue a más personas
💬 Deja un mensaje de apoyo
🔁 Compártelo: la información también salva vidas

Dirección

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

Página web

http://www.drleonardorangel.com/

Notificaciones

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