Dr. Leonardo Rangel Castilla

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

CEREBELLAR ARTERIOVENOUS MALFORMATIONEMBO FOR CURE 🧠⁉️An arteriovenous malformation, also known as an AVM, is a tangle o...
06/08/2025

CEREBELLAR ARTERIOVENOUS MALFORMATION

EMBO FOR CURE 🧠⁉️

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 cerebellum, located at the vermix, lower cerebellar hemisphere and tonsils. The AVM had arterial supply from both PICAs. After recovering from the hemorrhage. He underwent ENDOVASCULAR EMBOLIZATION with complete obliteration.

EMBO FOR CURE ❤️‼️

1. 3D AVM reconstruction
2. AP view angiography showing AVM
3. lateral view angiography showing AVM
4. Embolization
5. Embolization
6. AP view angiography post Embolization, no AVM visible
7. Lateral view angiography post Embolization, no AVM visible

GIANT FACIAL VASCULAR MALFORMATION Vascular malformations of the face are abnormal formations of blood vessels present ...
05/08/2025

GIANT FACIAL VASCULAR MALFORMATION

Vascular malformations of the face are abnormal formations of blood vessels present at birth. They can vary in type, from capillary (port wine stains) to venous, lymphatic, and arteriovenous malformations (AVMs). These malformations can be visible as birthmarks or swellings and may cause cosmetic concerns, pain, or functional problems.
This 12 year/old male presented with progressive pulsatile facial, nose and cheek red-wine lesion that grew over the years and had several bleeds. He emergently presented with massive uncontrolled nose bleeding. He was taking emergently for partial Embolization to stop bleeding and partial vascular malformation cure. The lesion is very large and needs further treatment. It has extended into the orbit and cerebral circulation (ophthalmic artery) is now contributing
1. Nose and upper lip hypertrophy and severe bleeding
2. Vascular malformation affecting the left face. Enlarged Lingual and sphenopalatine arteries
3. Ophthalmic artery contribution
4. Embolization
5. Embolization
6. Embolization
7. Embolization
8. Embolization
9. Control angiography. Still malformation alive that will require a second Embolization

Congreso Nacional de Cirugía Neurologica 2025Sociedad Mexicana de Cirugía NeurologicaIt was a true honor and pleasure to...
03/08/2025

Congreso Nacional de Cirugía Neurologica 2025

Sociedad Mexicana de Cirugía Neurologica

It was a true honor and pleasure to serve as vicepresident of the scientific committee of the XXVIII Mexican Congress of Neurological Surgeons in Guadalajara 🇲🇽. It was a terrific experience with hundrends of neurosurgeons participating and more than 60 international speakers 🇺🇸 🇧🇷 🇦🇷 🇧🇴 🇵🇪 🇨🇦 🇨🇱 🇮🇳 🇩🇴 🇮🇹 🇩🇪.

1. Plenary session talk
2. Live case - Embolization of PCom aneurysm with flow diversion, co-surgeon with Drs Gustavo Melo and Mario Flores
3. During surgery - broadcasting to hundreds of attendees
4. Dr Giuseppe Lanzino and Dr Fady Charbel
5. CV section talk
6. Moderating with Dr Edgar Nathal
7. Robert Starke
8. Marco Barajas
9. Jonathan Russin
10. Jaime Torres Corzo
11. Kenan Arnautovic
12. Peter Nakaji
13. Angela Downes
14. International dinner
15. Flavio Requejo
16. Eager students
17. International dinner
18. Vanessa Milanese
19. Giuseppe Lanzino
20. Closure

Today is a great day to think about your brain health.World Brain Day | July 22
22/07/2025

Today is a great day to think about your brain health.
World Brain Day | July 22

RECURRENT BRAIN 🧠 ANEURYSM 🎈FLOW DIVERSION STENT Although rare, aneurysm recurrence after endovascular treatment is poss...
22/07/2025

RECURRENT BRAIN 🧠 ANEURYSM 🎈
FLOW DIVERSION STENT

Although rare, aneurysm recurrence after endovascular treatment is possible. Surgery, more coiling or flow diversion stent are options for this scenario. This is a mid 50s woman with a posterior communicating artery aneurysm previously treated with stent-assisted coiling. Over a period of 2 years a residual neck has grown significantly. We decided to treat with a flow diversion stent.

1. AP angiography showing PComA aneurysm recurrence
2. 3D showing PComA aneurysm recurrence
3. Micro catheter with stent prior to delivery
4. and 5. Flow diversion stent delivered from MCA to cavernous ICA, covering the aneurysm

CHOROID PLEXUS TUMORChoroid plexus papilloma, also known as papilloma of the choroid plexus, is a rare benign neuroepith...
19/07/2025

CHOROID PLEXUS TUMOR

Choroid plexus papilloma, also known as papilloma of the choroid plexus, is a rare benign neuroepithelial intraventricular WHO grade I lesion found in the choroid plexus. It leads to increased cerebrospinal fluid production, thus causing increased intracranial pressure and hydrocephalus. The first treatment for choroid plexus tumors is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and remove as much tumor as possible without causing more symptoms.

This patient is a mid 70 gentleman who presented with ataxia, nystagmus and diplopia. He was found to have a very large interventricular tumor within the fourth ventricle with gadolinium enhancing consistent with a choroid plexus papilloma. Patient underwent suboccipital craniotomy and gross total resection.

BRAIN 🧠 ANEURYSM 🎈 Hypertension remains as one of the most common risk factors for brain aneurysm growth and rupture. Ao...
19/07/2025

BRAIN 🧠 ANEURYSM 🎈

Hypertension remains as one of the most common risk factors for brain aneurysm growth and rupture. Aortic coarctation (narrow aorta) should be suspected in any young patient with uncontrollable hypertension. Here we present a 30 year old woman with hypertension secondary to aortic coarctation and multiple cerebral aneurysms. she has a basilar tip and a anterior cerebral artery aneurysm.

Because the anatomy, size, and morphology the basilar artery aneurysm had a higher risk of rupture therefore we treated it first. It was a good candidate for a flow diverter stent. We used a transradial approach to access the posterior circulation directly.

1. 3D view of the basilar tip aneurysm
2. Observe the unusual basilar artery tortuosity in a young patient
3. Road map - with the flow divertion device before deployment
4. Deployment
5. Progressive deployment
6. Progressive deployment 2
7. Angiography after device deployment, notice early aneurysmal flow stasis
8. Device fully opened
9. Anterior cerebral artery aneurysm to be treated in a second time


LARGE AND COMPLEX WIDE NECK ANTERIOR COMMUNICATING ARTERY ANEURYSM“X” DOUBLE STENT-ASSISTED COILING WITH JAILING TECHNIQ...
12/07/2025

LARGE AND COMPLEX WIDE NECK ANTERIOR COMMUNICATING ARTERY ANEURYSM

“X” DOUBLE STENT-ASSISTED COILING WITH JAILING TECHNIQUE

Endovascular treatment of brain aneurysms is getting safer and more precise due to new technology. X double stent and coiling is a technique that allows treatment of wide neck aneurysms, in which preservation of 4 related arteries is imperative, the stents prevents coils from getting out of the aneurysm while maintaining all related arteries open and preventing artery occlusion (most feared complication). Double access is necessary, a large working catheter is place in each internal carotid arteries. A microcatheter from each side (2 total) is maneuvered into ipsilateral A1 and contralateral A2, and two open-cell stents are delivered. A third microcatheter is placed in the aneurysm. The aneurysm is filled up with coils until obliteration.

1. 3D reconstruction demonstrating a complex ACom partially thrombosed wide neck aneurysm
2. Angiography from right internal carotid artery
3. Angiography from left internal carotid artery
4. Microcatheter work right side
5. Microcatheter work left side
6. Both stents in place “X”
7. Coils going inside Aneurysm
8. Final Embolization - Aneurysm Treated

This a 70 year old woman with a 8 mm ACom aneurysm. Procedure performed in 2 hrs, patient went home next day.

ICAD — Intracranial atherosclerotic disease Intracranial atherosclerotic disease (ICAD) is the most common proximate mec...
10/07/2025

ICAD — Intracranial atherosclerotic disease

Intracranial atherosclerotic disease (ICAD) is the most common proximate mechanism of ischemic stroke worldwide. It consists of progressive cholesterol/platelets plaque built up within arterial wall, occluding the artery and potential break off and embolization.

There are several possible mechanisms of ischemic stroke in ICAD: artery-artery embolism, hypoperfusion, and branch atheromatous disease. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. Compared with other stroke subtypes, patients with ICAD are at a higher risk of recurrent ischemic events and death. Once diagnosis is suspected, initial tratment with statins and platelet inhibitors is inititated. In some cases endovascular angioplasty with or without stent is necessary.

We present a 65 year old female with recurrent ischemic strokes in left hemisphere despite medical treatment, found to have ICA stenosis and after failing beat medical treatment she was treated with stent angioplasty.

Imagen:

1. 3DAngiography showing right middle cerebral artery critical stenosis
2. Angiography showing critical MCA stenosis
3. Microwire getting distal access
4. Stent deployment
5. Revascularizarion of MCA after balloon angioplasty and stent



www.drleonardorangel.com
USA 🇺🇸 - Trained
🌐 San Luis Potosí, México
📧 lrcastilla@hotmail.com
☎️ Office 4444 23 31 01

CEREBRAL ARTERIOVENOUS MALFORMATIONSAn arteriovenous malformation, also known as an AVM, is a tangle of blood vessels th...
06/07/2025

CEREBRAL
ARTERIOVENOUS MALFORMATIONS

An arteriovenous malformation, also known as an AVM, is a tangle of blood vessels that creates irregular connections between arteries and veins. This disrupts blood flow and prevents tissues from receiving oxygen. An AVM can occur anywhere in the body, including in the brain. Because the tangled blood vessels in an AVMS 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. The most common complications of an arteriovenous malformation are bleeding and seizures. Bleeding can cause brain damage and may cause death if you don’t get treated.

This young female patient had a cerebral HEMORRHAGE from the AVM. It’s location (deep in the thalamus and basal ganglia) makes treatment very challenging. Surgery and radio surgery are not options due to location and size. Endovascular Embolization is the only initial alternative.

1. AP angiography showing the large and deep AVM with deep draining veins.
2. Lateral angiography showing same features.
3. Posterior circulation contributing through PCA, PCom and posterior choroidal branches.
4. Liquid embolic cast occluding most of the AVM, balloon in the MCA was used for protection. Initial Embolization was done through MCA lenticulostriate branches, PCA and PCom branches.
5. Most of the AVMs has been occluded.
6. Remaining AVM will requiere a Second transvenous Embolization.

Dirección

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

Página web

Notificaciones

Sé el primero en enterarse y déjanos enviarle un correo electrónico cuando Dr. Leonardo Rangel Castilla publique noticias y promociones. Su dirección de correo electrónico no se utilizará para ningún otro fin, y puede darse de baja en cualquier momento.

Contacto El Consultorio

Enviar un mensaje a Dr. Leonardo Rangel Castilla:

Atajos

Compartir

Share on Facebook Share on Twitter Share on LinkedIn
Share on Pinterest Share on Reddit Share via Email
Share on WhatsApp Share on Instagram Share on Telegram