RESUMEN
We describe a subaortic left brachiocephalic vein, a congenital anomaly that can be suspected during the rapid central vein assessment before central venous catheterization. Since the vein descends vertically/obliquely rapidly from its origin, we suggest that the puncture should be made at a greater angle (50°-60°) than what is usually used to puncture this vein (20°-30°). Failure to identify this anomaly may cause a failed puncture or complications from the puncture of adjacent blood vessels.
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Venas Braquiocefálicas , Cateterismo Venoso Central , Humanos , Venas Braquiocefálicas/diagnóstico por imagen , Venas Braquiocefálicas/cirugía , Ultrasonografía Intervencional , Cateterismo Venoso Central/efectos adversos , Ultrasonografía , PuncionesRESUMEN
Scaphocephaly (SC) is defined as an elongation of the anteroposterior axis of the skull resulting from the abnormal fusion of the sagittal suture. This study describes the "Peau d'ours" technique and results for correcting SC. We conducted a consecutive and retrospective analysis of patients treated from 2011 to 2016. We evaluated the gender, age, and surgical outcomes. A total of 53 patients were enrolled with a mean age of 19 months old. The advantages of this technique are healthy coronal and lambdoid suture preservation and symmetrical parietal bone flap opening. This technique is safe and simple to reproduce, allowing good surgical outcomes with a low incidence of secondary craniosynostosis. This technique is ideal for patients older than six months old.
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Craneosinostosis , Suturas Craneales/cirugía , Craneosinostosis/cirugía , Humanos , Lactante , México , Estudios Retrospectivos , Cráneo/cirugíaRESUMEN
BACKGROUND: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state. CASE DESCRIPTION: We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM). CONCLUSION: We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.
RESUMEN
INTRODUCTION: Focal hydrocephalus including trapped temporal horn (TTH), isolated lateral and fourth ventricles, is caused by obstruction and/or adhesion related to various etiologies. With the advent of the neuroendoscope, endoscopic procedures have become an alternative in selected cases. CASE REPORT: A 2-year-old male from a rural town in México was referred to our institution because of multiple supra- and infra-tentorial abscesses and hydrocephalus. The patient had progressive deterioration and developed bilateral trapped temporal horn related to multi-septated hydrocephalus, so we performed an endoscopic ventricular-cistern-ventriculostomy through a single right temporal burr hole. POSTOPERATIVE COURSE: Bilateral TTH and multi-septated hydrocephalus were effectively treated with a single external ventricular drainage (EVD) catheter, from the right temporal horn to the left temporal horn through the interpeduncular cistern; after clamping the EVD for 3 days with no evidence of hydrocephalus, the EVD was removed. The size of the ventricles remained stable afterwards, and no clinical or radiological evidence of hydrocephalus was observed after 3 months of follow-up. DISCUSSION: Endoscopic ventriculocisternostomy is effective in selected cases of TTH. We know that dilatation of the temporal horn widens the window between the anterior choroidal artery and optic tract superiorly, and the posterior communicating and CN III inferiorly, making the described procedure feasible, even in the approach to the contralateral side. Even though this is a rare condition, we believe it is a safe and effective option to eliminate multiple shunts and/or to reduce the number of catheters needed to treat bilateral THH related to multi-septated hydrocephalus.
Asunto(s)
Ventrículos Cerebrales/diagnóstico por imagen , Cisterna Magna/diagnóstico por imagen , Micosis/diagnóstico por imagen , Neuroendoscopía/métodos , Lóbulo Temporal/diagnóstico por imagen , Ventriculostomía/métodos , Antifúngicos/uso terapéutico , Ventrículos Cerebrales/cirugía , Preescolar , Cisterna Magna/efectos de los fármacos , Cisterna Magna/cirugía , Humanos , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/tratamiento farmacológico , Masculino , Micosis/tratamiento farmacológico , Micosis/cirugía , Lóbulo Temporal/cirugía , Resultado del TratamientoRESUMEN
Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.