RESUMO
Objective: To establish the frequency and results in patients carriers with multiple aneurysms (MA) treated by microsurgery and/or neurological endovascular therapy (NET) in the Hospital of Specialties on The National Medical Center La Raza. Method: It is an ambispective, descriptive and longitudinal study that includes patients carriers of MA treated in the National Medical Center La Raza from March the 1st of 2009 to April the 30th of 2014. Results: 62 patients carriers of 151 aneurysms were treated. According to the type of treatment, 30 patients (49%) were included in the surgical group (GQ), 25 (40%) in the endovascular group (GE) and 7 (11%) in the combinated group (GC). The number of aneurysms was distributed this way: 69 (46%) in the GQ, 61 (40%) in the GE and 21 (14%) in the GC. At GQ, it was not possible to exclude all their aneurysms on 21% of the patients, while it was feasible in only 27%. In all GE patients (40%) the exclusion of all aneurysms was achieved. The GC, meaning surgical cases that were not completed by NET, formed 11% of the cases. At GQ there was a rate of 6% of complications, meanwhile at GE it was 0.5%.
Assuntos
Aneurisma Intracraniano/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/epidemiologia , Aneurisma Roto/terapia , Embolização Terapêutica/métodos , Embolização Terapêutica/mortalidade , Embolização Terapêutica/estatística & dados numéricos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Hospitais Especializados , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Estudos Longitudinais , Masculino , Microcirurgia/mortalidade , Microcirurgia/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Distribuição por Sexo , Stents , Resultado do TratamentoRESUMO
BACKGROUND: The dorsal spinal intradural arteriovenous fistulas (DSIAF) are infrequent and complex injuries are underdiagnosed condition and disability. The aim is to present our experience in the endovascular management. METHODS: A retrospective and prospective study of patients with DSIAF treated by endovascular therapy (EVT) with n-butyl-cyanoacrylate during the period 2007-2013. RESULTS: 15 patients, 12 men and 3 women, mean age 37 years, were included. In 12 cases, the presentation was progressive and insidious over a period between 6 months and one year, while 3 had bleeding. The lesion in the thoracic location had 73 % of cases, lumbar 20 % and cervical 7 %. Prior to treatment observed disability grades 5 and 4 in 73 %, and 67 % had micturition disturbances. Complications grade 3, only one patient had transient deterioration of alert 6 hours after the procedure. Improvement to grades 1 and 2 disability at 48 hours, 3 and 6 months, 53 %, 73 % and 87 % respectively was found. CONCLUSION: EVT has a short operating time, bleeding volume is very low and the hospital stay is short compared with other surgical techniques. EVT is a safe and significant effectiveness in treating DSIAF procedure. This is the first series of cases treated with EVT in Mexico.
Introducción: las fístulas arteriovenosas intradurales dorsales espinales (FAVIDE) son lesiones poco frecuentes y complejas que son subdiagnósticadas y condicionan discapacidad. El objetivo es presentar nuestra experiencia en el manejo endovascular. Métodos: estudio ambispectivo de pacientes con FAVIDE, tratados mediante terapia endovascular (TEV) con n-butil-cianoacrilato en el periodo de 2007 a 2013. Resultados: se incluyeron 15 pacientes con edad media de 37 años. En 12 casos la presentación fue progresiva e insidiosa en un lapso de entre 6 meses y un año, mientras que 3 presentaron hemorragia. La lesión tuvo localización torácica en 73 % de los casos, lumbar en 20 % y cervical en 7 %. Previo al tratamiento observamos discapacidad de grados 5 y 4 en 73 %, y 67 % tenían alteraciones de la micción de grado 3. Como complicaciones, solo una paciente tuvo deterioro del estado de alerta transitorio 6 horas después del procedimiento. Se encontró una mejoría hacia los grados 1 y 2 de discapacidad, a las 48 horas, 3 y 6 meses, de 53 %, 73 % y 87 %, respectivamente. Conclusiones: con la TEV se tiene un tiempo quirúrgico corto, el volumen de hemorragia es bajo y la estancia hospitalaria es corta, respecto de otras técnicas quirúrgicas. La TEV es un procedimiento seguro y con efectividad significativa en el tratamiento de FAVIDE. Esta es la primera serie de casos tratados con TEV en México.
Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Coluna Vertebral/irrigação sanguínea , Adolescente , Adulto , Embucrilato/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adesivos Teciduais/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
The fenestration of the basilar artery is an uncommon anatomical variant that may be associated with saccular aneurysms; however this association is rare. We report the case of a patient who presented with subarachnoid hemorrhage that was successfully treated by coil embolization and review the literature.
Assuntos
Aneurisma Roto/terapia , Artéria Basilar , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Stents , Adulto , Aneurisma Roto/complicações , Embolização Terapêutica/métodos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/complicações , Ruptura Espontânea/terapia , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapiaRESUMO
OBJECTIVES: To identify and evaluate the cerebral aneurysm remnants after clipping and the endovascular treatment in our institution. METHODS AND MATERIALS: We made a clinical ambispective collection of all aneurysms microsurgically clipped during four years and we analyzed their endovascular treatment. RESULTS: There were 290 cerebral aneurysms; in 270 a digital subtraction angiography was made. Ten aneurysm remnants were found (3.7%); of these, a second operation was performed on two, and coil placement was done in six patients. CONCLUSION: The cerebral aneurysm remnants after clipping in our institution are equivalent to international results. The endovascular treatment of this aneurysm is safe and effective.
Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/instrumentação , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Instrumentos Cirúrgicos , Falha de TratamentoRESUMO
Persistent primitive trigeminal artery is a rare anatomical variant resulting from the absence of obliteration of the embryonic trigeminal artery. The shunt between the persistent primitive trigeminal artery and the cavernous sinus is called trigeminal-cavernous fistula. We report the case of a woman with a trigeminal-cavernous fistula secondary to head trauma who was treated by transarterial embolization.
Assuntos
Seio Cavernoso , Fístula/diagnóstico , Doenças do Nervo Trigêmeo/diagnóstico , Fístula Vascular/diagnóstico , Adulto , Feminino , HumanosRESUMO
Los tumores epidermoides representan alrededor del 1 por ciento de todos los tumores intracraneales sindo el ángulo pontocerebeloso el sitio más frecuente de localización. La lesiones del IVto ventrículo son raras. Presentamos el caso de una paciente de 22 años que desarolló hidrocefalia condicionada por un tumor epidermoide del IVto ventrículo.
Epidermoid tumors account for 1 percent of intracranial neoplasms. They are usually found at the cerebello-pontine angle and location in the fourth ventricle is rare. We report the case of a 22-year-old woman with an epidermoid tumor of the fourth ventricle revealed by hydrocephalus.
Assuntos
Humanos , Feminino , Adulto , Carcinoma de Células Escamosas/cirurgia , Quarto Ventrículo , Cisto Epidérmico/cirurgia , Cisto Epidérmico/diagnóstico , HidrocefaliaRESUMO
BACKGROUND: An endoscopic endonasal transsphenoidal approach is reported as less invasive, allowing an earlier discharge. Published series have never focused on its use in acromegalic patients. OBJECTIVE: To assess the effectiveness of an endoscopic endonasal transsphenoidal approach in the management of growth hormone-secreting adenomas. PATIENTS AND METHODS: Nineteen consecutively operated patients were assessed with a prospective follow-up of one year. RESULTS: Sex ratio was 0.7/1 and gross total removal was obtained in 16 cases (84%), subtotal in three (16%). The only complication was a cerebrospinal fluid leak requiring spinal drainage. The median in-hospital stay was 2.5 days. Sixteen patients experienced clinical improvement (84%) and no changes were observed in three (16%). Residual tumor was seen in two cases (11%). Growth hormone levels < 2 ng/dl were seen in 17 cases (89%) and only two patients (11%) had a level >2 ng/dl. Insulin-like growth factor-1 levels were normalized in 16 cases (84%) and remained elevated in three patients (16%). One patient presented an isolated elevated level of insulin-like growth factor-1. Patients with residual tumor and elevated growth hormone and insulin-like growth factor-1 levels underwent complementary radiosurgery. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach seems to be useful in acromegaly, with a high rate of clinical and biochemical cure among other benefits.