Bilobulated aneurysms at the origin of the posterior communicating artery

OBJECTIVE: The purpose of this paper is to describe the occurrence of bilobulated aneurysms at the origin of the posterior communicating artery. BACKGROUND: Bilobulated aneurysms at the origin of the posterior communicating artery from the internal carotid artery are rarely reported in the literature. A review of the literature showed only one report in which this type of aneurysm was addressed. METHODS: A consecutive series of 85 aneurysms operated by a single surgeon in 75 patients during an eight-year period (March 1995-February 2003) at the University Hospital was reviewed retrospectively. The incidence, radiological findings, intraoperative findings, surgical treatment and outcome of patients with bilobulated aneurysms at the origin of the posterior communicating artery were analyzed. The pathophysiologic mechanism for the formation of the bilobulated aneurysm was analyzed for each case. RESULTS: Thirty-two aneurysms (37.6%) located at the origin of the posterior communicating artery were operated. Four patients who had angiographic evidence of a bilobulated aneurysm at the origin of the posterior communicating artery were identified and operated. Among those four patients, only three had a bilobulated aneurysm. In one patient, microsurgical exploration revealed the presence of two consecutive aneurysms originating from the posterior communicating artery. The incidence of bilobulated aneurysms at the origin of the posterior communicating artery was 9.4%. One patient died during the postoperative period for a 25% mortality rate. CONCLUSIONS: The incidence of this type of aneurysm is low; therefore, they represent a technical challenge to the neurosurgeon.

Petrous apex region. Surgical anatomy, lesions, and operative techniques

The author describes the anatomy of the region of the petrous apex giving emphasis to the limits of surgical resection. The cochlea, located at the apex of the angle formed by the intersection of a line along the sphenopetrosal groove and a line from the facial hiatus to the internal auditory canal, has to be protected to preserve hearing. Surgical approaches can be divided in the posterior presigmoid approach that provides exposure to the posterior petrous bone and upper two thirds of the clivus, and the anterior subtemporal approach that provides exposure to the trigeminal ganglion, petrous carotid artery, Meckel's cave, and posterior cavernous sinus. Opening of Meckel's cave provides additional space for medial and inferior resection of the petrous apex. Two illustrative cases of primary petrous apex lesions are presented to demonstrate the surgical exposure obtained with each approach

Eficacia clinica de la cefoperazona asociada a tinidazol en el tratamiento de infecciones mixtas en adultos / Clinic efficacy of the cefoperazone associated with tinidazole in mixed infections treatment in adult

Se evaluó, en infecciones mixtas por microorganismos aerobios y anaerobios, la eficacia y tolerancia del tratamiento combinado de Cefoperazona (2g/dia) y tinidazol (0.8g/d), administrados por via intravenosa en 36 pacientes (rango de edad 13-65 anos, 20 mujeres y 16 hombres) durante 5-16 dias (promedio 7.8 dias) con las siguientes infecciones severas: peritonitis (n=3), enfermedad inflamatoria pelviana (n=3), neumonia (n=2) colecistitis(n=1), osteomielitis (n=1), abceso subfrenico (n=3), abceso hepatico, tubo ovarico y gangrena de miembros inferiores (1 caso c/u). Los microorganismos sensibles a cefoperazona y/o tinidazol aislados fueron: E. coli, Acinetobacter, sp., Bacteroides, sp., P.aeruginosa, K. pneumoniae, Peptoestreptococcus, Enterococos, P. vulgaris, P. mirabilis y Bacteroides, sp