Clipado microquirúrgico de aneurismas parcialmente embolizados / Microsurgical clipping of partially embolized cerebral aneurisms

Objetivo: el manejo quirúrgico de los pacientes embolizados con coils plantea un problema ya que las cirugías en estos casos suelen ser más complejas. Material y métodos: presentamos siete pacientes embolicados, seis mujeres y un varón, operados entre abril del 2009 y septiembre de 2010, con un rango de edad entre 32 y 56 años (media 46) que requirieron posteriormente cirugía. Las cirugías fueron realizadas en el Hospital El Cruce y en otros tres centros quirúrgicos, por lo tanto el tratamiento endovascular fue realizado por diferentes equipos. Los aneurismas tratados fueron 2 comunicantes anteriores, 3 comunicantes posteriores y 2 Silvianos. Resultados: no hubo mortalidad en esta serie. Una paciente presentó un infarto frontal postoperatorio. Uno de los aneurismas presentó una rama a nivel del cuello aneurismático, por lo que solo fue posible reducir el cuello con un clip fenestrado y uno recto y empaquetar el aneurisma. En tanto que el clipado microquirúrgico en el resto de los aneurismas se logró con éxito. Conclusión: el manejo quirúrgico de los aneurismas previamente embolizados es un desafío emergente en la práctica neuroquirúrgica. La cirugía de un aneurisma embolizado es técnicamente más compleja y potencialmente más riesgosa para el paciente. Creemos que es fundamental una correcta selección de pacientes y una cuidadosa planificación del tratamiento para disminuir la incidencia de pacientes embolizados que requieran luego tratamiento quirúrgico.

Biopsia estereotáctica cerebral guiada tomográficamente: Análisis de una serie de 192 casos / Tomographically guided stereotactic brain biopsy: Review of a series of 192 cases

Objective. Stereotactic CT-guided biopsy is a safe procedure for the diagnosis of brain lesions unsuitable for surgical treatment because of their location, number, histology or poor medical status. The objective of this study is to analyze the indications,demography, topography, anatomopathologic diagnosis and complications in a series of stereotactic CT-guided brain biopsies. Method. 192 CT assisted stereotactic brain biopsies in 186 patients were retrospectively reviewed from june 1998 to june of 2008. Results. 186 patients, 101males (54.3%) and 85 females (45.7%), were analyzed. Mean age was 54.5 years. 144 (75%) of the biopsies were performed in hemispheric lesions, 43 (22.4%) in “deep seated” localization. The most frequent anatomopathologic diagnosis were glioblastoma (36,5%) and anaplasic astrocytoma (17%). 90,62% of the biopsies were positive, 7,3% were negative and 2,08% nondiagnostic. Morbility rate was 3,64% and mortality 2,08%. Conclusion.Stereotactic brain biopsy is a safe and effective procedure providing tissue for definitive anatomopathological diagnosis; it offers low morbidity and mortality rate. Our findings are similar to the literature.

Hemangioma capilar medular: Reporte de un caso y revisión de la literatura / Spinal cord capillary hemangioma: Report of a case and bibliographical review

Objective. To describe a rare case of intramedullary capillary haemangioma of the thoracic spinal cord asociated with extensive cord edema and review of the literature. Description. A 65-yeard-old male pacient presented a 4-months history of dorsal back pain, progressive 4/5 paraparesis and sensory abnormality of the lower extremities. MR studies of the thoracic spine show a well-defined intramedullary mass at the D6 level, isointense on T1, hiperintense on T2 and homogeneous, strong enhancement with gadolinium, compatible with vascular lesion, asociated with extensive cord edema from D8-C2. Intervention. A D6-D7 laminectomy was performed and the tumor was completly removed en bloc by using standard microneurosurgical technique. Conclusion. It is very important to know about the existence of intramedullary capillary haemangiomas. Despite of being extremely rare, they are benign vascular neoplasms with a good outcome after their complete resection. Therefore, it´s necessary to distinguish them of other malignant tumors, to avoid overtreatment of these benign lesions.

Tratamiento quirúrgico de la neuralgia del trigémino: Experiencia en 10 años / Surgical treatment of trigeminal neuralgia: A 10 years experience

Introduction. Surgical treatment of trigeminal neuralgia remains a matter of debate since there are no studies comparing long term effectiveness of the different surgical techniques. We present our 10 year experience. Description. Series: 40 patients. Period: 1998 - 2008. Surgical techniques: microvascular decompression, radiofrequency thermorhizotomy and balloon compression. Analyzed parameters: age, sex, nerve root involved, pain relief, recurrence, complications, need to restart medication and reintervention. Discussion. Microvascular decompression offers better long term results, radiofrequency is adequate for special cases (higher recurrence rate), and balloon compression is better for V1 neuralgia. Our sample is too small for statistics, yet our findings are coincident with the literature. Conclusion. Better patient selection criteria for each technique are needed. Microvascular decompression should be the treatment of choice when possible. How to treat recurrence remains unanswered.