ABSTRACT
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%.
Subject(s)
Intracranial Aneurysm/therapy , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/epidemiology , Aneurysm, Ruptured/therapy , Embolization, Therapeutic/methods , Embolization, Therapeutic/mortality , Embolization, Therapeutic/statistics & numerical data , Endovascular Procedures/methods , Endovascular Procedures/mortality , Endovascular Procedures/statistics & numerical data , Female , Hospitals, Special , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/epidemiology , Longitudinal Studies , Male , Microsurgery/mortality , Microsurgery/statistics & numerical data , Prospective Studies , Retrospective Studies , Sex Distribution , Stents , Treatment OutcomeABSTRACT
BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in premature lightweight. While in the decade of 1970-1980 the incidence was 40-50%, now it is at least 20%. But it presents a challenge because of the multiple existing therapies and the results in terms of neurological sequelae. MATERIAL AND METHODS: We performed a retrospective review of 48 patients managed with ventriculo subgaleal shunt and a therapeutic decision based on gestational age, weight, and grade of intraventricular hemorrhage. RESULTS: Of the patients, 29 (60%) of the cases were female and 19 (40%) were male. The average gestation age for placing the subgaleal system was 30 months, with an average weight of 1,511 g, and with an infection rate of 4%. In 44 cases peritoneal system was placed (92%) because four died (8%). No mortality was observed at surgery. CONCLUSIONS: Mortality in the past appeared in 75% of patients, with the realization that derivation of subgaleal irrigation reduces infections besides allowing proper control of hydrocephalus and thus decreases the long-term neurological sequelae.
ABSTRACT
BACKGROUND: epidermoid neoplasm (EN) accounts for 1 % of whole intracranial neoplasms. Usually, it is found at the cerebello-pontine angle and the location in the fourth ventricle (FV) is rare. The aim was to report two cases of EN of the FV. CLINICAL CASES: case 1: a female 22 year old presented with an intense headache with a history of 3 months. At the hospital entry, symptoms and signs of high intracranial pressure were found. Tomography images showed hydrocephalus with high pressure in the FV. She was treated with a shunt from ventricular to peritoneal cavity. After that an encapsulated neoplasm was drawn. It had a pearled aspect. The histology report showed an EN originating in the FV. Case 2: a female 44 year old with a history of five years of dizziness; three years before admission she presented intermittent diplopia and disophagia. At the hospital admission the patient presented paresis of the 6th and 7th cranial nerve. The tomography and the magnetic resonance studies showed a mass in the FV. The neoplasm was extirpated. CONCLUSIONS: the EN of the FV is an infrequent benign lesion. Magnetic resonance is the standard diagnostic study, but it could lead to confusion with neurocisticercosis. The extirpation and the treatment of the hydrocephalus are indicated.
Introducción: los tumores epidermoides representan 1 % de las neoplasias intracraneales; el ángulo pontocerebeloso es la localización más frecuente y en el cuarto ventrículo son raros. Casos clínicos: caso 1: mujer de 22 años de edad con cefalea intensa de tres meses de evolución. Al ingreso se identificó hipertensión endocraneana. La tomografía mostró hidrocefalia con aumento del volumen del cuarto ventrículo. La paciente fue tratada con derivación ventrículo-peritoneal; posteriormente se extirpó tumoración encapsulada de aspecto perlado. El estudio histológico indicó tumor epidermoide en el cuarto ventrículo. Caso 2: mujer de 44 años de edad con vértigo ocasional de cinco años de evolución, así como con diploplía y disfagia intermitentes de tres años de evolución. Al ingresó se identificó paresia bilateral de los nervios craneales VI y VII. La tomografía computarizada y la resonancia magnética mostraron lesión en el cuatro ventrículo. El manejo fue quirúrgico. Conclusiones: la resonancia magnética es el estudio diagnóstico específico para el diagnóstico del tumor epidermoide del cuarto ventrículo que, sin embargo, puede confundirse con neurocisticercosis. Están indicados la exéresis del quiste y el tratamiento de la hidrocefalia.
