What is the ideal grade of resection for parasagittal meningiomas with the invasion of superior sagittal sinus? Simpson I or Simpson II resection? A retrospective observational study.

Background: Parasagittal meningioma (PSM) is a tumor located in the parasagittal angle which extends to and/ or invades the superior sagittal sinus (SSS). Surgical resection of the PSM, the standard treatment in such cases, poses a challenge for neurosurgery, particularly where there is an invasion of the SSS. This is due to the risk of complications through injury to the adjacent vascular structures. The objective of the study was to perform a comparative evaluation of the surgical techniques for total resection of the PSM (Simpson Grade [SG] I and SG II), which present the highest rates of success in terms of the following variables: mortality, recurrence, and postoperative complications. Methods: Fifty-six patients undergoing resection surgery for PSM with the invasion of the SSS were enrolled. The patients were divided into two groups: Group A, comprising 26 cases of patients subjected to SG I PSM resection surgery and Group B, with 31 cases of patients subjected to SG II PSM resection surgery, with preservation of the SSS. Results: The results showed that Group B had lower rates of postoperative deficit (P = 0.026), zero mortality, and reduced recurrence. The use of complementary radiotherapy for atypical meningiomas (WHO II) in Group B was satisfactory in controlling the disease. Conclusion: The Simpson II, with preservation of the SSS, was better as it diminishes the vascular risks of surgery, reduces the frequency of severe postoperative deficit, and reduces mortality.

Intracranial rebleeding post spinal anesthesia in pregnant patient with undiagnosed chronic subdural hematoma: case report.

Intracranial hematoma after spinal anesthesia is a rare complication. It generally presents with posture-dependent headache that becomes persistent. We describe the case of patient submitted to spinal anesthesia for cesarean section who presented a non-posture-dependent headache, resistant to clinical treatment, that progressively worsened and with symptoms of intracranial hypertension. The patient had a history of head trauma without symptoms. The CT-scan revealed a chronic bilateral parietal hematoma with a recent bleeding component, treated surgically. We concluded that spinal puncture led to chronic hematoma to rebleed. We have reported the case to draw attention to the importance of investigating atypical headache after spinal anesthesia.

Diagnosis of Lumbar Spinal Stenosis with Functional Myelography.

BACKGROUND AND STUDY AIMS: The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced myelography, now considered an old-fashioned technique. It was our hypothesis that functional myelography still plays an important role in selected cases. We investigated how our surgical strategy was influenced by the results of MRI, functional myelography, and postmyelography computed tomography (CT) in patients with a lumbar spinal stenosis. METHODS: The sagittal diameters of the lumbar spinal canal were measured from L1 to S1 on patients with lumbar spinal stenosis. MRI, functional myelography, and postmyelography CT were compared in each of the patients. Sensitivity and specificity were calculated in each method. We examined how the surgical strategy was influenced by the results of these different methods. RESULTS: Fifty consecutive patients (21 women and 29 men; mean age: 70 years, [range: 49-86 years]) fulfilled the inclusion criteria. Functional myelography revealed a sensitivity of 0.99, a specificity of 0.79, and a positive predictive value of 0.45. The MRI exhibited a sensitivity of 0.93, a specificity of 0.74, and a positive predictive value of 0.39. Postmyelography CT showed a sensitivity of 0.96, a specificity of 0.75, and a positive predictive value of 0.41. A functional myelography revealed more information than the MRI and resulted in a change in the surgical strategy in 11 of 50 patients (22%) in comparison with the sole results of MRI or a postmyelography CT. CONCLUSIONS: In selected cases with multilevel lumbar spinal stenosis, functional myelography revealed the highest precision in reaching a correct diagnosis. It resulted in a change in the surgical approach in every fifth patient in comparison with the MRI and proved most helpful, especially in elderly patients.

Burns related to electrosurgery - Report of two cases / Queimaduras relacionadas à eletrocirurgia - Relato de dois casos

Abstract Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.

Resumo A eletrocirurgia é uma tecnologia que se desenvolveu muitos nos últimos anos e se tornou um instrumento de grande importância na cirurgia moderna. A maioria dos equipamentos é considerada segura, embora existam riscos relacionados ao seu uso. Várias lesões podem ser causadas por eletrocautérios, as queimaduras são as mais frequentes e temidas. Relatamos dois casos de queimaduras relacionadas ao uso do bisturi elétrico e promovemos uma revisão de literatura, pois o conhecimento dos fundamentos da eletrocirurgia, seu uso correto, a escolha de um equipamento seguro, o monitoramento constante e a investigação imediata diante de quaisquer suspeitas com certeza podem melhorar a experiência operacional para ambos, cirurgião e paciente.

Cerebral venous thrombosis after spinal anesthesia: case report / Trombose venosa cerebral após raquianestesia: relato de caso

Abstract Introduction Cerebral venous thrombosis (CVT) is a rare but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia and had postoperative headache complicated with CVT. Case report Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged on the eighth day without sequelae. Discussion Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to CVT in some patients with prothrombotic conditions.

Resumo Introdução: A trombose venosa cerebral (TVC) é uma complicação rara, mas grave, após raquianestesia. Está frequentemente relacionada com a presença de fatores predisponentes, como gestação, puerpério, uso de contraceptivos orais e doenças malignas. O sintoma mais frequente é a cefaleia. Descrevemos um caso de um paciente submetido à raquianestesia que apresentou cefaleia no período pós-operatório complicada com TVC. Relato de caso: Paciente de 30 anos, ASA 1, submetido à cirurgia de artroscopia de joelho sob raquianestesia, sem intercorrências. Quarenta e oito horas após o procedimento apresentou cefaleia frontal, ortostática, que melhorava com o decúbito. Foi feito diagnóstico de sinusite em pronto socorro geral e recebeu medicação sintomática. Nos dias subsequentes teve pioria da cefaleia, que passou a ter localização holocraniana e mais intensa e com pequena melhora com o decúbito dorsal. Evoluiu com hemiplegia esquerda seguida de convulsões tônico-clônicas generalizadas. Foi submetido à ressonância magnética com venografia que fez o diagnóstico de TVC. A pesquisa para fatores pró-coagulantes identificou a presença de anticorpo lúpico. Recebeu como medicamentos anticonvulsivantes e anticoagulantes e teve alta hospitalar em oito dias, sem sequelas. Discussão: Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne muito prolongada, deve ser submetido a exames de imagem para excluir complicações mais sérias como a TVC. A perda de líquido cefalorraquidiano leva à dilatação e à estase venosa, que, associadas à tração provocada pela posição ereta, podem, em alguns pacientes com estados protrombóticos, levar à TVC.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report.

OBJECTIVE:: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS:: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS:: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION:: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

[Cerebral venous thrombosis after spinal anesthesia: case report]. / Trombose venosa cerebral após raquianestesia: relato de caso.

INTRODUCTION: Cerebral venous thrombosis (CVT) is a rare, but serious complication after spinal anesthesia. It is often related to the presence of predisposing factors, such as pregnancy, puerperium, oral contraceptive use, and malignancies. Headache is the most common symptom. We describe a case of a patient who underwent spinal anesthesia who had postoperative headache complicated with CVT. CASE REPORT: Male patient, 30 years old, ASA 1, who underwent uneventful arthroscopic knee surgery under spinal anesthesia. Forty-eight hours after the procedure, the patient showed frontal, orthostatic headache that improved when positioned supine. Diagnosis of sinusitis was made in the general emergency room, and he received symptomatic medication. In subsequent days, the headache worsened with holocranial location and with little improvement in the supine position. The patient presented with left hemiplegia followed by tonic-clonic seizures. He underwent magnetic resonance venography; diagnosed with CVT. Analysis of procoagulant factors identified the presence of lupus anticoagulant antibody. The patient received anticonvulsants and anticoagulants and was discharged eight days without sequelae. DISCUSSION: Any patient presenting with postural headache after spinal anesthesia, which intensifies after a plateau, loses its orthostatic characteristic or become too long, should undergo imaging tests to rule out more serious complications, such as CVT. The loss of cerebrospinal fluid leads to dilation and venous stasis that, coupled with the traction caused by the upright position, can lead to TVC in some patients with prothrombotic conditions.

[Burns related to electrosurgery - Report of two cases]. / Queimaduras relacionadas à eletrocirurgia ­ Relato de dois casos.

Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.

Choroid plexus coagulation for pediatric hydrocephalus: review of historical aspects and rebirth

This study aims to review historical aspects and rebirth of the endoscopic choroid plexus coagulation (CPC) for pediatric hydrocephalus. The first CPC procedure goes back to early 1930s. After the development of other treatment methods and the understanding of CSF dynamics, the application of CPC dramatically decreased by 1970s. In 2000s, there was a rebirth of CPC in combination with endoscopic third ventriculostomy (ETV), and remains one of the options for the treatment of pediatric hydrocephalus in selected cases. CPC might provide a temporary reduction in CSF production to allow the further development of CSF absorption in infant, and adding to ETV for infants with communicating hydrocephalus may increase the shunt independent rate thus avoiding the consequence of late complication related to the shunt device. This is important for patients who are difficult to be followed up, due to geographical and/or socioeconomic difficulties. And also adding CPC to ETV for obstructive hydrocephalus in infants younger than 1 year of age may also increase the successful rate. Furthermore, CPC may be an option for cases with high chance of shunt complication such as multiloculated hydrocephalus, extreme hydrocephalus and hydranencephaly. In comparison with the traditional treatment of CSF shunting, the role of CPC needs to be further evaluated in particular concerning the neurocognitive development.

Traumatic extrusion of C5-C6 intervertebral disc associated to mielopathy without bone lesion: report of 2 cases and review

The authors reports two cases of cervical disc herniation caused by trauma without osseous lesions in articular facets, vertebral bodies or dislocations. It constitutes uncommon lesions in spinal cord injury. The literature is reviewed.

Results of microsurgical treatment of paraclinoid carotid aneurysms.

The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990-2010). Age, 11-72 years old. Sex, 74:21 female/male. Follow-up; 1-192 months (mean = 51.7 months). Eighty-six patients had single and 9 had multiple paraclinoid aneurysms. Sixty-six were ophthalmic, 14 were in the ICA superior wall, 13 in the inferior, 10 in the medial, and 3 in the ICA lateral wall. Eleven were giant, 29 were large, and 66 were small. Sixty-three patients had ruptured and 32 had unruptured aneurysms. Two patients with bilateral aneurysms had bilateral approaches, totaling 97 procedures. A total of 98.2% of aneurysms were clipped (complete exclusion in 93.8%). ICA occlusion occurred in 10 (5.6%). There was no patient rebleeding during the follow-up period. A good outcome was achieved in 76.8%, with better results for unruptured aneurysms, worse results for patients with vasospasm, and with no difference according to size. Thirty-six (37.9%) patients had transient/permanent postoperative neurological deficits (25.4% ruptured vs. 62.5% unruptured aneurysms). The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6%, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.

Pre, intra and post-ischemic hypothermic neuroprotection in temporary focal cerebral ischemia in rats: morphometric analysis.

OBJECTIVE: To evaluate the neuroprotection of mild hypothermia, applied in different moments, in temporary focal cerebral ischemia in rats. METHODS: Rats was divided into Control (C), Sham (S), Ischemic-control(IC), Pre-ischemic Hypothermia (IH1), Intra-ischemic Hypothermia (IH2), and Post-ischemic Hypothermia (IH3) groups. Morphometry was performed using the KS400 software (Carl Zeiss®) in coronal sections stained by Luxol Fast Blue. Ischemic areas and volumes were obtained. RESULTS: Statistically, blue areas showed difference for C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.01; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH vs. IH2 (p=0.39; p=0.85; p=0.63). Red areas showed difference between C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.009; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH1 vs. IH2 (p=0.48; p=0.27; p=0.68). Average ischemic areas and ischemic volumes showed difference between IC vs. IH1 and IC vs. IH2 (p=0.0001 and p=0.0011), and no difference between IC vs. IH3 and IH1 vs. IH2 (p=0.57; p=0.79). CONCLUSION: Pre-ischemic and intra-ischemic hypothermia were shown to be similarly neuroprotective, but this was not true for post-ischemic hypothermia.

Pre, intra and post-ischemic hypothermic neuroprotection in temporary focal cerebral ischemia in rats: morphometric analysis / Neuroproteção hipotérmica pré, intra e pós-isquêmica na isquemia cerebral focal temporária em ratos: análise morfométrica

OBJECTIVE: To evaluate the neuroprotection of mild hypothermia, applied in different moments, in temporary focal cerebral ischemia in rats. METHODS: Rats was divided into Control (C), Sham (S), Ischemic-control(IC), Pre-ischemic Hypothermia (IH1), Intra-ischemic Hypothermia (IH2), and Post-ischemic Hypothermia (IH3) groups. Morphometry was performed using the KS400 software (Carl Zeiss®) in coronal sections stained by Luxol Fast Blue. Ischemic areas and volumes were obtained. RESULTS: Statistically, blue areas showed difference for C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.01; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH vs. IH2 (p=0.39; p=0.85; p=0.63). Red areas showed difference between C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.009; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH1 vs. IH2 (p=0.48; p=0.27; p=0.68). Average ischemic areas and ischemic volumes showed difference between IC vs. IH1 and IC vs. IH2 (p=0.0001 and p=0.0011), and no difference between IC vs. IH3 and IH1 vs. IH2 (p=0.57; p=0.79). CONCLUSION: Pre-ischemic and intra-ischemic hypothermia were shown to be similarly neuroprotective, but this was not true for post-ischemic hypothermia.

OBJETIVO: Avaliar a neuroproteção da hipotermia leve, aplicada em diferentes momentos, durante isquemia cerebral focal temporária em ratos. MÉTODOS: Ratos foram divididos em grupos: Controle (C), Sham (S), Controle-isquêmico (IC), Hipotermia Pré-isquêmica (IH1), Hipotermia Intra-isquêmica (IH2) e Hipotermia Pós-isquêmica (IH3). A morfometria foi realizada em secções coronais coradas por Luxol Fast Blue através do programa KS400 (Carl Zeiss®). Foram calculados áreas e volumes isquêmicos. RESULTADOS: Estatisticamente, áreas azuis demonstraram diferença entre os grupos C vs. IC, IC vs. IH1 e IC vs. IH2 (p=0,0001; p=0,01; p=0,03), e nenhuma diferença entre C vs. S, IC vs. IH3 e IH vs. IH2 (p=0,39; p=0,85; p=0,63). Áreas vermelhas demonstraram diferença entre C vs. IC, IC vs. IH1 e IC vs. IH2 (p=0,0001; p=0,009; p=0,03), e nenhuma diferença entre C vs. S, IC vs. IH3 e IH1 vs. IH2 (p=0,48; p=0,27; p=0,68). Áreas isquêmicas médias e volumes isquêmicos demonstraram diferença entre os grupos IC vs. IH1 e IC vs. IH2 (p=0,0001 and p=0,0011), e nenhuma diferença entre IC vs. IH3 and IH1 vs. IH2 (p=0,57; p=0,79). CONCLUSÃO: Hipotermias pré-isquêmica e intra-isquêmica demonstraram neuroproteção em grau semelhante, o que não ocorreu com hipotermia pós-isquêmica.

Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso / Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report

JUSTIFICATIVA E OBJETIVOS: O hematoma subdural intracraniano é uma complicação rara após raquianestesia. O diagnóstico é muitas vezes difícil porque os sintomas iniciais são os mesmos da cefaleia pós-punção da dura-máter. O objetivo é relatar o caso de um hematoma subdural diag nosticado precocemente, após uma raquianestesia realizada com agulha de calibre fino e punção única. RELATO DO CASO: Paciente de 48 anos, ASA I, submetida a raquianestesia para cirurgia de correção de incontinência urinária. Foi realizada a raquianestesia com agulha 27G Quincke e punção única. A cirurgia foi sem intercorrências, e a paciente recebeu alta hospitalar. Após 48 horas da punção raquidiana, a paciente relatou cefaleia de início súbito, de forte intensidade, acometendo principalmente a região orbitária, mas também a região temporal, com melhora importante no decúbito dorsal e acompanhada de dois episódios de vômitos. Foi solicitada tomografia de crânio que revelou a presença de um hematoma subdural agudo frontotemporoparietal esquerdo. Foi indicado tratamento conservador com analgésicos, dexametasoma e hidantoína. Após 17 dias, apresentou quadro de cefaleia intensa, acompanhada de dormência e paresia do membro superior direito, e distúrbio da fala e comportamento. O hematoma foi drenado cirurgicamente. A paciente evoluiu bem sem sequelas. CONCLUSÕES: A cefaleia é a complicação mais frequente após raquianestesia e é considerada de evolução benigna. Faz com que diagnósticos potencialmente fatais, como o hematoma subdural, não sejam feitos em muitos casos, ou sejam tardios. Este caso descreve uma ocorrência rara, um hematoma subdural agudo após uma raquianestesia com agulha fina em uma paciente sem fatores de risco para sangramento.

BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spinal anesthesia was performed with 27G Quincke needle and single puncture. There was no unexpected event in the surgery and the patient was discharged. After 48 hours of spinal puncture, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus and followed by two vomiting episodes. A cranial tomography was requested and revealed the presence of an acute left frontotemporoparietal subdural hematoma. A conservative treatment with analgesics, dexamethasone and hydantoin was indicated. After 17 days, the patient had intense headache, followed by dormancy and paresis of right upper limb and speech and behavior disorders. The hematoma was surgically drained. The patient evolved well and without sequelae. CONCLUSIONS: Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding.

JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara posterior a la raquianestesia. El diagnóstico es en muchas ocasiones difícil, porque los síntomas iniciales son los mismos de la cefalea postpunción de la duramadre. El objetivo de este estudio, es relatar el caso de un hematoma subdural diagnosticado rápidamente, y posterior a una raquianestesia realizada con una aguja de calibre fino y punción única. RELATO DEL CASO: Paciente de 48 años, ASA I, sometida a la raquianestesia para la cirugía de corrección de incontinencia urinaria. Fue realizada la raquianestesia con una aguja 27G Quincke y una punción única. La cirugía transcurrió sin problemas, y la paciente recibió alta. Después de 48 horas de efectuada la punción raquídea, la paciente relató cefalea de inicio súbito, de fuerte intensidad, afectando principalmente la región orbitaria, pero también la región temporal, con una mejoría importante en el decúbito dorsal, y acompañada de dos episodios de vómitos. Se le solicitó la tomografía de cráneo que arrojó un hematoma subdural agudo frontotemporoparietal izquierdo. Fue indicado un tratamiento conservador con analgésicos, dexametasoma e hidantoína. Después de 17 días, debutó con un cuadro de cefalea intensa, seguida de adormecimiento y paresia del miembro superior derecho, y un disturbio del habla y del comportamiento. El hematoma fue drenado quirúrgicamente. La paciente evolucionó bien y sin secuelas. CONCLUSIONES: La cefalea es la complicación más frecuente después de la raquianestesia y se le considera de evolución benigna. Ella logra que diagnósticos potencialmente fatales, como el hematoma subdural, se eviten en muchos casos o se hagan más tarde. Este caso describe una aparición rara, un hematoma subdural agudo posterior a una raquianestesia con una aguja fina en una paciente sin factores de riesgo para el sangramiento.

Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report.

BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spinal anesthesia was performed with 27G Quincke needle and single puncture. There was no unexpected event in the surgery and the patient was discharged. After 48 hours of spinal puncture, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus and followed by two vomiting episodes. A cranial tomography was requested and revealed the presence of an acute left frontotemporoparietal subdural hematoma. A conservative treatment with analgesics, dexamethasone and hydantoin was indicated. After 17 days, the patient had intense headache, followed by dormancy and paresis of right upper limb and speech and behavior disorders. The hematoma was surgically drained. The patient evolved well and without sequelae. CONCLUSIONS: Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding.