Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report.

INTRODUCTION: Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. CASE REPORT: An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. DISCUSSION: The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. CONCLUSION: This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.

Evaluación del trofismo del músculo temporal posquirúrgico en relación con el tiempo de manipulación y la infiltración transoperatoria de bupivacaína isobárica al 0.5% en pacientes sometidos a craneotomía pterional / Evaluation of temporal muscle trophism in relation to the manipulation time and infiltration of 0.5% isobaric bupivacaine through a pterional approach

Introducción: Existen diferentes técnicas para reconstrucción del músculo temporal (MT) en el abordaje pterional (AP) con el objetivo de evitar y disminuir la atrofia, hasta el momento ninguna ha logrado evitarla en su totalidad. La administración de bupivacaína genera regeneración de fibras musculares. Aún no existe en la literatura médica estudios que evalúen el tiempo de manipulación del MT y que den uso a la bupivacaína para el tratamiento de la atrofia después de un abordaje pterional, el presente estudio pretende describir los efectos de estas variables. Pacientes y métodos: Estudio longitudinal, incluyendo pacientes de 18-80 años y sometidos a abordaje pterional en los años 2016-2017. Evaluamos los efectos de la manipulación del MT y la administración de bupivacaína al 0,5% sobre el trofismo y la función del MT. Resultados: Veintinueve pacientes fueron sometidos a AP; 16(55,17%) contaron con criterios para infiltración con bupivacina al 0,5%. Se encontró una correlación negativa entre los tiempos de manipulación y el trofismo, no estadísticamente significativo (p>0,05). Se evalúo los índices de disfunción de Helkimo y Fonseca prequirúrgicos y posquirúrgicos encontrándose un incremento estadísticamente significativo en la disfunción (p<0,05). En pacientes infiltrados con bupivacaína al 0,5% se observó una diferencia media del espesor de MT de 0,275±1,18mm, en contraste con los no infiltrados de 2,39±1,30mm (t[27] = -5,118, p=0,0001). Conclusiones: La manipulación del MT durante el abordaje pterional, condiciona un impacto sobre la calidad de vida de acuerdo con los índices de disfunción, debido a la atrofia. Esta investigación presenta que la administración de bupivacaína al 0,5% durante la cirugía ofrece una disminución en la atrofia del MT

Introduction: There are different techniques for the reconstruction of the temporal muscle (TM) in the pterional approach (PA) in order to avoid and reduce atrophy, it has not been able to avoid it in its entirety. The administration of bupivacaine generates regeneration of muscle fibres. There are no studies in the medical literature that evaluate the time of TM manipulation and the use of bupivacaine for the treatment of atrophy after pterional approach, the present investigation aim is to describe the effects of these variables. Patient and methods: Longitudinal study, including patients from 18-80 years old with pterional approach at 2016-2017. We evaluated the effects of the TM manipulation times and the administration of 0.5% bupivacaine on the trophism and function of TM. Results: Twenty-nine patients underwent a PA; 16(55.17%) count with criteria for 0.5% bupivacain infiltration. We found a negative correlation between manipulation times and trophism, with no statistically significance (p>.05). We evaluated presurgical and postsurgical index of Helkimo and Fonseca's index, finding an increase of disfunction with statistically significance (p<.05). In patients who were infiltrated with 0.5% bupivacaine we observed a mean difference in the TM's trophism of 0.275±1.18mm, in contrast with no infiltrated which was 2.39±1.30mm (t[27] = -5.118, p=.0001). Conclusions: The manipulation of the TM during a pterional approach conditioned an impact on the quality of life according to the disfunction indexes, due to atrophy. This investigation exhibits that de administration of 0.5% bupivacaine during surgery offers a decrease in the TM atrophy

Evaluation of temporal muscle trophism in relation to the manipulation time and infiltration of 0.5% isobaric bupivacaine through a pterional approach. / Evaluación del trofismo del músculo temporal posquirúrgico en relación con el tiempo de manipulación y la infiltración transoperatoria de bupivacaína isobárica al 0,5% en pacientes sometidos a craneotomía pterional.

INTRODUCTION: There are different techniques for the reconstruction of the temporal muscle (TM) in the pterional approach (PA) in order to avoid and reduce atrophy, it has not been able to avoid it in its entirety. The administration of bupivacaine generates regeneration of muscle fibres. There are no studies in the medical literature that evaluate the time of TM manipulation and the use of bupivacaine for the treatment of atrophy after pterional approach, the present investigation aim is to describe the effects of these variables. PATIENT AND METHODS: Longitudinal study, including patients from 18-80 years old with pterional approach at 2016-2017. We evaluated the effects of the TM manipulation times and the administration of 0.5% bupivacaine on the trophism and function of TM. RESULTS: Twenty-nine patients underwent a PA; 16(55.17%) count with criteria for 0.5% bupivacain infiltration. We found a negative correlation between manipulation times and trophism, with no statistically significance (p>.05). We evaluated presurgical and postsurgical index of Helkimo and Fonseca's index, finding an increase of disfunction with statistically significance (p<.05). In patients who were infiltrated with 0.5% bupivacaine we observed a mean difference in the TM's trophism of 0.275±1.18mm, in contrast with no infiltrated which was 2.39±1.30mm (t[27] = -5.118, p=.0001). CONCLUSIONS: The manipulation of the TM during a pterional approach conditioned an impact on the quality of life according to the disfunction indexes, due to atrophy. This investigation exhibits that de administration of 0.5% bupivacaine during surgery offers a decrease in the TM atrophy.