Guía de práctica clínica sobre tromboprofilaxis y manejo de los fármacos anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos / Clinical practice guideline on thromboprophylaxis and management of anticoagulant and antiplatelet drugs in neurosurgical and neurocritical patients

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[Usefulness of IPC continuous monitoring in shunt dysfunction]. / Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfuncion valvular.

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correct diagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino® sensor and neuroPICture software (developed by first author) for data collection and graphic representation were used. Complications related to monitoring were absent and graphics obtained useful for qualitative analysis.

Utilidad de la monitorizacion de la PIC en pacientes con sospecha de disfunción valvular / No disponible

La sospecha de disfunción valvular constituye una situación frecuente en neurocirugía. En numerosas ocasiones ni la clínica, ni la exploración, ni la radiología pueden confirmar o descartar el diagnóstico. La monitorización continua de la PIC es un método seguro y fiable que aporta valiosa información acerca de la situación de la dinámica del LCR en estos pacientes. El sistema de registro debe permitir no sólo el análisis cuantitativo de la PIC sino también morfológico deltrazado, para identificar ondas patológicas (como las B de alta amplitud) relacionadas con situaciones de disfunción valvular. En el presente trabajo se recogela experiencia de monitorización continua de la PIC en pacientes con sospecha de disfunción valvular sincriterios clínicos y radiológicos concluyentes, en los que el análisis morfológico del registro permitió un diagnósticofiable que se tradujo en la mejoría de todos los pacientes tratados conforme a este criterio. El método utilizado fue un sensor intraparenquimatoso Camino®con software de recogida y representación neuroPICture© (desarrollado por el primer autor). Las complicaciones relacionadas con la monitorización fueron nulas y el registro obtenido útil para las objetivos propuestos (AU)

Shunt dysfunction is a common situation in neurosurgery. Often symptoms, physical examination and radiology are not enough to set a diagnosis. ICP continuous monitoring is a safe and reliable tool that provides valuable information about CSF dynamics in these patients. Not only quantitative analysis is needed but also a qualitative one that enables pathological waves identification, because high amplitude B waves are strongly related to shunt dysfunction. In this paper experience about ICP continuous monitoring in patients with shunt dysfunction suspect is presented. Quantitative and qualitative data analysis led to a correctdiagnosis, improving all the patients treated according to this criterion. An intraparenchymatous Camino®sensor and neuroPICture software (developed by firstauthor) for data collection and graphic representation were used. Complications related to monitoring wereabsent and graphics obtained useful for qualitative analysis (AU)

["Idiopathic" syringomyelia: report of a case]. / Siringomielia "idiopática"; a propósito de un caso.

Syringomyelia is the condition in which cavities fulfilled with CSF are found within spinal cord. Syringes are caused by obstructions of CSF pathways of different causes. If we can not find a cause responsible for the blockage, we call it "idiopathic" syringomyelia. Drainage procedures have been widely used but results, especially long-term results, are not favourable and complication rate is high. Some authors prefer to restore CSF circulation instead to drain the syrinx. Results of this treatment modality are better in literature than drainage procedures. Adequate radiological studies help to identify problem location and to plan the approach. A case of "idiopathic" syringomyelia is presented. Treatment consisted on arachnoid webs dissection and dural plastia. Clinical and radiological response was good. Literature concerned about this kind of syringomyelia and treatment modalities are reviewed.

Siringomielia “idiopática”: a propósito de un caso / No disponible

intramedularllena de líquido cefalorraquídeo (LCR). En laetiología de toda cavidad siringomiélica subyace unaalteración en la circulación del LCR de diversa índole.Hablamos de formas "idiopáticas" cuando no se identificanmecanismos causales de la misma. El uso de procedimientosderivativos ha sido ampliamente practicadopero el resultado de los mismos, especialmente a largoplazo, no es favorable y asocian un índice de complicacionesimportante. Otras modalidades de tratamientopretenden restaurar la circulación del LCR, eliminandoasí el mecanismo causal de la cavidad. Los resultadoscon este tipo de tratamiento son mejores a la luz de laliteratura publicada. Un adecuado estudio radiológicopermite identificar el espacio problema y planear eficazmenteel abordaje.Se presenta un caso de siringomielia idiopática tratadomediante disección de bridas aracnoideas y plastiadural con buena respuesta clínica y radiológica asícomo se revisa la literatura publicada en torno a estamodalidad de siringomielia y los distintos abordajesterapéuticos (AU)

Syringomyelia is the condition in which cavities fulfilledwith CSF are found within spinal cord. Syringesare caused by obstructions of CSF pathways of differentcauses. If we can not find a cause responsible forthe blockage, we called it "idiopathic" syringomyelia.Drainage procedures have been widely used but results,especially long-term results, are not favourable and complication rate is high. Some authors prefer to restoreCSF circulation instead to drain the syrinx. Resultsof this treatment modality are better in literature thandrainage procedures. Adequate radiological studieshelp to identify problem location and to plan the approach.A case of "idiopathic" syringomyelia is presented.Treatment consisted on arachnoids webs dissection anddural plastia. Clinical and radiological response wasgood. Literature concerned about this kind of syringomyeliaand treatment modalities are reviewed (AU)

[Quality of life in intracranial aneurysm: surgery versus endovascular treatment]. / Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular.

BACKGROUND: Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. METHODS: The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization (n=37). RESULTS: The quality of life of some patients was impaired but 50% of patients treated with surgery and 40.5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. CONCLUSIONS: Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment.

Calidad de vida en pacientes con aneurismas intracraneales: cirugía versus tratamiento endovascular / Quality of life in intracranial aneurysm: surgery versus endovascular treatment

Objetivo. Basados en estudios anteriores, nuestro propósito es determinar la calidad de vida de los pacientes con aneurismas intracraneales después de haber sido intervenido mediante cirugía o embolización y comparar la calidad de vida de estos dos grupos. Material y métodos. El cuestionario SF-36 fue aplicado retrospectivamente a 93 pacientes con aneurismas tratados mediante cirugía (n=56) o embolización (n=37). Resultados. La calidad de vida de los pacientes tratados con cirugía estaba deteriorada en el 50% y en los pacientes tratados por embolización el 40,5% no mostraron ningún deterioro en ninguno de los dominios delSF-36. Los análisis muestran que el dominio de la función física está menos deteriorada en los pacientes que han sido embolizados que los que han sido intervenidos quirúrgicamente. Conclusiones. Los pacientes con aneurismas intracraneales tratados mediante cirugía o embolización tienen afectada la calidad de vida. El tratamiento endovascular puede causar menos limitaciones en la función física. En la calidad de vida de estos pacientes influyen varios factores, además del tipo de tratamiento

Background. Based on earlier studies, we aimed to determine the quality of life of patients with intracranial aneurysm after their treatment by surgery or embolization and to compare the quality of life of these two groups. Methods. The SF-36 health questionnaire was retrospectively applied to 93 patients with intracranial aneurysm treated with surgery (n=56) or embolization(n=37).Results. The quality of life of some patients was impaired but 50% of patients treated with surgery and40,5% of patients treated with embolization showed no impairment in any SF-36 domain. The quality of life in the Physical Functioning domain was higher in embolization-treated than in surgery-treated patients. Conclusions. Some patients with intracranial aneurysms treated with surgery or endovascular embolization have an impaired quality of life. Endovascular treatment may cause less limitation in physical function. The quality of life of these patients is affected by numerous factors, in addition to the type of treatment

[Neuropsychological impairment in patients with intracranial aneurysms: surgical versus endovascular treatment]. / Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular.

OBJECTIVES: To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. MATERIAL AND METHODS: Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. RESULTS: Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better in patients treated by embolization. CONCLUSIONS: Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments.

Alteraciones neuropsicológicas en pacientes con aneurismas cerebrales: tratamiento quirúrgico versus tratamiento endovascular / Neuropsychological impairment in patients with intracraneal aneurysms: surgical versus endovascular treatment

Objetivos. Describir el rendimiento neuropsicológico de pacientes con aneurismas cerebrales que han sido tratados mediante cirugía o embolización, y determinarla existencia de diferencias en función de la modalidad de tratamiento. Material y métodos. Serie clínica compuesta por 93pacientes voluntarios, con aneurismas cerebrales, tratados mediante cirugía (n = 56) o embolización (n = 37). A ambos grupos se les realizó una evaluación neuropsicológica retrospectiva, al menos un año después de realizar el tratamiento. Resultados. En ambos grupos se encontraron pacientes con déficit neuropsicológicos. En el grupo de pacientes tratados quirúrgicamente el porcentaje de pacientes sin ninguna afectación neuropsicológica es del 35.7%, mientras que en el grupo de pacientes embolizados este porcentaje asciende al 43.2%. Los análisis muestran una ejecución mejor en el grupo de tratamiento endovascular, respecto al quirúrgico, sólo en memoria visual y en el recuerdo con claves de la memoria verbal. Conclusiones. Años después del tratamiento, un importante porcentaje de pacientes presenta alteraciones neuropsicológicas. El tratamiento endovascular se asocia con un mejor rendimiento en memoria visual yen el recuerdo con claves de la memoria verbal, aunque explica un porcentaje muy escaso de la varianza. Por lo tanto, en la explicación del deterioro neuropsicológico parece más importante el propio efecto de la hemorragia que la modalidad de intervención

Objectives. To describe the neuropsychological status of patients with intracranial aneurysms and to compare the cognitive status of patients with intracranial aneurysm treated by surgical or endovascular methods. Material and methods. Ninety-three cases with intracranial aneurysms treated with surgery (n = 56) or embolization (n = 37) were included. A neuropsychological assessment was applied to both groups retrospectively, at least one year after treatment. Results. Neuropsychological impairment was found in both groups. 35.7% of the patients treated with surgery and 43.2%, of those treated with embolization did not show any cognitive impairment. Visual Memory and Cued Recall of verbal information are better inpatients treated by embolization. Conclusions. Our results show that a large proportion of patients with intracranial aneurysms have cognitive impairment after treatment. Endovascular management may cause less impairment in visual and verbal memory. However, bleeding may be the most important factor to explain these cognitive impairments