Estudio de la prevalencia del nacimiento y de la presencia de bucle caudal extracraneano de arterias cerebelosas posteroinferiores en una población estudiada por angiografía cerebral / Study of the prevalence of origin and the presence of an extracranial caudal loop of the posterior inferior cerebellar arteries in a population studied by cerebral angiography

Introducción. La arteria cerebelosa posteroinferior (ACPI) nace de la arteria vertebral en la cara anterolateral del tronco cerebral, generalmente a la altura de la oliva inferior, transcurriendo en forma rostral a través de las raíces de los nervios glosofaríngeo, vago y accesorio. El objetivo del trabajo es determinar la prevalencia del nacimiento de la arteria cerebelosa postero inferior a nivel extracraneano, la presencia de bucle caudal extracraneano y las relaciones con estructuras oseas adyacentes, en una población estudiada por angiografía de vasos supraaórticos. Material y métodos. Estudio prospectivo, descriptivo, de una muestra consecutiva realizada durante un año (septiembre 2021 a agosto 2022) de todos los pacientes a los que se les realizó un cateterismo de vasos de cuello y cerebrales en Neurointervencionismo del Hospital de Alta Complejidad en Red "El Cruce", Buenos Aires, Argentina.Los estudios se realizaron en dos angiógrafos digitales en forma indistinta en incidencia perfil, con y sin digitalización de imagen, focalizadas en la unión craneo-cervical en todos los pacientes estudiados entre 18 y 80 años. Se objetivó el lugar de nacimiento de las arterias ACPI y la presencia de bucles extracraneanos por visión directa en los estudios sin y con sustracción. Se definió como bucle o loop extracraneano a la presencia de un segmento curvo de la arteria con dirección caudal que se extiende por debajo del foramen magno. Se buscó la concordancia interobservador entre 2 profesionales en forma independiente. Resultados. De los 404 procedimientos realizados en el período estudiado ingresaron 288 pacientes al estudio, de los cuales 152 fueron mujeres. La edad promedio fue de 49,2 años. Se analizaron 422 ACPI, 214 derechas y 208 izquierdas. Se observaron un total de 102 ACPI con bucles extracraneanos, representando un 24,1% del total: 49 derechos (48%) y 53 izquierdos (52%). En relación a arterias con origen extracraneal, se observaron en total 58 (13,7%) de las cuales 29 fueron derechas (50%). En 10 casos se observó en la misma arteria nacimiento y loop extracraneano (10%) y en dos casos nacimiento y loop extracraneano bilateral (3.9%). En 13 casos la arteria vertebral fue terminal en ACPI, de las cuales 5 presentaron un loop extracraneano, representando el 38,5 % de su población, siendo en su totalidad del territorio derecho. Conclusión. La prevalencia del nacimiento extracraneano de la ACPI en la población estudiada por angiografía fue de 13,7% y la prevalencia de bucle extracraneano fue del 24%. Ambos porcentajes se encuentran dentro de los resultados hallados en estudios previos, anatómicos y por imágenes: 0,7 al 20% y 9,5 al 35% respectivamente. La prevalencia de bucle extracraneano en arterias vertebrales con terminación en ACPI fue del 38,5%, siendo significativamente superior a los estudios reportados

Background. The posteroinferior cerebellar artery (PICA) arises from the vertebral artery on the anterolateral aspect of the brain stem, generally at the level of the inferior olive, running rostrally through the roots of the glossopharyngeal, vagus and accessory nerves. The objective of the work is to determine the prevalence of the origin of the posterior inferior cerebellar artery at the extracranial level, the presence of an extracranial caudal loop and the relationships with adjacent bone structures, in a population studied by angiography of supra-aortic vessels. Methods. Prospective, descriptive study of a consecutive sample carried out for one year (September 2021 to August 2022) of all patients who underwent catheterization of neck and cerebral vessels in the "Hospital de Alta Complejidad en Red El Cruce", Buenos Aires, Argentina. The studies were carried out in two digital angiographers indistinctly in profile incidence, with and without image digitization, focused on the cranio-cervical junction in all patients studied between 18 and 80 years of age. The birthplace of the ACPI arteries and the presence of extracranial loops were observed by direct vision in the studies without and with subtraction. An extracranial loop was defined as the presence of a curved segment of the artery with a caudal direction that extends below the foramen magnum. Interobserver agreement was sought between 2 professionals independently. Results. Of the 404 procedures performed in the studied period, 288 patients entered the study, of which 152 were women. The average age was 49,2 years; 422 PICA were analyzed, 214 right and 208 left. A total of 102 PICA with extracranial loops were observed, representing 24.1% of the total: 49 right (48%) and 53 left (52%). In relation to arteries with extracranial origin, a total of 58 (13.7%) were observed, of which 29 were right (50%). In 10 cases birth and extracranial loop were observed in the same artery (10%) and in two cases birth and bilateral extracranial loop (3.9%). In 13 cases the vertebral artery was terminal in PICA, of which 5 presented an extracranial loop, representing 38.5% of its population, being entirely in the right territory. Conclusions. The prevalence of extracranial origin of the PICA in the population studied by angiography was 13.7% and the prevalence of extracranial loop was 24%. Both percentages are within the results found in previous anatomical and imaging studies: 0.7 to 20% and 9.5 to 35% respectively. The prevalence of extracranial loop in vertebral arteries ending in PICA was 38.5%, being significantly higher than the reported studies

Fístula arteriovenosa dural del canal del hipogloso: reporte de caso y descripción de la anatomía / Dural arteriovenous fistula of the hypoglossal canal: case report and description of the anatomy

Introducción. Las fístulas durales arteriovenosas del canal del hipogloso (FDCH) son infrecuentes y suelen ser diagnosticadas tardíamente. Habitualmente se presentan con compromiso del par XII aunque pueden presentarse con síntomas diversos. Objetivos. Presentar un caso de FDCH que se presentó con proptosis y ojo rojo tratado por vía endovascular y describir la anatomía asociada. Descripción del caso. Un hombre de 51 años consultó por quemosis, exoftalmo y dolor ocular leve persistente durante un año. Las pruebas de imagen revelaron una lesión en la base del cráneo, sugestiva de malformación arteriovenosa, con drenaje hacia el bulbo yugular derecho y la vena oftálmica superior derecha. Se descartaron otras causas como tumores metastásicos. Intervención. Se realizó tratamiento por vía endovascular. Se utilizó un abordaje combinado arterial y venoso. La embolización arterial se hizo con un agente embolizante líquido de etilen vinil alcohol -logrando una oclusión parcial- y luego se completó la misma por vía venosa con hélices de platino (coils), logrando la oclusión total de la fístula. El paciente se recuperó favorablemente, con mejoría progresiva de los síntomas oculares. Experimentó una leve paresia del nervio XII derecha en el período postoperatorio inmediato, que se trató con corticoides. Fue dado de alta al quinto día. En el seguimiento a los 6 meses, la lesión no mostraba persistencia en las imágenes de resonancia magnética. Conclusión. Se presenta un caso de fístula dural arteriovenosa del canal del hipogloso tratada por vía endovascular con oclusión completa de la misma

Background. Dural arteriovenous fistulas of the hypoglossal canal are infrequent and are usually diagnosed late. They usually present with involvement of the XII cranial nerve, although they can present with various symptoms. Objectives. To present a case of dural arteriovenous fistulas of the hypoglossal canal that presented with proptosis and red eye treated endovascularly and describe the associated anatomy. Description of the case. A 51-year-old man presented with chemosis, exophthalmos, and mild eye pain that had persisted for one year. Imaging tests revealed a lesion at the skull base, suggestive of arteriovenous malformation, with drainage towards the right jugular bulb and the right superior ophthalmic vein. Other causes such as metastatic tumors were ruled out. Surgery. Endovascular embolization was performed to treat the dural arteriovenous fistula. A combined approach using arterial and venous was used. The arterial embolization was done with a liquid embolization agent of ethylene vinyl alcohol -achieving partial occlusion- and then was completed through a venous approach with platinum coils, achieving total occlusion of the fistula. The patient recovered favorably, with progressive improvement of ocular symptoms. He experienced mild right XII nerve palsy postoperatively, which was treated with steroids. He was discharged on the fifth day. At 6-month follow-up, the lesion showed no persistence on magnetic resonance images. Conclusion. A case of arteriovenous dural fistula of the hypoglossal canal treated endovascularly with complete occlusion is presented

Tratamiento de la hipertensión endocraneana idiopática con angioplastía de seno transverso / Transverse Sinus Stenting: A Treatment for Idiopathic Intracranial Hypertension. Technical Note

Introducción: La hipertensión endocraneana idiopática (HEI) o pseudotumor cerebri es una enfermedad de origen y fisiopatología desconocida que puede generar graves consecuencias. El abordaje terapéutico clásico inicial es la dieta hipocalórica y la acetazolamida. La fenestración de la vaina del nervio óptico y la colocación de un sistema de derivación de LCR constituyen procedimientos quirúrgicos clásicos aceptados para esta entidad en los casos sin respuesta al manejo farmacológico. En 1995 se describió la asociación de la HEI y la estenosis de senos transversos y en 2002 se publicó el primer caso de angioplastía de seno transverso como tratamiento exitoso de la HEI en un paciente. En los últimos 20 años se han reportado múltiples casos y series de casos con excelentes resultados pasando a formar parte de las herramientas válidas para el tratamiento de esta entidad. Objetivo: Describir la técnica de angioplastía e implantación de stent en el seno transverso como tratamiento de la hipertensión endocraneana idiopática. Material y métodos: Descripción de la técnica quirúrgica y los dispositivos utilizados para la angioplastía del seno transverso en un paciente con HEI asociado a estenosis del mismo. Conclusiones: Se describe la técnica de angioplastía e implantación de un stent en el seno transverso en una paciente con diagnóstico de HEI asociado a estenosis de seno trasverso con buena evolución(AU)

Background: Idiopathic intracranial hypertension (IIH) is a disease of unknown etiology and physiopathology that can generate serious consequences. The initial classical treatment is weight loss and acetazolamide. Optic nerve fenestration surgery and CSF diversion are accepted as surgical procedures for the treatment of this entity. In 1995, the association of IIH and dural sinus stenosis by venography was described and in 2002 the first case of stent implantation in transverse sinus as a successful treatment of IIH in a patient was published. In the last 20 years have been published multiple case reports and case series with excellent results, becoming part of the valid tools for the treatment of this disease. Objective: To describe surgical technique of stenting the transverse sinus in a patient with IIH diagnosis. Material and methods: Description of diagnosis steps and stenting technique of transverse sinus in a patient with IIH associated to transverse sinus stenosis. Conclusions: We describe stenting technique of transverse sinus in a patient with IIH diagnosis(AU)

Transradial Approach to Cerebral Aneurysm Occlusion in a Patient with an Aberrant Right Subclavian Artery: A Case Report.

BACKGROUND Retroesophageal right subclavian artery, aberrant right subclavian artery, or lusoria artery constitutes an anatomical variation with a very low prevalence in the general population. Its presence in a patient does not add difficulty for cerebral arteries catheterization when a femoral approach is used, but may make the catheterization of cerebral vessels difficult when a right transradial approach is used. Unfortunately, this type of configuration of the artery is discovered after the decision to use the type of approach. CASE REPORT A 60-year-old woman with a diagnosed subarachnoid hemorrhage was studied with angiography through a transradial approach. A left carotid bifurcation aneurysm was diagnosed after three-vessel angiography was performed with a Simmons type 2 catheter, making a complete loop between the right subclavian artery, aortic arc, and left carotid artery. The ruptured cerebral aneurysm was completely occluded with 8 coils. The microcatheter used for the procedure emerged from the tip of an intermediate catheter located at the union of the vertical and horizontal segment of the petrous segment of the left carotid artery. CONCLUSIONS The presence of an aberrant right subclavian artery during cerebral angiography performed through a right transradial approach renders the treatment of a left carotid cerebral aneurysms more difficult but not impossible. Utilizing an appropriate intermediate catheter allows for stable navigation of the microcatheter and complete treatment of the aneurysm. This is the first report of cerebral aneurysm embolization through a right transradial approach in a patient with an aberrant right subclavian artery.

Approach to the Superior Ophthalmic Vein for Endovascular Treatment of Cavernous Dural Fistula.

The cavernous sinus area is the second most common location for intracranial dural fistulas. Although these spontaneous dural cavernous fistulas are self-limited, a sizeable number of patients will develop progressive vision loss, diplopia, or intractable glaucoma, which warrant interventional therapy.1,2 We present the case of a 54-year-old male with hypertension and type 2 diabetes, who presented with a red right eye associated with progressive exophthalmos, ophthalmoparesis, and deterioration of visual acuity. The angiotomography showed the exophthalmos with an ingurgitated superior ophthalmic vein, with early filling in the arterial phase. A digital angiography was made, and a diagnosis of dural cavernous fistula, Barrow type D was made.3 Considering several transvenous approaches, alternatives included inferior petrosal sinus, access through the superior ophthalmic vein, and an open approach.4 In this particular case the inferior petrosal sinus was not present, so we tried to catheterize through the facial vein and also puncture the ophthalmic vein. Both procedures were unsuccessful. We decided to perform, then, an open approach with the oculoplastic surgery team (Video 1). Through an eyelid dissection, we localized the superior ophthalmic vein and then canalized it by direct visualization.5 With this approach, we were able to perform the cavernous sinus packing with coils and achieved a complete occlusion of the fistula. We reproduced the direct approach to the superior ophthalmic vein in a cadaveric specimen and schematized it step by step with 3-dimensional photographs.6.

Outpatient treatment of cerebral aneurysms: A case series.

BACKGROUND: Major advances in the endovascular treatment of cerebral aneurysms have reduced the incidence of intra- and postprocedural complications. The length of stay after treatment for incidental aneurysms remains between early next-day discharge and 2 days. We hypothesized that discharging patients the same day would not be associated with any increase in the rate of postdischarge adverse events. METHODS: We retrospectively reviewed the charts of patients who underwent an elective coiling procedure between 2015 and 2020 at three centers and were discharged from hospital on the same day as the procedure. Patients were clinically evaluated 6 h, 1 week, and 6 months after the procedure, with repeat cerebral angiography performed 1 year after the procedure. RESULTS: Eleven eligible patients underwent outpatient treatment of 12 aneurysms treated through the wrist. No complications were identified within 1 week of the procedure. Clinical evaluation 6 months after treatment also failed to reveal any complication associated with the procedure. Only one of the seven patients who underwent 1 year angiography required retreatment. CONCLUSION: It is possible to safely perform coiled embolization of cerebral aneurysms in select outpatients with unruptured cerebral aneurysms.

La búsqueda de un estándar teórico en la educación de los neurocirujanos de la Argentina / The search for a theoretical standard in the education of neurosurgeons in Argentina

Uno de los objetivos de la Asociación Argentina de Neurocirugía (AANC) es la educación. La heterogeneidad en la formación teórica de los neurocirujanos argentinos originó la falta de un estándar en la adquisición, crecimiento y mantenimiento de las competencias. Para resolverlo se comenzó un proceso centrado en la educación de calidad que buscó establecer estándares teóricos. Fue esencial el uso del aprendizaje electrónico para poder llegar a todos los rincones del país y lograr una formación teórica homogénea. Al aprobar los contenidos de los cursos on-line, más la experiencia práctica obtenida durante la residencia, el postulante estaría en condiciones de rendir el examen final de certificación e ingresar como miembro titular a la AANC. Los resultados de esta estrategia mostraron que todos los postulantes para los exámenes de certificación tuvieron la misma formación teórica. También se produjo un gran aumento de los postulantes a la certificación. Los resultados demuestran que cuando se crean las condiciones adecuadas, los profesionales participan y se someten a las exigencias de un examen de certificación.

One of the objectives of the Asociación Argentina de Neurocirugía (AANC) is education. Heterogeneity in the theoretical training of Argentine neurosurgeons caused the lack of a standard in the acquisition, growth and maintenance of competencies. To resolve this, a process focused on quality education began, which sought to establish theoretical standards. The use of electronic learning was essential to be able to reach all corners of the country and achieve homogeneous theoretical training. By passing the contents of the online courses, plus the practical experience obtained during the residency, the applicant would be able to take the final certification exam and enter the ANA as a full member. The results of this strategy demonstrated that all applicants for the certification exam had the same theoretical training. Also, there was a large increase in applicants for certification and that when the right conditions are created, professionals participate and submit to the demands of a certification exam

Transradial approach and its variations for neurointerventional procedures: Literature review.

BACKGROUND: The transfemoral approach (TFA) has been the standard in neuroradiology over the years. However, the transradial approach (TRA) and its variants offer several benefits over the TFA. METHODS: Review of the literature about TRA and its variations. We present our results for different neurointerventional procedures at our institution between January 2018 and December 2019. RESULTS: We wrote an educational review describing anatomical and technical aspects, advantages, and complications of this approach. In the past year we increased the percentage of neurointerventional procedures performed through radial or ulnar arteries. CONCLUSION: There are clearly proven benefits of employing a wrist approach in patients for neurointerventional procedures and its utilization should especially be considered on a daily basis.

Residencia médica: el camino hacia la confección de un marco de referencia en neurocirugía / Medical residency: the path towards the creation of a frame of reference in neurosurgery

Las residencias médicas conforman la base de la educación médica de posgrado y es el método idóneo que permite el paso del médico graduado al médico general o especializado. Desde la asociación consideramos que es fundamental establecer estándares educativos válidos y confiables, absolutamente necesarios para la formación de postgrado. Luego de un trabajo de varios meses, que incluyó un censo y una encuesta de residencias, se arribó a la versión definitiva del marco de referencia sobre la residencia médica en la especialidad Neurocirugía. En la Argentina censamos, entre públicos y privados, 62 programas de residencia. La encuesta buscó diseñar un mapa de las residencias, relevando datos duros y características generales a través de una encuesta diseñada ad hoc. La necesidad de contar con una base teórica que regule y organice el desarrollo pedagógico de las residencias médicas, determinó el diseño y la implementación de un procedimiento de trabajo basado en acuerdos metodológicos y de contenidos, cuyo producto final fue el marco de referencia de la residencia. Su lectura y análisis propiciará propuestas y acciones que impulsen a una autoevaluación -siempre necesaria y beneficiosa- y, consecuentemente, al mejoramiento de la calidad de la formación que otorgamos y reciben los futuros especialistas en Neurocirugía

Medical residences form the basis of postgraduate medical education and is the ideal method that allows the passage of the graduate doctor to the general or specialized doctor. From the association we consider that it is essential to establishg valid and reliable educational standards, absolutely necessary for postgraduate training. After a work of several months, which included a census and a survey of residences, the final version of the framework on medical residence in the specialty Neurosurgery was reached. In Argentine we censure, between public and private, 62 residency programs. The survey sought to design a map of the residences, relieving hard data and general characteristics through a survey designed ad hoc. The need to have a theoretical basis that regulates and organizes the pedagogical development of medical residences, determined the design and implementation of a work procedure based on methodological and content agreements, whos final product was the reference framework of the residence. Its reading and analysis will propitiate proposals and actions that promote a self-evaluation -always necessary and beneficial- and, consequently, to improve the quality of the training that we grant and receive the future specialists in Neurosurgery

Distal radial approach for neurointerventional diagnosis and therapy.

BACKGROUND: The transradial approach results in fewer complications at the puncture site, lower hospital costs, and greater comfort for patients. The distal transradial approach (dTRA) adds some benefits over the conventional radial approach. The objective is to describe initial experience with distal radial approach technique and the results obtained for neuroendovascular diagnostic and therapeutic procedures. METHODS: Description of distal radial approach technique and obtained data from the first 3 months experience using this approach as the first choice for neuroendovascular procedures in two neuroendovascular centers. RESULTS: Of the total of 94 procedures performed during 3 months, 67 were diagnostic and 27 were therapeutic. Eleven (16%) of the diagnostic procedures were performed through the dTRA. Of the 27 embolizations, eight (30%) were done using this approach. Every distal radial approach that was performed for diagnosis and therapeutics was successful. CONCLUSION: Puncture of the radial artery within the anatomical snuffbox is a radial approach variation option for diagnostic and therapeutic neuroendovascular procedures.

Transradial approach for endovascular diagnosis and treatment of ruptured cerebral aneurysms: A descriptive study.

BACKGROUND: For cardiovascular procedures, the transradial approach has been documented to yield fewer complications than the femoral approach. It has become the approach of choice for diagnostic and therapeutic interventions involving the coronary arteries. However, few published data exist on using this approach for neuroendovascular procedures and we describe a series of ruptured cerebral aneurysms diagnosed and treated using the transradial approach. METHODS: All patients scheduled for cerebral angiography to diagnose and treat subarachnoid hemorrhages at our hospital from June 2016 to May 2018, by right radial artery access, were recruited and followed prospectively. The main outcomes of interest were the length of the procedure (in minutes), the success of treatment, and the incidence of postprocedural complications. RESULTS: Over the observation period, 59 patients (66% women, mean age = 48 years) with a combined 61 aneurysms treated were identified who met inclusion criteria. Of the 61 aneurysms treated, eight (13%) were within the posterior circulation (13%) and 53 (87%) the anterior circulation. Average procedural duration was 64.9 min. No occlusion or spasm of the radial artery was observed during any procedure. All patients had immediate pre- and post-embolization angiography, which revealed the guide catheter coming from the right subclavian artery. A radial pulse was evident after all interventions. All procedures were considered successful at treating the ruptured aneurysm, and no patient experienced a clinically significant complication related to the approach. CONCLUSIONS: The transradial approach is a viable option for the diagnosis and endovascular treatment of acute cerebral aneurysms in different locations.

Catheter fragment retrieved from an arterial branch of the right middle cerebral artery.

BACKGROUND: Cerebral emboli is a rare complication of endovascular procedures and foreign bodies in the cerebrovascular system can lead to stroke. When an intravascular foreign body is identified, endovascular retrieval should be attempted due to its high success rate and minimal morbidity. CASE DESCRIPTION: A 59-year-old male patient underwent cine-coronario-graphy through a trans-radial approach because of angina. During the study, a 6Fr catheter fragment ruptured, detached and migrated to a right middle cerebral artery branch. We recovered it with a coronary balloon. CONCLUSION: A coronary angioplasty balloon is an option for retrieving foreign objects or device fragments that have migrated into cerebral vasculature.

Transradial approach to treating endovascular cerebral aneurysms: Case series and technical note.

BACKGROUND: Several benefits have been described over the years of the transradial versus femoral endovascular approach to cardiac interventions. Consequently, its use has become habitual at most centers that perform cardiac catheterizations. This paper details a right transradial approach, incorporating a variety of coils or flow diverters, which can be utilized for the endovascular treatment of different cerebral aneurysms. METHODS: From 2014 to 2016, we performed 40 endovascular procedures to treat cerebral aneurysms adopting the same right transradial approach. Five aneurysms were treated with flow diverters and 35 were treated with coils. Seven of these aneurisms were asymptomatic, whereas 33 had already ruptured. RESULTS: Satisfactory treatment was achieved in all cases through the same approach in the absence of any complications. CONCLUSIONS: A right transradial approach may be satisfactory for the endovascular treatment of different cerebral aneurysms, including aneurysms in either hemisphere. This is the largest series of cerebral aneurysms treated through a transradial approach.

Fístula dural cavernosa. presentación de 3 casos y revisión bibliográfica / Cavernous dural fistula. presentation of 3 cases and bibliographic review

Objetivo: Describir la etiología, forma de presentación, evolución y conducta terapéutica adoptada en tres casos de fístulas durales cavernosas (FDC) y realizar una revisión bibliográfíca. Materiales y métodos: Se presentan tres casos de FDC, una, post-traumática; otra, secundaria a trombosis del seno cavernoso contralateral; y la tercera sin causa conocida. Todos los pacientes se presentaron con proptosis, diplopía, quemosis, ptosis palpebral e inyección conjuntival. Dos de ellos referían disminución de la agudeza visual. Ante la sospecha clínica, se realizaron estudios por imágenes no invasivos en dos pacientes, y el diagnóstico fue confirmado por angiografía digital cerebral en los tres casos. La conducta terapéutica consistió en la oclusión del seno cavernoso con coils a través de un acceso venoso femoral transoftálmico en el primer caso, anticoagulación como tratamiento de la trombosis de seno cavernoso contralateral en el segundo y compresión ocular diaria por 3 meses en el tercero. Resultados: En todos los casos, se logró la resolución completa de los síntomas. Conclusiones: La FDC es una entidad diferenciada del resto de las fístulas durales. Se dispone de diversas estrategias terapéuticas, con resultados favorables. También se observa una alta tasa de remisión espontánea. En dos de los casos presentados, el manejo de forma conservadora fue eficaz para la resolución del cuadro. En el caso que requirió tratamiento endovascular para el cierre de la fistula, el acceso por vía venosa femoral transoftálmica constituyó un abordaje efectivo para lograr la oclusión de la misma.

Objective: To describe the etiology, presentation, evolution and therapeutic approach adopted in three cases of dural cavernous fistulas (DCCF) and to perform a literature review.Materials and methods: Three cases of DCCF are report, one, post-traumatic lession; another secondary to contralateral cavernous sinus thrombosis; and the third with unknown etiology. All patients presented with proptosis, diplopia, chemosis, ptosis and conjunctival injection. Two of them concerned vision impairment. Noninvasive imaging studies were performed in two patients, and the diagnosis were confirmed by cerebral angiography digital in all three cases. The therapeutic approach consisted of cavernous sinus occlusion with coils through a femoral venous access in the first case, anticoagulation treatment of contralateral cavernous sinus thrombosis in the second and ocular compression daily for 3 months in the third. Results: Complete resolution of symptoms was achieved in all cases.Conclusions: The FDC is a distinct entity from the rest of the dural fistulas. It has several therapeutic strategies, with favorable results. A high rate of spontaneous remission is also observed. In two cases, conservative management was effective in the resolution of the picture. In the case requiring endovascular treatment for closure of the fistula, femoral vein transoftálmic acces was an effective approach to achieve occlusion of it.

Angiografía cerebral por abordaje transradial. experiencia inicial y resultados / Cerebral angiography by transradial approach. initial experience and results

Introducción: El abordaje transradial es utilizado en forma rutinaria para la realización de angiografías coronarias y en menor medida cerebrales. El objetivo de este trabajo es presentar la experiencia inicial de este abordaje realizado en un centro. Material y métodos: Realizamos una revisión de todas las angiografías cerebrales diagnósticas realizadas en forma consecutiva en el Hospital El Cruce, entre julio y diciembre de 2015, y los resultados obtenidos mediante el abordaje transradial. Se calculó la proporción de estudios realizados por esta vía, el tiempo de estadía hospitalaria de los pacientes y la ocurrencia de complicaciones asociadas al mismo. La elección del abordaje se realizó de acuerdo a la decisión del operador. Resultados: Entre julio y diciembre de 2015, se realizaron 89 angiografías cerebrales en pacientes de 14 a 80 años. Los abordajes realizados por punción de la arteria radial fueron 45 (50,56%) y en todos los casos se logró el diagnóstico adecuado de la anatomía vascular. No se observaron complicaciones asociadas al abordaje. La estadía del paciente luego de la angiografía fue en promedio de 75 min. Conclusiones: El abordaje transradial permitió el estudio de todas las arterias cerebrales en todos los pacientes sometidos al mismo. No hubo limitaciones para realizar este abordaje en relación a sexo ni edad. El tiempo de estadía posterior al procedimiento fue similar al promedio descripto en la literatura con este abordaje. No se observaron complicaciones severas asociadas a esta vía.

Introduction: The transradial approach is routinely used to perform both coronary and, to a lesser extent, cerebral angiographic studies. The aim of this study was to review our experience with this approach.Methods: We review all diagnostic cerebral angiographies performed consecutively in the El Cruce Hospital between July and December 2015 and the results obtained using the transradial approach. The proportion of studies conducted in this way, the length of hospital stay of patients and the occurrence of complications associated with it are calculated. The choice of approach was performed according to the decision of the operator.Results: Between July and December 2015, 89 cerebral angiograms were performed in patients between 14 and 80 years old. Of these, 45 (50.6%) were performed utilizing a transradial approach. No complications were observed associated with this technique. The patient's mean stay post angiogram was 75 minutes. Moreover, all the studies performed via the transradial approach allowed for the adequate diagnosis of cerebral vessels anatomy.Conclusions: In our experience performing cerebral angiographies, the transradial approach is associated with complete studies, a negligible complication rate and a short stay post-procedure. No important complications were observed with this approach.

Clipado parcial de vaso receptor asociado a sutura microvascular: modelo experimental en ratas / Partial clipping of receptor Wessel associated to microvascular suture: experimental model in rats

Objetive: to determine the possibility of partial clamping and maintaining small arteries flow within a modified clip. To perform an end to side anastomosis in an artery partially clamped and demonstrate its permeability. Method: partial carotid clamping in rats and intraluminal flow measurement. End to side anastomosis suture of the vessels clamped. Histopathologic study of the brains. Results: the persistence of flow during partial clamping of the vessel. Anastomosis remained permeable after the procedures. Eas confirmed no signs of ischemia in brains fixed were reported. Conclusion: this modification in the clip allows an end to side anastomosis with partial clamping of the recipient vessel, keeping the flow within in, in small vessels.

Fístula carótido-cavernosa: reporte del primer caso tratado en el Hospital El Cruce con microbalones desprendibles por vía endovascular / Carotid-cavernous fistula: report of the first case treated at El Cruce Hospital with removable microballoons by endovascular

Se presenta el caso de un paciente de 31 años derivado de hospital oftalmológico con antecedente de trauma asociado a ojo rojo derecho, de 15 días de evolución. Al exámen el paciente presenta exoftalmos y oftalmoparesia con inyección conjuntival en ojo derecho. Se realizó angiografía digital cerebral que evidenció la presencia de fístula carótido-cavernosa derecha directa con ausencia de flujo carotídeo distal y una pobre irrigación de la carótida contralateral a través de la anteria comunicante anterior. Se realizó el tratamiento por vía endovascular colocando dos microbalones desprendibles con recuperación del flujo carotídeo derecho, desaparición de la comunicación anómala arterio-venosa y recuperación de la función oftálmica y óculomotora del ojo afectado.