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1.
Acta Neurochir (Wien) ; 165(5): 1261-1267, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36932233

RESUMO

PURPOSE: The intracranial aneurysm (IA) rupture is associated with a subarachnoid hemorrhage. One third of patients die, and one third remain depend for daily activities. Genetic factors are crucial in the formation and clinical evolution of IAs. Multiple loci have been associated with AIs, much of them implicating multiple pathways related to vascular endothelial maintenance and extracellular matrix integrity. Thus, the aim of our study was to characterize whether polymorphisms in genes implicated in the vascular endothelial maintenance could modify the risk of developing IAs. SUBJECTS AND METHODS: We have studied 176 patients with IA recruited in the Service of Neurosurgery at the University Hospital of Valladolid (Spain) and a control group if 150 sex-matched healthy subjects. Clinical variables were collected from each patient. We have analyzed VEGFA rs833061, VEGFR2 rs2071559, endothelin rs5370, endoglin rs3739817, and eNOS rs1799983 polymorphisms. RESULTS: Our results showed that allele T of the eNOS rs1799983 polymorphism is correlated with decreased risk of developing the disease; thus, allele G of the eNOS rs1799983 polymorphism increased the risk of developing IA. CONCLUSION: The association of eNOS rs1799983 polymorphism with the risk to suffer IA reinforces the hypothesis that genetic variants in eNOS gene could be crucial in the pathogenesis of IA.


Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/genética , Aneurisma Intracraniano/complicações , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Hemorragia Subaracnóidea/complicações , Aneurisma Roto/genética , Aneurisma Roto/complicações , Polimorfismo de Nucleotídeo Único/genética , Predisposição Genética para Doença/genética , Estudos de Casos e Controles
2.
Neurol Neurochir Pol ; 56(4): 333-340, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35467006

RESUMO

INTRODUCTION: Chronic subdural haematomas (cSDH) are one of the most common types of traumatic intracranial lesion. Burr-hole craniostomy followed by closed-system drainage has become the treatment of choice. However, there is no definitive indication as to the number of burr-holes needed. Our aim was to to assess clinical and radiological outcomes taking into account the number of burr-holes made. MATERIAL AND METHODS: A retrospective single-centre-study was performed including patients treated for cSDH by performing burr-hole craniostomy from 2012 to 2018. After collecting data regarding demographics, comorbidities, and clinical and radiological records, haematomas were grouped depending on the number of burr-holes made (Group 1: single burr-hole; Group 2: double burr-holes). Clinical and radiological outcomes were statistically compared between groups, as well as the main complications. RESULTS: After collecting 171 patients, 205 cSDHs were analysed. 173 were treated with a single burr-hole (we called these Group 1) and 32 with double burr-holes (Group 2). No differences in preoperative characteristics were found between the groups, except for diabetes mellitus and previous antiplatelet/anticoagulation treatment. No radiological differences were found regarding haematoma volume (p = 0.7) or thickness (p = 0.3). Surgical site infection (p = 0.13), recurrence (p = 0.6), acute rebleeding (p = 0.25) and mortality (p = 0.94) were assessed without evidencing statistically significant differences. At the time of hospital discharge, most patients showed a remarkable clinical improvement, regardless of the number of burr-holes made (p = 0.7). CONCLUSIONS: This study suggests that cSDH can be efficiently evacuated by a single burr-hole craniostomy, a less invasive and shorter surgical procedure with quite good clinical outcomes and a low rate of complications.


Assuntos
Hematoma Subdural Crônico , Craniotomia/métodos , Drenagem/efeitos adversos , Drenagem/métodos , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
3.
J Neurol Surg A Cent Eur Neurosurg ; 83(2): 210-213, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34077979

RESUMO

Malignant middle cerebral artery (MCA) infarction warranting decompressive craniectomy (DC) is unusual in the population younger than 40 years. Specifically, only a few cases affecting pregnant women have been described in the literature. We present the case of a 39-year-old woman in the 24th week of pregnancy who suffered a right malignant MCA infarction that eventually required DC. The patient delivered a healthy baby and underwent a second surgery for cranioplasty 7 months later. We present both this case and a review of the literature, including all cases of DC in pregnant women published to date.


Assuntos
Craniectomia Descompressiva , Adulto , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/cirurgia , Gravidez , Gestantes , Resultado do Tratamento
4.
Neurointervention ; 16(2): 158-164, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34130371

RESUMO

Coil prolapse or migration is a rare but potentially serious complication that may occur during aneurysm embolization, with no standard management currently described. Here we describe our experience with the Embolus Retriever with Interlinked Cages (ERIC) device® (Microvention, Aliso Viejo, CA, USA) for the retrieval of prolapsed or migrated coils in a case series and Flow-Model analysis. First, a retrospective review was performed using our institution database for patients in which coil prolapse or migration occurred during aneurysm embolization, and data was collected and analyzed. Second, an in vitro Flow-Model analysis was performed comparing the ERIC device® with other stent retrievers for coil retrieval. In 2 cases, the ERIC device® successfully retrieved the displaced coil from intracranial circulation in 1 pass, after failure with other devices. In the Flow-Model, again the ERIC device® achieved success for retrieving a detached coil, whereas 2 other different stent retrievers failed to capture the coil after 2 attempts. The ERIC device® appears to be a safe and effective tool for retrieving a prolapsed or migrated coil from the intracranial circulation.

5.
Interv Neuroradiol ; 27(2): 230-234, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32967502

RESUMO

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports. Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Estudos Retrospectivos , Stents , Resultado do Tratamento
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 195-200, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193900

RESUMO

Los quistes aracnoideos espinales son entidades raras y casi siempre tienen una etiología congénita o espontánea. Los casos secundarios son muy poco frecuentes y muchas veces constituyen una causa de deterioro neurológico tras varios meses o años de un traumatismo espinal. Presentamos el caso de un varón diagnosticado de quiste aracnoideo espinal de etiología traumática, agrupamos los casos descritos hasta el momento en la literatura y revisamos las distintas opciones quirúrgicas relacionándolas con las teorías fisiopatológicas que tratan de explicar la génesis de estas lesiones


Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions


Assuntos
Humanos , Masculino , Idoso , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Cistos Aracnóideos/cirurgia , Cistos Aracnóideos/etiologia , Cistos Aracnóideos/diagnóstico , Dor Lombar/etiologia , Espectroscopia de Ressonância Magnética , Distúrbios Somatossensoriais/diagnóstico por imagem , Propriocepção
7.
Neurocirugia (Astur : Engl Ed) ; 31(4): 195-200, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31611140

RESUMO

Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions.


Assuntos
Cistos Aracnóideos , Compressão da Medula Espinal , Doenças da Medula Espinal , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia
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