Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas / No disponible

Introducción y objetivos Las fístulas arteriovenosas piales son malformaciones vasculares infrecuentes. Generalmente son congénitas y su historia natural es ominosa. El objetivo es describir nuestra experiencia en su manejo endovascular y analizar la literatura. Pacientes y métodos Es un estudio retrospectivo descriptivo de pacientes tratados por vía endovascular durante 3 años en 3 instituciones latinoamericanas. Resultados Fueron 6 pacientes con edad media de 22 años. Un caso fue resultado de un traumatismo. El 50% presentó hemorragia intracraneal, el 66% desarrollaron clínica secundaria a efecto de masa y al flujo retrógrado. En los estudios de imagen se observaron varices intracraneales en el 83% de los casos. La angiografía cerebral mostró arterias fistulosas provenientes de la circulación anterior en el (..) (AU)

[Endovascular treatment of non-galenic pial arteriovenous fistulas]. / Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas.

INTRODUCTION AND OBJECTIVES: Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature. PATIENTS AND METHODS: This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals. RESULTS: The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free. CONCLUSIONS: Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.

[Management of chronic subdural hematoma with twist-drill craniostomy. Report of 213 patients]. / Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.

Aneurismas infecciosos / Infectious aneurysms

Los aneurismas micóticos de la circulación cerebral, son poco frecuentes y se asocian generalmente con endocarditis bacteriana. Se asocian a morbimortalidad elevada y su diagnóstico, auque se basa principalmente en datos clínicos además de algunas características angiográficas, tal como la localización y morfología, pueden ser un verdadero reto. Aunque muchos de estos aneurismas han presentado regresión con el manejo antibiótico, su comportamiento no es predecible en relación a su ruptura. Por tanto el objetivo del tratamiento, aunque difícil, debe ser la exclusión del aneurisma del árbol circulatorio ya sea mediante técnicas quirúrgicas o endovasculares.

Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes / Management of chronic subdural hematoma with twist-drill craniostomy: report of 213 patients

Objetivos: Aún existen controversias respecto a la técnica en el manejo quirúrgico del hematoma subdural crónico. Este estudio tiene como objetivo describir nuestra experiencia en la craneostomía mediante el uso de minitrépano (twist drill). Pacientes y métodos: Fueron tratados 213 pacientes en los hospitales “Teodoro Maldonado Carbo” y “Alcívar” de Guayaquil, entre los meses de enero del 1992 y febrero del 2005. La técnica quirúrgica consistió en la evacuación del hematoma mediante minitrépano que se realizó en la cama del paciente y bajo anestesia local. Para evaluar los resultados utilizamos las escalas de Markwalder y la escala de evolución de Glasgow. Valoramos la evolución, las complicaciones y la recidiva. Resultados: Existió antecedente traumático en 65 % de los casos. Setenta y nueve por ciento ingresaron en grado 2 de la escala de Markwalder. Nueve por ciento presentó alguna complicación. Ocho por ciento recidivó, pero mostró curación después de un nuevo procedimiento. A los 6 meses, el 97 % evolucionó en grado 5 según la escala de evolución Glasgow. Conclusiones: La craneostomía por minitrépano es un método rápido, seguro, efectivo y menos costoso.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.