RESUMEN
OBJECTIVES: Since the introduction of endovascular treatment for cerebral aneurysms, hospitals in which subarachnoid hemorrhage is treated show different availability and/or preferences towards both treatment modalities. The main aim is to evaluate the clinical and angiographic results according to the hospital's treatment preferences applied. METHODS: This study was conducted based on use of the subarachnoid hemorrhage database of the Vascular Pathology Group of the Spanish Neurosurgery Society. Centers were classified into 3 subtypes according to an index in the relationship between endovascular and surgical treatment as: endovascular preference, high endovascular preference, and elevated surgical preference. The clinical results and angiographic results were evaluated among the 3 treatment strategies. RESULTS: From November 2004 to December 2017, 4282 subarachnoid hemorrhage patients were selected for the study: 630 (14.7%) patients from centers with surgical preference, 2766 (64.6%) from centers with endovascular preference, and 886 (20.7%) from centers with high endovascular preference. The surgical preference group obtained the best angiographic results associated with a greater complete exclusion (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). The surgical preference subgroup obtained the best outcome at discharge (65.45%), followed by the high endovascular preference group (61.5%) and the endovascular preference group (57.8%) (odds ratio: 1.359; 95% confidence interval: 1.025-1.801; P = 0.033). CONCLUSIONS: In Spain, there is significant variability in aneurysm exclusion treatment in aneurysmal subarachnoid hemorrhage. Surgical centers offer better results for both surgical and endovascular patients. A multidisciplinary approach and the maintenance of an elevated quality of surgical competence could be responsible for these results.
Asunto(s)
Procedimientos Endovasculares , Aneurisma Intracraneal/cirugía , Procedimientos Neuroquirúrgicos , Hemorragia Subaracnoidea/cirugía , Adulto , Anciano , Bases de Datos Factuales , Procedimientos Endovasculares/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Instrumentos Quirúrgicos , Resultado del TratamientoAsunto(s)
Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Hipofisarias/diagnóstico , Adenoma , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Persona de Mediana Edad , Neoplasias Primarias Múltiples/cirugía , Neoplasias Hipofisarias/cirugíaAsunto(s)
Neoplasias Cerebelosas/complicaciones , Hemangioblastoma/complicaciones , Hidrocefalia/etiología , Complicaciones Neoplásicas del Embarazo , Adulto , Neoplasias Cerebelosas/cirugía , Cesárea , Femenino , Hemangioblastoma/cirugía , Humanos , Embarazo , Complicaciones Neoplásicas del Embarazo/cirugía , Tercer Trimestre del EmbarazoRESUMEN
Spinal dural arteriovenous fistulas (SDAVF) are the most frequently occurring vascular malformations of the spinal cord but their optimal treatment remains contentious. We retrospectively analyzed 19 consecutive patients treated between 1996 and 2007. Endovascular embolization was considered the first treatment option for nine patients. Ten patients did not fulfill the endovascular indications and underwent surgery. Four patients required a second treatment with surgery: three following failed embolization and one following surgery. Clinical outcomes were assessed using the Aminoff-Logue disability scale (ALS). The mean follow-up time was 36 months (range=4-103 months). At follow-up, 79% of patients showed stabilization or improvement on the ALS. The overall efficacy of embolization was 55.6%, compared to 100% with surgery (p=0.03). Multidisciplinary treatment with embolization or surgery offers good long-term results. Whenever embolization does not ensure a complete closure of the venous side of the fistula, surgery should be considered as the first treatment because of its lower late recurrence rate.
Asunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/terapia , Embolización Terapéutica , Enfermedades de la Médula Espinal/terapia , Médula Espinal/anomalías , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Médula Espinal/irrigación sanguínea , Resultado del TratamientoRESUMEN
Blunt traumatic injuries of the intracranial carotid arteries can result in pseudoaneurysm formation. A pseudoaneurysm of the intracavernous carotid artery may rupture into the cavernous sinus, causing life-threatening epistaxis. We report a case of intracavernous traumatic psedoaneurysm presenting with delayed massive epistaxis. The endovascular treatment with overlapping self-expanding stents achieved complete exclusion of the pseudoaneurysm with preservation of the intracavernous carotid artery.