[Presentation of distal saccular aneurysm as a subdural haematoma]. / Aneurisma sacular distal presentándose como hematoma subdural.

INTRODUCTION: Intracranial aneurysms are one of the most frequent vascular diseases. Nevertheless, saccular aneurysms that are not due to an inflammatory aetiology, which are located in the peripheral segment of the posterior circulation, are extremely rare. They are most frequently located in the thickest arterial branches within the region of the anterior brain circulation, as is the case of the complex made up of the anterior cerebral artery posterior communicating artery, middle cerebral artery and posterior communicating artery. No clinical manifestations are produced in many of these aneurysms, and their rupture and the subsequent development of a subarachnoid haemorrhage is the cause of the most intense neurological damage, which on occasions can lead to fatal consequences. CASE REPORT: We report the case of a patient who was a carrier of distal aneurysm, located in the posterior region of the brain circulation, and also the neuroradiological findings, the form of clinical presentation and surgical treatment carried out, which allowed us to identify and close the afferent vessel and the resection of the aneurysmatic sac. CONCLUSION: From the presentation of the symptoms of this patient in the form of a subarachnoid haemorrhage, accompanied by a subdural haematoma, it could be inferred that these clinical and imagenological findings point to the rupture of a distal aneurysm. Application of the stereotactic approach would be one of the first choice treatments for aneurysms in the distal region if we bear in mind the characteristics of the afferent vessel, the size of the neck and the morphology of the sac

[Direct approach to carotid cavernosa fistula type of arterio venous dural malformation. Case report and review of the literature]. / Abordaje directo de la malformaci n arteriovenosa dural tipo fistula carotidacavernosa. Presentaci n de un caso y revisi n de la literatura.

OBJECTIVES: Barrow's D type carotid cavernosa fistula (FCC) with progressive symptoms and in whom endovascular procedures have failed meet criteria for a direct approach. We report a case of this type of vascular lesion in whom partial endovascular embolization was done together with a direct approach to the FCC, using a method of localization involving a transoperative imaging guide. Digital subtraction angiography and Estereoflex stereotactic system was used. PATIENTS AND METHODS: A female patient had had a previous minor head injury. She had a progressive neurological disorder with marked visual defect, and had been diagnosed on angiography as having FCC with afferents from branches of the internal carotid artery (ACI) and external carotid artery (ACE). After failure of endovascular treatment orbito zygomatic craniotomy was done with extra intradural dissection and exposure of the antero lateral triangle of the cavernous sinus (SC). The fistula was closed completely by anterior packing with the venous component. Transoperative stereotactic angiographic checks were done to localize and control the packing. CONCLUSIONS: The Barrow's type D FCC in which embolization treatment has failed may be treated using a direct approach to the anterolateral triangle of the SC. The AC1 remained permeable, fistula was occluded and there was minimal morbidity.

[Complications of stereotaxic surgery for cerebral tumors. Minimal access neurosurgery]. / Complicaciones de la cirugía estereotáxica de los tumores cerebrales. Neurocirugía de mínimo acceso.

INTRODUCTION: Complications of neurosurgery include the clinical, neurological and neurosurgical aspects. Their prevention and correction depend on satisfactory preoperative assessment and close postoperative follow-up. Although minimum access neurosurgery reduces some problems, the complexity and depth of many cerebral lesions cause problems. Therefore it is important to adhere to the above principles to obtain good results. OBJECTIVES: To determine the clinical complications, their early detection and course to be followed when they occur. PATIENTS AND METHODS: We studied 29 patients with intracranial tumors operated on using stereotaxic surgery during a period of two years. They were evaluated before and after surgery and the complications recorded. RESULTS: We discuss the most significant clinical aspects of peri-operative management. The main complications found were lower respiratory tract infection and hyperglycemia. CONCLUSIONS: These results show the need for suitable management, even in minimum access surgery, in patients with cerebral tumors operated on using stereotaxis and underline the most significant complications.

[Stereotaxic microsurgical resection of intracranial tumors guided by imaging and assisted by computer]. / Resección microquirúrgica estereotáxica de tumores intracraneales guiada por imagen y asistida por computadora.

INTRODUCTION: The microsurgical techniques for resection of intracranial lesions are limited where anatomical references do not exist or cannot be used as guides in the dissection of deeply located lesions or in more superficial eloquent areas. The stereotaxic guide, guided by imaging gives precise volumetric and geometric definition in intracranial lesions. Its application in the resection of intracranial tumors has special characteristics due to their biological condition and varied localization. OBJECTIVES: Spatial orientation during surgery is essential. We show this application of stereotaxic surgery in the Centro Internacional de Restauración Neurológica (CIREN) in La Havana, Cuba, between May 1994 and February 1988, describing 65 microsurgical operations done using stereotaxis in 62 patients with intracranial cerebral tumors. PATIENTS AND METHODS: The procedure was divided into three stages: acquiring an image, computerized axial tomography and surgical planning, with the STASSIS planning system and microsurgical procedures, including systems of stereotaxis: Leksell, Micromar and Estereoflex. RESULTS: Of the total, 27 of these patients had glial tumors, 33 non-glial tumors and only 2 had non-neoplastic lesions of different sites and sizes. A total of 30 resections were done. Surgical morbidity was minimal and there was no surgical mortality. CONCLUSIONS: The main advantages of this method are: exact localization of the site for craniotomy, easy spatial orientation and ease in distinguishing the delimitation between the tumour and the healthy tissue. It has been shown that Estereoflex may be used in cerebral microsurgery.

[Sepsis and antibiotic prophylaxis in stereotaxic neurosurgery]. / Sepsis y profilaxis antibiótica en neurocirugía estereotáxica.

INTRODUCTION: Stereotaxic surgery is becoming increasingly important because of the possibility of approaching the deep zones of the brain with less risk. It is in daily use in cerebral tumours and in the functional surgery of Parkinson's disease. The use of antibiotic prophylaxis in neurosurgery is controversial, although in many centres, including ours, all patients receive it. OBJECTIVE: To study the pre-operative clinical characteristics analysing the antibiotic prophylaxis used, septic complications seen and their management. PATIENTS AND METHODS: In this study we included 93 patients with neurosurgical disorders operated on using a stereotaxic approach in the Neurosurgical Department of the Centro Internacional de Restauración Neurologica (Cuba) during 1997 and 1998, in which antibiotic prophylaxis was used and septic patients detected. The variables studied included age, sex, neurological disorders, surgical operations done and the antibiotic used for prophylaxis. We analysed the test of clinical criteria for sepsis in all patients. RESULTS: We found that a greater number of patients operated on had had functional surgery, which showed its importance as an alternative surgical method in Parkinson's disease. There was satisfactory use of antibiotic prophylaxis with a reduction in the rate of nosocomial infection; most infections were seen in the lower respiratory tract. CONCLUSION: These results support the hypothesis of use of antibiotic prophylaxis in stereotaxic surgery to achieve a reduction in intra-hospital infections in surgical patients.