Manejo de la enfermedad aneurismática múltiple. Experiencia en un Hospital de Especialidades.

Objective: To establish the frequency and results in patients carriers with multiple aneurysms (MA) treated by microsurgery and/or neurological endovascular therapy (NET) in the Hospital of Specialties on The National Medical Center La Raza. Method: It is an ambispective, descriptive and longitudinal study that includes patients carriers of MA treated in the National Medical Center La Raza from March the 1st of 2009 to April the 30th of 2014. Results: 62 patients carriers of 151 aneurysms were treated. According to the type of treatment, 30 patients (49%) were included in the surgical group (GQ), 25 (40%) in the endovascular group (GE) and 7 (11%) in the combinated group (GC). The number of aneurysms was distributed this way: 69 (46%) in the GQ, 61 (40%) in the GE and 21 (14%) in the GC. At GQ, it was not possible to exclude all their aneurysms on 21% of the patients, while it was feasible in only 27%. In all GE patients (40%) the exclusion of all aneurysms was achieved. The GC, meaning surgical cases that were not completed by NET, formed 11% of the cases. At GQ there was a rate of 6% of complications, meanwhile at GE it was 0.5%.

[Ventriculo subgaleal shunt in hydrocephalus secondary to intraventricular hemorrhage in prematures]. / Derivación ventrículo-subgaleal en hidrocefalia secundaria a hemorragia intraventricular (HIV) en el prematuro.

BACKGROUND: Intraventricular hemorrhage (IVH) is one of the most serious complications in premature lightweight. While in the decade of 1970-1980 the incidence was 40-50%, now it is at least 20%. But it presents a challenge because of the multiple existing therapies and the results in terms of neurological sequelae. MATERIAL AND METHODS: We performed a retrospective review of 48 patients managed with ventriculo subgaleal shunt and a therapeutic decision based on gestational age, weight, and grade of intraventricular hemorrhage. RESULTS: Of the patients, 29 (60%) of the cases were female and 19 (40%) were male. The average gestation age for placing the subgaleal system was 30 months, with an average weight of 1,511 g, and with an infection rate of 4%. In 44 cases peritoneal system was placed (92%) because four died (8%). No mortality was observed at surgery. CONCLUSIONS: Mortality in the past appeared in 75% of patients, with the realization that derivation of subgaleal irrigation reduces infections besides allowing proper control of hydrocephalus and thus decreases the long-term neurological sequelae.

[Trigeminal-cavernous fistula. Report of a case and review of the literature]. / Fístula trigeminocavernosa. Reporte de un caso y revisión de la literatura.

Persistent primitive trigeminal artery is a rare anatomical variant resulting from the absence of obliteration of the embryonic trigeminal artery. The shunt between the persistent primitive trigeminal artery and the cavernous sinus is called trigeminal-cavernous fistula. We report the case of a woman with a trigeminal-cavernous fistula secondary to head trauma who was treated by transarterial embolization.