Tratamiento de fístulas carótido-cavernosas / Treatment of carotid-cavernous fistulas

Objetivos. Valorar los resultados del tratamiento de 33 pacientes con fístula carótido-cavernosa (FCC) de acuerdo con criterios clínicos y angiográficos. Material y métodos. De enero de 1993 a diciembre de 2003, 33 pacientes fueron diagnosticados y tratados de FCC en nuestro hospital. Se realizó examen clínico y angiografía antes y después del tratamiento. Las modalidades terapéuticas disponibles son el tratamiento conservador, mediante compresiones, y el tratamiento intervencionista, con distintos procedimientos según la vía de abordaje y el material de embolización empleados. Resultados. De las 11 FCC directas, una fue tratada de forma conservadora y 10 se sometieron a procedimientos de embolización. La vía de abordaje fue transarterial en 5, transvenosa en 2 y en 3 se utilizaron ambas, consiguiendo la desaparición de los síntomas en el 90% de los pacientes. De las 22 FCC indirectas o durales, 6 fueron tratadas de forma conservadora, con óptimo resultado, mientras que las 16 restantes se embolizaron, 11 por vía transarterial y 5 combinando los accesos transarterial y transvenoso. La terapia endovascular logró la desaparición completa de los síntomas en 9 pacientes y parcial en 7. Sólo se produjo una complicación transitoria. Conclusiones. La adecuada selección tanto del tipo de tratamiento (conservador o intervencionista), como del procedimiento (vía de abordaje y material de embolización), caso de que fuera necesario, optimiza los resultados en el manejo de pacientes con FCC

Objectives. To evaluate the results of the treatment of 33 patients with carotid-cavernous fistula (CCF) with respect to clinical and angiographic criteria. Material and methods. From January 1993 to December 2003, 33 patients were diagnosed with CCF and treated at our hospital. All patients underwent clinical examination and angiography before and after treatment. Available treatment modalities were conservative treatment, consisting of compressions, and interventional treatment, with different procedures depending on the approach and the materials employed for embolization. Results. Of the 11 direct CCFs, one received conservative treatment and 10 underwent embolization procedures. An arterial approach was used in 5 cases, a venous approach in 2, and a combined venous-arterial approach in the remaining 3, with symptoms disappearing in 90% of the patients. Of the 22 indirect or dural CCFs, 6 received conservative treatment, with optimal results, and the remaining 16 underwent embolization (11 using an arterial approach and 5 using a combined venous-arterial approach). Endovascular treatment brought about the complete disappearance of symptoms in 9 patients and partial disappearance in 7. Only one transitory complication was observed. Conclusions. The appropriate selection of both the type of treatment (conservative vs. interventional) and the interventional procedure (approach and material for embolization), yields optimal results in the management of patients with CCF

[T-type primary lymphoma of the central nervous system in immunocompetent patients]. / Linfoma primario tipo T del sistema nervioso central en pacientes inmunocompetentes.

INTRODUCTION: The primary lymphoma of the central nervous system is an infrequent neoplasia, which represents 1,5% of all primary neoplasias in adult patients. In the last decade its frequency has increased threefold, both in immunodepressed as well as in immunocompetent patients. The non Hodgkin lymphoma of B cells being the most frequent histological type, the primary T cell lymphoma of the CNS is a rare clinical entity. CASE REPORTS: In this study we present three cases of immunocompetent patients with primary lymphoma of the central nervous system of T cells seen during the 6 last years in our hospital, the diagnostic imaging by computerized tomography and magnetic resonance showed the tumorations, but the definitive diagnosis was by stereotaxic cerebral biopsy. CONCLUSIONS: The lymphomas are radiosensitive to radiotherapy with survivals of approximately 26 months, the combined treatment of surgery and chemotherapy, prior to radiotherapy, may increases survival up to 48 months. Certain aspects of the patient or of the tumor itself are determining factors with respect to the prognosis of survival. We review the relevant literature and study the clinical manifestation, their value of imaging techniques and differential diagnostic and prognosis of survival