Un nuevo dispositivo, de fácil acceso y bajo costo para el tratamiento no quirúrgico de fracturas deprimidas en «ping pong»: Nota técnica / A new, readily accessed and low-cost, device for treating depressed ping pong fractures non-surgically: Technical note

Objetivo El objetivo del trabajo es describir un sistema de reducción con aspiración manual de bajo costo y fácil acceso (SiRAMa) utilizado para tratar fracturas deprimidas en «ping pong» en 3 pacientes. Método El SiRAMa está compuesto por una máscara de anestesia pediátrica, parte de un macrogotero, una llave de 3 vías y 2 jeringas de 60ml. Previamente a su utilización en los pacientes el sistema se testó en 5 voluntarios adultos utilizando su máxima potencia, los cuales no refirieron dolor durante el procedimiento ni presentaron otra complicación Presentamos 3 casos clínicos de pacientes con fractura deprimida en «ping pong», los cuales fueron tratados con el SiRAMa al lado de la cama sin anestesia. Los pacientes fueron monitorizados por el equipo de neonatología durante todo el procedimiento. Resultados La radiografía de cráneo evidenció la reducción de la fractura tras el procedimiento realizado con el SiRAMa en todos los pacientes. La ecografía transfontanelar y el examen neurológico de control fueron normales. Los pacientes evolucionaron favorablemente y fueron dados de alta a las 24horas. Conclusiones Debido a sus componentes el SiRAMa es un sistema de bajo costo y fácil acceso. En este caso permitió la reducción satisfactoria de la fractura en «ping pong» en todos los pacientes. Este sistema permitiría simplificar el tratamiento de las fracturas de este tipo que así lo requieran (AU)

Objective The aim of this paper is to describe a low-cost and readily accessed Manual Aspiration Reduction System (MARS) for use treating ping-pong fractures in three patients. Method The MARS is composed of a pediatric anesthesia mask, part of a macro dripper, a 3-way stopcock, and two 60-ml syringes. Prior to its use in our patient, the system was tested on five adult volunteers to maximum negative pressure, and none reported pain during the procedure or experienced any other complication. We present three clinical cases of patients with depressed ping-pong fracture who were treated with the MARS at the bedside without anesthesia. The patients were monitored by the neonatology team throughout the procedure. Results Skull radiography revealed reduction of the fracture after the procedure performed with the MARS in all patients. The transfontanellar ultrasound and follow-up neurological examination were normal. The patient progressed favorably and was discharged from our service after 24h. Conclusions Due to its components, the MARS is a low-cost and readily accessed system. In this case, it permitted satisfactory reduction of a ping-pong fracture in all patients. This system should greatly simplify the treatment of such fractures (AU)

A new, readily accessed and low-cost, device for treating depressed ping pong fractures non-surgically: Technical note.

OBJECTIVE: The aim of this paper is to describe a low-cost and readily accessed Manual Aspiration Reduction System (MARS) for use treating ping-pong fractures in three patients. METHODS: The MARS is composed of a pediatric anesthesia mask, part of a macro dripper, a 3-way stopcock, and two 60-ml syringes. Prior to its use in our patient, the system was tested on five adult volunteers to maximum negative pressure, and none reported pain during the procedure or experienced any other complication. We present three clinical cases of patients with depressed ping-pong fracture who were treated with the MARS at the bedside without anesthesia. The patients were monitored by the neonatology team throughout the procedure. RESULTS: Skull radiography revealed reduction of the fracture after the procedure performed with the MARS in all patients. The transfontanellar ultrasound and follow-up neurological examination were normal. The patient progressed favorably and was discharged from our service after 24 h. CONCLUSIONS: Due to its components, the MARS is a low-cost and readily accessed system. In this case, it permitted satisfactory reduction of a ping-pong fracture in all patients. This system should greatly simplify the treatment of such fractures.

A new, low-cost device to treat depressed "ping-pong" fractures non-surgically: technical note.

OBJECTIVE: The aim of this paper is to describe a low-cost and readily accessed Manual Aspiration Reduction System (MARS) for use treating neonatal ping-pong fractures. METHODS: The MARS is composed of a pediatric anesthesia mask, part of a macro dripper, a 3-way stopcock, and two 60-ml syringes. Prior to its use in our patient, the system was tested on five adult volunteers to maximum negative pressure, and none reported pain during the procedure or experienced any other complication. CLINICAL CASE: A 15-day-old premature girl presented with a congenital ping-pong fracture. Her skull X-ray revealed a right parietal fracture. Neurological examination and transfontanellar ultrasound were normal. Treatment using the MARS was performed at the patient's bedside without sedation or anesthesia. The patient was monitored by the neonatology team throughout. RESULTS: Skull radiography revealed reduction of the fracture after the procedure performed with the MARS. The transfontanellar ultrasound and follow-up neurological examination were normal. The patient progressed favorably and was discharged from our service after 24 h. CONCLUSIONS: Due to its components, the MARS is a low-cost and readily accessed system. In this case, it permitted satisfactory reduction of a ping-pong parietal fracture. This system should greatly simplify the treatment of such fractures.

Three-dimensional imaging as a teaching method in anterior circulation aneurysm surgery.

OBJECTIVE: Our objective is to present and asses the utility of three-dimensional (3D) intraoperative imaging as a teaching method for anterior circulation aneurysm surgery. METHODS: The senior author's experience in anterior circulation aneurysm surgery during a 28-month period was documented and processed as 3D images and compared with two-dimensional (2D) images. Both 2D and 3D sets of images were created, and, along with a specially designed questionnaire, 30 physicians (15 experienced cerebrovascular surgeons and 15 neurosurgical trainees) were asked to answer the query and state the advantages and disadvantages of both methods. RESULTS: All physicians interviewed agreed that 3D imaging was better than 2D imaging, and that depth perception improved understanding of surgical tactics and anatomical landmarks. The resident/young trainee group seemed to receive more benefit from this than the experienced group. A total of 40% of residents and 20% of the experienced surgeons acknowledged a change in clipping strategy when comparing both sets. 3D imaging improved understanding of the ophthalmic segment in 66.6% of residents and 33.3% of the experienced group. CONCLUSION: Real 3D imaging in anterior circulation aneurysm surgery is an excellent tool to enhance vascular training. Inexperienced trainees seem to benefit greatly from it. This technique might be of use in the future development of new technologies.

Clipado microquirúrgico de aneurismas parcialmente embolizados / Microsurgical clipping of partially embolized cerebral aneurisms

Objetivo: el manejo quirúrgico de los pacientes embolizados con coils plantea un problema ya que las cirugías en estos casos suelen ser más complejas. Material y métodos: presentamos siete pacientes embolicados, seis mujeres y un varón, operados entre abril del 2009 y septiembre de 2010, con un rango de edad entre 32 y 56 años (media 46) que requirieron posteriormente cirugía. Las cirugías fueron realizadas en el Hospital El Cruce y en otros tres centros quirúrgicos, por lo tanto el tratamiento endovascular fue realizado por diferentes equipos. Los aneurismas tratados fueron 2 comunicantes anteriores, 3 comunicantes posteriores y 2 Silvianos. Resultados: no hubo mortalidad en esta serie. Una paciente presentó un infarto frontal postoperatorio. Uno de los aneurismas presentó una rama a nivel del cuello aneurismático, por lo que solo fue posible reducir el cuello con un clip fenestrado y uno recto y empaquetar el aneurisma. En tanto que el clipado microquirúrgico en el resto de los aneurismas se logró con éxito. Conclusión: el manejo quirúrgico de los aneurismas previamente embolizados es un desafío emergente en la práctica neuroquirúrgica. La cirugía de un aneurisma embolizado es técnicamente más compleja y potencialmente más riesgosa para el paciente. Creemos que es fundamental una correcta selección de pacientes y una cuidadosa planificación del tratamiento para disminuir la incidencia de pacientes embolizados que requieran luego tratamiento quirúrgico.

Soft tissue assessment in midface advancement: the use of regional flaps to enhance facial projection.

Classically, soft tissue repair when indicated is done before or after the skeletal mobilization especially in those cases that present midface deficiency with severe midline soft tissue restriction by scars or congenital affectation. The distraction osteogenesis method has contributed to improve substantially this problem elongating bones, muscles, and ligaments, but some situations need specific and more precise reconstruction of the subunits to gain in aesthetics. The labial-columella junction, the tip of the nose, and the more projecting point of the cheeks are one of these exigent anatomic areas, where only sophisticated reconstruction by flaps can improve facial proportions and projections.

El desarrollo e implementación de la resonancia magnética intraoperatoria en neurocirugía (remain) y su aplicación en 83 intervenciones en la Argentina / Development of REMAIN for neurosurgery and application in 83 operative intervention in Argentina

Objective: To show implementation and development of an operating room in which we operated 83 patients using intraoperative MRI (REMAIN). Method: We used a side-opening-magnet, 0.23 Tesla, installed in a surgical area specially designed with all the advances of the modern operating rooms. Results: A great variety of neuro-surgical procedures can be made with REMAIN controls. The obtained images are clear, without devices and with an excellent definition of the anatomical structures and the pathology, that allows the neurosurgeon to make more precise and safer interventions. Conclusions: The images of REMAIN in a surgical scope, make possible that injuries can be identified and located with absolute precision. It is particularly useful in determining with exactitude the tumor-like limits, optimizing the surgical approaches, obtaining complete extirpations of brain injuries and controlling the possible intraoperative complications.

Diferentes tecnicas neuroendoscopicas para el tratamiento de la hidrocefalia en pediatria. Estudio multicentrico en 360 pacientes / Different neuroendoscopical Techniques for the treatment of pediatric hydrocephalus Study in 360 patients

Objective: To analize our experience in the endoscopical treatment of pediatrichydrocephalus. Methods: In a retrospective study we analyzed 360 hidrocephalic patients treated endoscopically in 5 Pediatric Neurosurgical Services in Buenos Aires. 374 procedures were performed: 207 third-ventriculostomies, 70 septal fenestrations, 48 catheter implantations, 26 cyst-ventriculostomies, 11 septomies, 7 catheter removals, 4 aqueductoplasties and 1 monoplasty. Results: Third ventriculostomy was the most frequent procedure with a very low failure rate (19,8 por ciento). The overall complication rate was 4,5 por ciento. IN pineal tumor related hydrocephalus, a simultaneous biopsy procedure was always sucessful. Conclusions: Endoscopic treatment of hydrocephalus must always be consideraded as an effective method and as the first choice treatment in an important number of patients

Diferentes tecnicas neuroendoscopicas para el tratamiento de la hidrocefalia en pediatria. Estudio multicentrico en 360 pacientes / Different neuroendoscopical Techniques for the treatment of pediatric hydrocephalus Study in 360 patients

Objective: To analize our experience in the endoscopical treatment of pediatrichydrocephalus. Methods: In a retrospective study we analyzed 360 hidrocephalic patients treated endoscopically in 5 Pediatric Neurosurgical Services in Buenos Aires. 374 procedures were performed: 207 third-ventriculostomies, 70 septal fenestrations, 48 catheter implantations, 26 cyst-ventriculostomies, 11 septomies, 7 catheter removals, 4 aqueductoplasties and 1 monoplasty. Results: Third ventriculostomy was the most frequent procedure with a very low failure rate (19,8 por ciento). The overall complication rate was 4,5 por ciento. IN pineal tumor related hydrocephalus, a simultaneous biopsy procedure was always sucessful. Conclusions: Endoscopic treatment of hydrocephalus must always be consideraded as an effective method and as the first choice treatment in an important number of patients (AU)