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1.
J Neurosurg Sci ; 2015 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-26606547

RESUMEN

Microsurgical clipping of intracranial aneurysms often requires access to the subarachnoid space deep in the brain. In the past, fixed retractors have been used to maintain the surgical corridor. However, studies have shown that fixed retraction leads to brain injuries. Here we present strategies to replace conventional fixed retractor blades with dynamic retraction so that the brain is no longer under constant pressure. We show that dynamic retraction without fixed retractors, when combined with optimal patient position and neuroprotective anesthetics, can provide the surgeon with adequate visualization of aneurysms and excellent surgical outcomes.

2.
AJNR Am J Neuroradiol ; 34(8): 1593-9, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23391842

RESUMEN

BACKGROUND AND PURPOSE: Distal ACA aneurysms remain difficult to treat with endovascular therapy, but improved technology and experience allows for the treatment of some of these aneurysms with excellent results. The purpose of this study was to assess the status of endovascular treatment of distal ACA aneurysms by comparing our results with recent endovascular and microsurgical series of distal ACA aneurysms. MATERIALS AND METHODS: Between 2000 and 2008, a total of 22 consecutive patients (14 women; mean age, 58.4 years) with distal ACA aneurysms underwent coil placement at Barrow Neurological Institute. Clinical presentations, radiographic findings, endovascular management, and outcomes were reviewed retrospectively. RESULTS: Of the 22 patients, 13 (59%) presented with subarachnoid hemorrhage. Six patients were HH grade I or II, 1 was grade III, 5 were grade IV, and 1 was grade V. Frontal lobe hematomas occurred in 5 patients with ruptured aneurysms. The mean aneurysm size was 7.5 mm (range, 2.8-25 mm); 55% were smaller than 7 mm. Twelve aneurysms (55%) arose from the origin of the callosomarginal artery (55%). Complete occlusion was achieved in 50% of the cases and near-complete occlusion in 45%. The few periprocedural complications included 1 retroperitoneal hematoma and 1 intraoperative rupture. Four patients had thromboembolic events adequately treated intraprocedurally with abciximab. No deaths occurred in the patients treated. CONCLUSIONS: The characteristics of the patients and aneurysms treated in our series were comparable to previous reports of endovascular treatment of ACA aneurysms with respect to rupture status. Periprocedural morbidity and mortality rates in our series fared well compared with previous reports, as did our combined rate of complete or near-complete occlusions. Recent advances in endovascular devices and techniques have improved outcomes of distal ACA aneurysms.


Asunto(s)
Angiografía Cerebral/métodos , Revascularización Cerebral/métodos , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
3.
Acta Neurochir (Wien) ; 150(8): 829-31; discussion 831, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18574547

RESUMEN

Persistent abdominal pain directly induced by a peritoneal catheter of a ventriculoperitoneal shunt, which is associated with no other complications such as bowel perforation, pseudocyst or infection, has not been previously reported. A 65-year-old woman with hydrocephalus developed persistent lower abdominal pain radiating to the perineal area after shunt insertion. Radiography suggested that the distal end of a peritoneal catheter was located in a cul-de-sac of the pelvis. Otherwise, all studies were negative for shunt infection, fluid collection, or other abdominal and pelvic events. The patient's pain resolved completely after surgery in which the peritoneal catheter was shortened. In the presence of unexplained, persistent lower abdominal pain after shunt placement, the need to shorten the peritoneal catheter should be considered.


Asunto(s)
Dolor Abdominal/etiología , Hidrocefalia/cirugía , Dolor Pélvico/etiología , Derivación Ventriculoperitoneal/efectos adversos , Dolor Abdominal/cirugía , Anciano , Embolización Terapéutica , Diseño de Equipo , Femenino , Humanos , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/terapia , Dolor Pélvico/cirugía , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/terapia , Derivación Ventriculoperitoneal/instrumentación
4.
Acta Neurochir (Wien) ; 150(5): 487-9; discussion 489, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18351283

RESUMEN

Developmental venous anomalies (DVAs), cavernous malformations, and capillary telangiectasias are related vascular malformations of the central nervous system. Mixed lesions of the central nervous system vasculature have been reported in a host of combinations, including many possible concomitant combinations of cavernous malformations, venous anomalies, capillary telangiectasias, and arteriovenous malformations (AVMs). We describe the natural history of disease in a female with developmental venous anomaly, cavernous malformation, and capillary telangiectasias appearing in sequence.


Asunto(s)
Seno Cavernoso/anomalías , Malformaciones Vasculares del Sistema Nervioso Central , Anomalías Múltiples , Adulto , Seno Cavernoso/patología , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico , Malformaciones Vasculares del Sistema Nervioso Central/fisiopatología , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos/efectos adversos
5.
Zentralbl Neurochir ; 68(3): 151-4; discussion 154, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17665344

RESUMEN

Cerebral aneurysms often recur after selective endovascular treatment with detachable coils and are usually treated by recoiling. Sometimes, however, surgical treatment is required, and application of the clip can be difficult. Evacuation of embolic material risks injuring eloquent structures or perforators, especially in the posterior circulation. In such cases parent vessel occlusion for reversal of flow might be an option. If collateral flow is adequate, an additional bypass is not required. When using this technique, known as Hunterian ligation, intraoperative monitoring such as electrophysiological monitoring and intraoperative angiography can be of great help and are advisable. We describe this procedure and related intraoperative considerations in one case report.


Asunto(s)
Arteria Basilar , Angiografía Cerebral , Aneurisma Intracraneal/diagnóstico por imagen , Ligadura , Procedimientos Neuroquirúrgicos , Femenino , Humanos , Aneurisma Intracraneal/cirugía , Periodo Intraoperatorio , Persona de Mediana Edad , Recurrencia , Accidente Cerebrovascular/etiología
6.
Minim Invasive Neurosurg ; 49(2): 70-3, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16708334

RESUMEN

The use of minimally invasive techniques has not yet been reported for the treatment of recurrent aneurysms after coil embolization. A 47-year-old man with a long history of headaches had an anterior communicating aneurysm that had previously been coil embolized. Three-year follow-up angiography showed a significant recurrence. A 50-year-old woman with subarachnoid hemorrhage and acute visual loss underwent coil embolization of a large ophthalmic artery aneurysm, which recurred 3 months later. In both cases, a keyhole fronto-orbital one-piece craniotomy was performed. In the first patient, the aneurysm was clip ligated. The coil mass, which had eroded through the dome, was excised. In the second patient, the anterior clinoid was removed and the aneurysm was clip ligated. Postoperative angiography showed no residual aneurysm and no evidence of branch or parent vessel compromise in either patient. Both patients had an uncomplicated postoperative course. Recurrent previously coiled aneurysms are technically challenging to treat. A minimal fronto-orbital craniotomy provides a sufficiently capacious working space for successful treatment of some recurrent aneurysms of the anterior circulation.


Asunto(s)
Craneotomía , Aneurisma Intracraneal/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Ligadura , Masculino , Persona de Mediana Edad , Radiografía , Recurrencia , Retratamiento
7.
Acta Neurochir (Wien) ; 148(2): 227-8, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16322902

RESUMEN

Giant serpentine aneurysms are a rare but important subset of giant aneurysms, with unique management considerations. We present long-term follow-up clinical and imaging features of a giant serpentine middle cerebral artery lesion treated with extracranial-intracranial bypass and proximal occlusion more than a decade earlier. Calcification of the obliterated aneurysm sac and durability of this management strategy are demonstrated.


Asunto(s)
Revascularización Cerebral/métodos , Embolización Terapéutica/métodos , Aneurisma Intracraneal/cirugía , Arteria Cerebral Media/patología , Arteria Cerebral Media/cirugía , Adolescente , Calcificación Fisiológica/fisiología , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/fisiopatología , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Radiografía , Arterias Temporales/anatomía & histología , Arterias Temporales/fisiología , Arterias Temporales/cirugía , Tiempo , Resultado del Tratamiento
9.
Acta Neurochir (Wien) ; 147(2): 219; discussion 219-20, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15570439

RESUMEN

BACKGROUND: Spontaneous ventriculostomy related to progressive obstructive hydrocephalus is rare. Radiologic demonstration of such a phenomenon can be delineated with magnetic resonance imaging (MRI) and cine MRI. CASE PRESENTATION: A 59-year-old woman with a known tectal glioma and symptoms of chronic hydrocephalus developed progressively worsening headaches. During follow-up, she noted spontaneous relief of her headaches. Follow-up cine MRI demonstrated a spontaneous ventriculostomy via the floor of the third ventricle. INTERPRETATION: Clinicians should be aware of spontaneous ventriculostomy demonstrable on cine MRI because it may obviate the need for a CSF diversion procedure.


Asunto(s)
Neoplasias del Tronco Encefálico/complicaciones , Quistes del Sistema Nervioso Central/complicaciones , Glioma/complicaciones , Hidrocefalia/etiología , Rotura Espontánea/etiología , Adaptación Fisiológica , Neoplasias del Tronco Encefálico/diagnóstico por imagen , Quistes del Sistema Nervioso Central/diagnóstico por imagen , Femenino , Glioma/diagnóstico por imagen , Cefalea/etiología , Humanos , Hidrocefalia/patología , Hidrocefalia/fisiopatología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Radiografía , Remisión Espontánea , Rotura Espontánea/diagnóstico por imagen , Colículos Superiores/patología , Tercer Ventrículo/diagnóstico por imagen , Tercer Ventrículo/fisiopatología
11.
Interv Neuroradiol ; 9(Suppl 2): 95-7, 2003 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-20591289
12.
Interv Neuroradiol ; 9(Suppl 2): 101-2, 2003 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-20591291
13.
Interv Neuroradiol ; 9(Suppl 2): 103-5, 2003 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-20591292
14.
Acta Neurochir (Wien) ; 144(10): 1047-53, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12382133

RESUMEN

Endolymphatic sac tumors (EST) are rare intracranial tumors originating from the pars rugosa of the endolymphatic sac. Although typically described as histologically nonaggressive lesions, nevertheless they are termed adenocarcinomas and often become locally invasive. We report two patients with histologically proven EST with unique clinical features: the first pediatric case of an EST in an 11-year-old patient whose complaints started at the age of seven; and, a second patient, a 43-year-old man, the first report of metastatic EST which appeared in a remote location from the original site of surgery. Both patients underwent gamma-knife radiosurgery for recurrent tumor. This treatment has not been described previously for these tumors. Both patients have a follow-up of 7 years. Although not disease free they remain neurologically stable. We review the literature on EST.


Asunto(s)
Adenocarcinoma/cirugía , Neoplasias del Oído/cirugía , Saco Endolinfático/cirugía , Enfermedades del Laberinto/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasia Residual/cirugía , Radiocirugia , Neoplasias Craneales/cirugía , Hueso Temporal/cirugía , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adulto , Neoplasias Cerebelosas/patología , Neoplasias Cerebelosas/secundario , Neoplasias Cerebelosas/cirugía , Ángulo Pontocerebeloso/patología , Ángulo Pontocerebeloso/cirugía , Niño , Diagnóstico por Imagen , Neoplasias del Oído/patología , Embolización Terapéutica , Saco Endolinfático/patología , Femenino , Estudios de Seguimiento , Humanos , Enfermedades del Laberinto/patología , Masculino , Microcirugia , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Neoplasia Residual/patología , Reoperación , Neoplasias Craneales/patología , Hueso Temporal/patología
17.
Neurosurg Clin N Am ; 12(3): 541-55, viii, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11390313

RESUMEN

Cerebral revascularization offers an important adjunct to parent-vessel ligation in the treatment of large and otherwise inaccessible intracranial aneurysms. Good or excellent outcomes can be expected in approximately 80% of patients. Poor outcomes and ischemic complications were highest in posterior circulation lesions. Cranial neuropathies from mass effect associated with giant aneurysms of the cavernous and intradural internal carotid artery will improve and be cured in the majority of patients treated with universal revascularization approach. In combination with open parent vessel ligation or endovascular occlusion, durable protection from subarachnoid hemorrhage can be achieved.


Asunto(s)
Encéfalo/irrigación sanguínea , Encéfalo/cirugía , Revascularización Cerebral/métodos , Aneurisma Intracraneal/cirugía , Adolescente , Adulto , Anciano , Encéfalo/diagnóstico por imagen , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/cirugía , Angiografía Cerebral , Niño , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico , Masculino , Persona de Mediana Edad
18.
AJNR Am J Neuroradiol ; 22(4): 650-3, 2001 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11290472

RESUMEN

BACKGROUND AND PURPOSE: Transcranial Doppler studies have suggested that microemboli are released into the arterial circulation during the majority of carotid endarterectomy (CEA) procedures. This, together with the observation that neuropsychological performance may decline postoperatively, has led to concern that cerebral infarction may occur unrecognized during CEA. Our objective was to examine this risk with diffusion-weighted imaging, a technique that is highly sensitive to acute cerebral infarction. METHODS: Eighteen participants (median age, 68 years; age range, 56-87 years) were assessed with diffusion-weighted imaging and the National Institutes of Health Stroke Scale before and after CEA. Imaging was performed using single-shot echo-planar imaging with a maximum diffusion sensitivity of b = 1000 s/mm(2) applied to three orthogonal planes. Preoperative imaging was performed a median of 2.5 hours before surgery (range, 0.5-12.5 hours) and 15 hours after surgery (range, 1.5-58.5 hours). Two neuroradiologists independently interpreted the diffusion-weighted images, blinded to operative status and clinical findings. RESULTS: There was no diffusion-weighted imaging evidence of silent embolism in this series of 18 participants (95% confidence interval limits, 0 to 10%). Clinical complications were confined to one case of confusion occurring after CEA; the diffusion-weighted imaging results were normal in this case. CONCLUSION: There is no evidence from our series that silent cerebral infarction is a common occurrence during CEA. These data provide further support for the safety of CEA.


Asunto(s)
Infarto Cerebral/diagnóstico , Endarterectomía Carotidea , Aumento de la Imagen , Embolia Intracraneal/diagnóstico , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico , Anciano , Anciano de 80 o más Años , Difusión , Imagen Eco-Planar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Ultrasonografía Doppler Transcraneal
19.
J Neurosurg ; 95(2): 346-9, 2001 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-11780909

RESUMEN

Wyburn-Mason syndrome is a rare condition associated with multiple cerebral arteriovenous malformations. The disease, also called retinoencephalofacial angiomatosis, includes lesions of the retina, brain, and skin. This disorder stems from a vascular dysgenesis of the embryological anterior plexus early in the gestational period when the primitive vascular mesoderm is shared by the involved structures. The timing of the insult to the embryonic tissue determines which structures are affected. Extensions of the lesions vary widely but cutaneous lesions are unusual. Among reports in the literature, only three cases appear to have manifested without retinal involvement. The authors report the fourth case of Wyburn-Mason syndrome in which there was no retinal involvement and the first to involve neither the retina nor the face.


Asunto(s)
Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/patología , Enfermedades Orbitales/diagnóstico por imagen , Enfermedades Orbitales/patología , Enfermedades de la Retina/diagnóstico por imagen , Enfermedades de la Retina/patología , Circulación Cerebrovascular/fisiología , Femenino , Humanos , Lactante , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Enfermedades Orbitales/fisiopatología , Radiografía , Enfermedades de la Retina/fisiopatología
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