Carotid-cavernous fistula treatment with ethylene vinyl alcohol (onyx) exclusively through anterior venous approach.

The type of venous drainage of a direct carotid-cavernous fistula is an important issue to consider for the endovascular therapeutic decision. In case of an inadequate posterior drainage associated with a good anterior drainage, the facial vein is a useful alternative. The exclusive embolization with ethylene vinyl alcohol (EVOH Onyx), arterial and/or venous via the internal carotid artery (ICA) occlusion has been used successfully, in a few cases until now. Nevertheless, the use of this method through anterior transvenous approach has not been previously described. Presented here is the case of a 13-year-old female patient with left posttraumatic carotid-cavernous fistula, with predominant anterior drainage, as well as carrier of traumatic occlusion of the contralateral ICA. The treatment was by means of a transvenous approach with transient occlusion of the left ICA.

[Minimally invasive surgery in intracranial aneurysms]. / Cirugía de mínima invasión en aneurismas intracraneales.

INTRODUCTION: The use of minimally invasive procedures in neurosurgery permits a significant reduction in peri-operative morbidity and duration of hospital stay. The fronto-latero-basal (FLB) approach gives good exposure of the structures of the anterior and middle fossas with access to most aneurysms of the anterior circulation, thus avoiding extensive craniotomies and the use of brain retractors. OBJECTIVE: We present an analysis of 27 patients operated on to clip 29 aneurysms of the anterior circulation using the FLB approach. PATIENTS AND METHODS: The study included 27 patients, 18 women and 9 men with an average age of 47.53 years. On clinical staging, using the Hunt and Hess scale, 12 patients were between 0 and 1, 8 at stage II, 6 at stage III and 1 at stage IV. RESULTS: The aneurysms were mainly on the internal carotid artery (16), middle cerebral artery (5), anterior communicating artery (5) and bifurcation of the carotid and middle cerebral arteries (3). The surgical operation lasted an average of 166.15 minutes; it was possible to clip the artery in 28 cases (96.5%). Two patients died (of renal failure and of disseminated intravascular coagulation). Most patients were discharged with a score of 5 points on the Glasgow prognosis scale 7.6 days after operation. CONCLUSIONS: Use of minimally invasive procedures such as FLB gives optimal functional and aesthetic results, with the advantage of being possible using the basic instruments available in any neurosurgical department, without depending on advanced technology.

Cirugía de mínima invasión en aneurismas intracraneales / Minimally invasive surgery of intracranial aneurysms

Introducción. El uso de procedimientos de mínima invasión en neurocirugía permite disminuir de manera significativa la morbilidad transoperatoria y el tiempo de estancia hospitalaria. El abordaje frontolaterobasal (FLB) ofrece una buena exposición de estructuras del piso anterior y medio con acceso a la mayor parte de los aneurismas de la circulación anterior, evitando las craneotomías extensas así como el uso de retractores cerebrales. Objetivo. Presentar un análisis de 27 pacientes intervenidos para pinzadura de 29 aneurismas de la circulación anterior por medio del abordaje FLB. Pacientes y métodos. Se incluyeron 27 pacientes, 18 mujeres y 9 varones con una edad media de 47,53 años. El estadio clínico de acuerdo con la escala de Hunt y Hess ubicó a 12 pacientes en 0 o I, 8 en el II, 6 en el III y 1 en el estadio IV. Resultados. Los aneurismas se localizaron preferentemente en la carótida interna (16), cerebral media (5), comunicante anterior (5) y bifurcación de carótida con cerebral media (3). El tiempo quirúrgico promedio fue de 166,15 minutos, lográndose la pinzadura en 28 casos (96,5 por ciento) con dos fallecimientos (por insuficiencia renal y coagulopatía diseminada). La mayor parte de los pacientes se egresaron con 5 puntos en la escala pronóstica de Glasgow a los 7,6 días de realizado el procedimiento. Conclusiones. El uso de procedimientos de mínima invasión como el FLB ofrece resultados óptimos tanto funcionales como estéticos, con la ventaja de que puede realizarse con el instrumental básico de cualquier servicio de neurocirugía sin dependencia tecnológica (AU)