Giant early post-surgical aneurysm of the aortic arch in an infant.

Ten-day-old neonate who underwent correction of interrupted aortic arch developed a giant early post-surgical aneurysm. To our knowledge, this unusual complication has been only reported as a late complication.

Un caso de aneurisma coronario gigante en enfermedad de Kawasaki / A case of a giant coronary aneurysm in Kawasaki disease

La enfermedad de Kawasaki es una vasculitis que afecta arterias de mediano calibre que ocurre predominantemente en la población pediátrica, de etiología desconocida. Si no es tratada tempranamente existe riesgo de desarrollo de complicaciones tan severas como el desarrollo de aneurismas de arterias coronarias, las cuales pueden estar relacionadas con el desarrollo de trombosis coronaria y riesgo de infarto de miocardio. Se han asociado diversos factores de riesgo de desarrollo de aneurismas coronarios como el tiempo de evolución de la enfermedad o la edad del paciente, la importancia de la identificación de estos factores radica en la posibilidad de la pronta acción sobre aquellos que sean modificables en un intento de limitar el desarrollo de dichas complicaciones coronarias. El tratamiento a largo plazo para esta condición incluye terapia antiagregante y anticoagulante, ambas pueden representar un riesgo en sí mismas para el paciente además de ser limitantes para un paciente pediátrico por el riesgo de sangrado asociado a traumas (propios de la edad pediátrica).

Kawasaki disease is a vasculitis that affects medium-caliber arteries that occurs predominantly in the pediatric population, of unknown etiology. If it is not treated early, there is a risk of developing complications as severe as the development of coronary artery aneurysms, which may be related to the development of coronary thrombosis and the risk of myocardial infarction. Various risk factors have been associated with the development of coronary aneurysms such as the time of evolution of the disease or the age of the patient, the importance of identifying these factors lies in the possibility of prompt action on those that are modifiable in an attempt to limit the development of coronary complications. Long-term treatment for this condition includes antiplatelet and anticoagulant therapy, both may represent a risk in themselves for the patient as well as being limiting for a pediatric patient due to the risk of bleeding associated with trauma (typical of pediatric age).

Giant abdominal aortic aneurysms.

Giant abdominal aortic aneurysms (AAAs) are defined as AAAs >10 to 13 cm in the maximum transverse diameter. We have described a case of a patient who had presented for open repair of an 18-cm AAA and a review of reported cases of giant AAAs >10 cm in the maximum transverse diameter. Forty cases were compiled. The average maximum AAA diameter was 14.5 ± 4.1 cm. The AAA was ruptured on presentation in 12 patients (30%). Of the 40 cases, 34 (85%) were repaired with open surgery. The reported mortality was 15%. Despite the case complexity, five endovascular repairs were attempted.

Tratamiento endovascular del aneurisma esplénico incidental y en la urgencia / Endovascular treatment of incidental and emergency splenic aneurysm

Resumen Los aneurismas esplénicos verdaderos son dilataciones saculares que involucran todas las capas de la arteria esplénica. Se presentan más frecuentemente en mujeres, en el embarazo y pacientes con hipertensión portal. Son habitualmente asintomáticos y diagnosticados incidentalmente durante el estudio de otra afección abdominal. Hasta un 10% se puede presentar con ruptura, lo que supone un escenario con una alta morbilidad y mortalidad. El tratamiento de los aneurismas esplénicos es aún un tema de controversia y existen variadas modalidades terapéuticas. Presentamos dos casos de pacientes con aneurismas esplénicos: uno de ellos que se manifestó con rotura y el otro por un diagnóstico incidental. Ambos fueron resueltos mediante embolización endovascular con resultados óptimos. Esta modalidad terapéutica poco difundida para el tratamiento de aneurismas esplénicos gigantes o rotos, nos permitió resolver el cuadro de forma segura y efectiva, con mínima morbilidad y mortalidad.

Abstract True splenic aneurysms are saccular dilations of all the layers of the splenic artery, more common in women, pregnancy and portal hypertension. They are usually asymptomatic and diagnosed incidentally during the study of other abdominal diseases. Up to 10% may present with rupture, which implies a high morbidity and mortality. Treatment of splenic aneurysms is still a subject of controversy and there is a great variety of therapeutic modalities. We present two cases of patients with splenic aneurysms: one who presented with rupture and the other one incidentally diagnosed. Both were treated with endovascular embolization achieving optimal results. Although the utility of this therapy has not been assessed for giant or ruptured aneurysms, it allowed us to solve these scenarios in a secure and effective way, with minimum morbidity and mortality.

[Endovascular treatment of incidental and emergency splenic aneurysm]. / Tratamiento endovascular del aneurisma esplénico incidental y en la urgencia.

True splenic aneurysms are saccular dilations of all the layers of the splenic artery, more common in women, pregnancy and portal hypertension. They are usually asymptomatic and diagnosed incidentally during the study of other abdominal diseases. Up to 10% may present with rupture, which implies a high morbidity and mortality. Treatment of splenic aneurysms is still a subject of controversy and there is a great variety of therapeutic modalities. We present two cases of patients with splenic aneurysms: one who presented with rupture and the other one incidentally diagnosed. Both were treated with endovascular embolization achieving optimal results. Although the utility of this therapy has not been assessed for giant or ruptured aneurysms, it allowed us to solve these scenarios in a secure and effective way, with minimum morbidity and mortality.

Los aneurismas esplénicos verdaderos son dilataciones saculares que involucran todas las capas de la arteria esplénica. Se presentan más frecuentemente en mujeres, en el embarazo y pacientes con hipertensión portal. Son habitualmente asintomáticos y diagnosticados incidentalmente durante el estudio de otra afección abdominal. Hasta un 10% se puede presentar con ruptura, lo que supone un escenario con una alta morbilidad y mortalidad. El tratamiento de los aneurismas esplénicos es aún un tema de controversia y existen variadas modalidades terapéuticas. Presentamos dos casos de pacientes con aneurismas esplénicos: uno de ellos que se manifestó con rotura y el otro por un diagnóstico incidental. Ambos fueron resueltos mediante embolización endovascular con resultados óptimos. Esta modalidad terapéutica poco difundida para el tratamiento de aneurismas esplénicos gigantes o rotos, nos permitió resolver el cuadro de forma segura y efectiva, con mínima morbilidad y mortalidad.

Interhemispheric transcallosal transforaminal approach for decompression of a giant superior cerebellar artery thrombosed aneurysm: Three-dimensional operative video.

BACKGROUND: Giant brain aneurysms account for approximately 5% of all intracranial aneurysms, often presenting with intraluminal thrombosis that causes a mass effect in surrounding neural structures. Although its exact growing mechanism remains unknown, they have to be treated. Despite the most recent advances in neurosurgical fields, the best treatment modality remains unknown and surgery of giant superior cerebellar artery (SCA) aneurysms still is a challenge even for the most experienced neurosurgeons, due to their deep location, surrounding perforating vessels, and intraluminal thrombosis. CASE DESCRIPTION: In this video, we present the case of a 65-year-old woman with progressive hemiparesis and paresis of low cranial nerves. The symptoms were caused by a giant aneurysm located in the origin of the SCA. Despite endovascular embolization of the aneurysm and placement of a flow diverter stent, the aneurysm increased in size causing symptoms progression. In that scenario, we decided to perform a microsurgical decompression of the aneurysm thrombus and coagulation of the vasa vasorum, to reduce the mass effect and prevent the aneurysm from keep growing. CONCLUSION: Through an extensive description of the surgical anatomy, we illustrate an interhemispheric transcallosal transforaminal approach, with the removal of anterior thalamic tubercle to widely expose the aneurysm dome. The surgery was successfully performed, and the patient symptoms improved. The patient signed the Institutional Consent Form, which allows the use of her images and videos for any type of medical publications in conferences and/or scientific articles.

Aneurisma gigante de Arteria Cerebral Media: Trapping y By-Pass / Giant Aneurysm of the Middle Cerebral Artery: Trapping and By-Pass

Objetivo: Presentar la resolución quirúrgica de un aneurisma gigante de arteria cerebral media mediante técnica de Trapping y By-Pass. Introducción: La tasa de mortalidad a 5 años de pacientes con aneurismas gigantes es del 80%. Debido a su cuello ancho en ocasiones el clipado directo no es posible, requiriendo realizar Trapping del aneurisma seguido de revascularización mediante By-Pass. Material y Método: Se analizaron datos de historia clínica, imágenes complementarias pre y postquirúrgicas, así como imágenes de video intraoperatorias de un paciente portador de aneurisma gigante de arteria cerebral media intervenido en nuestro centro. Resultados: Mediante abordaje Pterional se localizó arteria temporal superficial y sus ramos. Luego de una cuidadosa disección del saco aneurismático se intentó el clipado primario, debido a su cuello ancho, aterosclerosis asociada y trombo intrasacular, el flujo en la rama temporal de arteria cerebral media era comprometido por el clip. Se decidió la oclusión del aneurisma mediante técnica de trapping y, en mismo tiempo quirúrgico, realización de By Pass extra-intracraneano de arteria temporal superficial a rama temporal de arteria cerebral media. A su vez se secciono el aneurisma y se removió el trombo contenido en su interior, logrando disminuir el efecto de masa ejercido por el mismo. Se corroboro permeabilidad intraquirurgica mediante Doppler y en el postoperatorio alejado mediante angiotomografía con reconstrucción 3D. El paciente evoluciono sin complicaciones asociadas con un Rankin modificado de 1. Conclusión: Se presentó resolución quirúrgica de aneurisma gigante de arteria cerebral media mediante técnica de Trapping seguida de By-Pass extra-intra craneano temporo-silviano

Objective: To present the surgical resolution of a giant aneurysm of the middle cerebral artery using Trapping and By-Pass technique. Introduction: The 5-year mortality rate of patients with giant aneurysms is 80%. Due to its wide neck, sometimes-direct clipping is not possible, requiring trapping of the aneu-rysm followed by bypass revascularization. Material and Method: Clinical history data and intraoperative video images of a pa-tient with a giant aneurysm of the middle cerebral artery were analyzed. Results: The superficial temporal artery and its branches were identified through a Pterional approach. After careful aneurysm dissection, primary clipping was attempted, but the flow in the temporal branch of the middle cerebral artery was compromised. Due to its wide neck, associated atherosclerosis and intrasaccular thrombus, an Extra-intracranial bypass was performed from superficial temporal artery to temporal branch of middle cerebral artery, followed by trapping technique of the aneurysm. Then the aneu-rysm was sectioned and the thrombus contained inside was removed, decreasing the mass effect exerted by it. A Doppler probe was used to corroborate bypass permeability, as well as 3D reconstruction angiotomography during the postoperative period. The pa-tient was discharged without associated complications and a modified Rankin scale of 1. Conclusion: Surgical resolution of a giant middle cerebral artery aneurysm was present-ed by Trapping technique followed by extra-intra-cranial temporo-Silvian bypass

Giant aneurysm of the right coronary artery, report of a case and review of the literature.

Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.

Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.

Aneurisma gigante de la arteria coronaria derecha, reporte de un caso y revisión de la literatura / Giant aneurysm of the right coronary artery, report of a case and review of the literature

Resumen Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.

Abstract Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.

Giant aneurysm of the right coronary artery, report of a case and review of the literature.

Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus toward its management in adult patients. The options are medical, surgical, or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with a history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.

Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.

Microsurgical Clip Placement for a Giant Anterior Communicating Artery Aneurysm With Intraluminal Thrombus: 2-Dimensional Operative Video.

Giant brain aneurysms account for approximately 5% of all intracranial aneurysms. Although treatment modalities can vary widely, none is ideal for every patient. Endovascular treatment is usually preferred, especially when the large size of the aneurysm limits visualization of the brain parenchyma and parent vessels that arise from the aneurysm, making surgical clip placement across the neck a difficult task. However, despite the higher chances of morbidity, microsurgery is an effective treatment modality due to lower recurrence rates. Surgically, a wide neck, calcifications, or atheroma are complicating factors to be considered while planning the best treatment. Thus, with an appropriate case selection, a favorable outcome is feasible in most cases. Here, we present the case of a 27-yr-old female who presented with a severe headache for 7 mo and 3 mo of progressive left temporal vision loss, which was confirmed by visual field perimetry using the Humphrey visual field analyzer. Magnetic resonance angiography and digital subtraction cerebral angiography showed an anterior communicating artery complex inferiorly and medially oriented aneurysm measuring 25.4 × 16.5 mm, with a 3 mm neck. It was fed by the right A1, associated with a hypoplastic left A1, incorporating the proximal right and left A2 segments, with an intraluminal thrombus and causing mass effect on the optic chiasm and hypothalamus. This video demonstrates the microsurgical steps required to perform this operation, through a right orbitozygomatic craniotomy. At a 3-mo follow-up, the patient was neurological intact without complaints. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

Treatment of Giant Intracranial Aneurysms: a Review Based on Experience from 286 Cases / Tratamento dos aneurismas gigantes intracranianos: uma revisão baseada na experiência de 286 casos

Aneurysms are classified as giant when their largest diameter is equal to or greater than 25 mm, which represents approximately 5­7% of intracranial aneurysms. Severe disease with poor natural history presents with 68% mortality in two years and 85% in five years for untreated cases. Thus, in the majority of cases, the patients require treatment, despite the risks of therapeutic options. We discuss the epidemiology, natural history, diagnosis, and treatment of giant aneurysms based on the experience of 286 operations and literature data.

Os Aneurismas são classificados como gigantes quando seu maior diâmetro é igual ou superior a 25 mm e representam aproximadamente de 5 a 7% dos aneurismas intracranianos. Trata-se de patologia grave com história natural ruim apresentando mortalidade de 68% em 2 anos e 85% em 5 anos para casos não tratados. Desta forma, na maioria dos casos, estes pacientes devem ser tratados apesar do alto risco das opções terapêuticas. Neste estudo, discutimos a epidemiologia, a história natural, o diagnóstico e o tratamento desta grave patologia baseado na experiência de 286 pacientes tratados e dados da literatura.

Bypass cerebral de alto flujo con vena safena interna. Revisión del procedimiento y presentación de nuestra experiencia / High flow cerebral bypass with internal saphenous vein. Review of the procedure and presentation of our experience

INTRODUCCIÓN: el bypass cerebral de alto flujo (BPC-AF) es un procedimiento que se realiza cada vez con más frecuencia. En los últimos treinta años se publicaron más de 1000 procedimientos. El manejo de la técnica y la selección de pacientes para este tipo de tratamientos se han ido optimizando a lo largo del tiempo. OBJETIVO: actualizar las indicaciones quirúrgicas para los BPC-AF. Describir nuestra experiencia en 31 BPC-AF con vena safena. MATERIAL Y MÉTODOS: se realizó una búsqueda bibliográfica de los casos de BPC-AF publicados. Se analizó la evolución en las indicaciones para este procedimiento. Se reportó nuestra experiencia en este tipo de cirugía. RESULTADOS: desde la década del 80 se publicaron 4622 artículos sobre bypass, de los cuales 2612 fueron publicados desde el año 2000; 1056 de 2612 casos publicados correspondieron a alto flujo. El BPC-AF está indicado principalmente en a) aneurismas carotídeos gigantes, como primer tratamiento o por fracaso de cirugía endovascular; b) como cirugía de anticipación a la isquemia, cuando hay riesgo de oclusión de un vaso arterial importante, principalmente en el curso de patología tumoral o vascular de la base del cráneo; y c) en casos seleccionados de enfermedad cerebro-vascular que persiste sintomática a pesar del tratamiento médico. Nuestra experiencia incluyó 31 procedimientos realizados en 30 pacientes (16 de sexo femenino y 14 masculinos). La mayoría eran adultos, excepto 1 adolescente y 1 niño. CONCLUSIÓN: las indicaciones actuales del BPC-AF son prácticamente las mismas desde que fue realizado por primera vez, habiendo cambiado la aceptación que actualmente tiene esta técnica quirúrgica y su mayor uso en patología tumoral y vascular de la base del cráneo

INTRODUCTION: extracranial-Intracranial high-flow bypass (EC-IC-HFBP) is a surgical procedure performed with increasing frequency. Over the last thirty years, more than one thousand of this surgical procedures have been published. Technical management and patient selection for this kind of surgeries have been optimized over the time. OBJECTIVE: to update surgical indications for EC-IC-HFBP. To describe our experience in 31 EC-IC-HFBP using saphenous vein. MATERIAL AND METHODS: bibliographic search for EC-IC was performed. Evolution of surgical indications and criteria were analyzed. Our experience with this surgical procedure is reported. RESULTS: from 1980, 4622 articles about cerebral bypass were published, 2612 of them were published from the beginning of the new century; 1056/2612 corresponded to high-flow bypassses. EC-IC-HFBP are indicated a) in giant carotid aneurysms, as first treatment or by failure of endovascular surgery; b) anticipated surgery to prevent ischemia, when there is occlusion risk main arteries, mostly on tumoral or vascular pathology at the skull base; and c) in selected cases of cerebral-vascular diseases that persist with symptoms despite medical treatment. Our experience included 31 EC-IC-HFBP using saphenous vein carried out in 30 patients (16 females and 14 males). Most of procedures were performed on adults, excepting 1 teenager and 1 child. CONCLUSION: actual indications for EC-IC-HFBP are the same that those for the first procedures published;what changed is the general acceptance about this technique and its greater use in skull base tumoral and vascular pathology

Microcirugía asistida por endoscopia en el clipado de aneurismas gigantes y del segmento carotídeo comunicante posterior / Endoscopic assited microsurgery for clipping of giant aneurysms and carotid portion of posterior communicating aneurysms

Objetivo. Describir la utilidad de la endoscopia en el clipado microquirúrgico de aneurismas cerebrales. Descripción: Paciente de 62 años de edad con diagnóstico de aneurisma gigante de la arteria carótida interna (ICA) asociado amúltiples aneurismas, uno de ellos en el segmento carotídeo comunicante posterior (Pcom). Intervención. Se resolvió el aneurisma gigante carotídeo y el comunicante posterior con técnica microquirúrgica mediante el clipado,y éste último se clipó con la asistencia del endoscopio. Conclusión. En casos con aneurismas de ICA gigantes y aneurismas ICA-PcomA la microcirugía asistida por endoscopia provee acceso a las áreas ocultas al microscopio, permitiendo una apropiada oclusión del cuello aneurismático con preservación de perforantes

Objective. To describe the importance of the aid of the neuroendoscopein the microsurgery of cerebral aneurysms. Description. 62 years old female patient with an internal carotidartery giant aneurysm (ICA) and multiple aneurysms, one of them in the posterior communicant carotid segment (pcom). Intervention. Both of them were treated with microsurgery, and the pcom aneurysm was clipped with the assistance of endoscopy. Conclusion. In cases with giant and pcom aneurysms the endoscope assisted microsurgery is useful, providing good access to hidden fields to microscope, allowing a properlyocclusion and preservation of perforators branches.

Microcirugía asistida por endoscopia en el clipado de aneurismas gigantes y del segmento carotídeo comunicante posterior / Endoscopic assited microsurgery for clipping of giant aneurysms and carotid portion of posterior communicating aneurysms

Objetivo. Describir la utilidad de la endoscopia en el clipado microquirúrgico de aneurismas cerebrales. Descripción: Paciente de 62 años de edad con diagnóstico de aneurisma gigante de la arteria carótida interna (ICA) asociado amúltiples aneurismas, uno de ellos en el segmento carotídeo comunicante posterior (Pcom). Intervención. Se resolvió el aneurisma gigante carotídeo y el comunicante posterior con técnica microquirúrgica mediante el clipado,y éste último se clipó con la asistencia del endoscopio. Conclusión. En casos con aneurismas de ICA gigantes y aneurismas ICA-PcomA la microcirugía asistida por endoscopia provee acceso a las áreas ocultas al microscopio, permitiendo una apropiada oclusión del cuello aneurismático con preservación de perforantes

Objective. To describe the importance of the aid of the neuroendoscopein the microsurgery of cerebral aneurysms. Description. 62 years old female patient with an internal carotidartery giant aneurysm (ICA) and multiple aneurysms, one of them in the posterior communicant carotid segment (pcom). Intervention. Both of them were treated with microsurgery, and the pcom aneurysm was clipped with the assistance of endoscopy. Conclusion. In cases with giant and pcom aneurysms the endoscope assisted microsurgery is useful, providing good access to hidden fields to microscope, allowing a properlyocclusion and preservation of perforators branches.(AU)

The orbitopterional approach for large and giant middle cerebral artery aneurysms: a report of two cases and literature review.

We report two cases of complex middle cerebral artery aneurysms that were surgically treated using the orbitopterional approach in a two-piece method. The objective of this work is to discuss the usefulness of the orbitopterional approach in the surgical management of large and giant middle cerebral artery aneurysms. A 32-year-old man with a giant aneurysm and a 50-year-old woman with a large and complex aneurysm presented with subarachnoid hemorrhages. Both aneurysms were successfully clipped through an orbitopterional approach. This approach permits a more basal view of the vascular structures with only a minor retraction of frontal lobe. It also increases the view angle and amount of working space available. This approach should be considered as an alternative to the classic pterional craniotomy for the surgical management of such complex lesions.

Aneurisma gigante de carótida derecha / Giant aneurysm of right carotid

Los aneurismas se definen como dilataciones localizadas y permanentes que suponen un incremento del calibre del vaso mayor del 50%. En la carótida interna son poco frecuentes, de etiología casi siempre aterosclerótica y aparecen con mayor frecuencia en mujeres mayores de 60 años. La porción cavernosa de la arteria carótida interna raramente sufre ruptura y tiene una clínica variada que incluye cefalea, diplopía, parálisis de los nervios oculomotores y dolor facial. Presentamos el caso clínico de un paciente del Hospital Vargas de Caracas con aneurisma gigante de arteria carótida derecha en seno cavernoso, quien inició de forma súbita cefalea holocraneana, acompañada de oftalmoplejía, midriasis, disminución de la agudeza visual y sin signos de irritación meníngea, que se manejó de forma médica conservadora con evolución satisfactoria

Aneurysms are defined as permanent expansions of the artery with an increase of arterial blood of 50 %. The ethiology is mostly atherosclerotic, and they appear more frequently in 60-year old women. The clinical presentation is more frequent with migraine, diplopya, paralysis of the oculomotor nerves and facial pain. We present a case of a patient with a gigantic aneurysm of the cavernous sinus of the carotid artery treated at the Hospital Vargas de Caracas, Venezuela. This patient had a sudden severe migraine, accompanied of ophthalmoplegia, mydriasis, impaired vision, without signs of meningeal irritation. The treatment was medical with satisfactory progress of the patient