[Surgical management of dural arteriovenous fistulae in six patients]. / Manejo quirúrgico de las malformaciones arteriovenosas durales craneales. Serie de seis casos.

OBJECTIVES: In this article, we describe our experience in surgical management of dural arteriovenous fistulae (dAVF). MATERIALS AND METHODS: From August 2001 to February 2006 a total of six patients, were admitted at our hospital, 2 women and 4 men with ages between 40 and 68 years. RESULTS: Four of the six cases were entered through the service of Emergency Service by neurological deficit (in two cases) or decrease in the level of consciousness (in two patients); the remaining two patients were referred by lengthy headache and alterations on neuroimaging studies suggestive of dAVF. All of them showed dAVF in different locations which were treated successfully with surgery after angiographic studies. CONCLUSION: Although multiple therapeutic options are available, surgery is the treatment of choice in dAVF which shows aggressive clinical course, especially intracranial hemorrhage.

Manejo quirúrgico de las malformaciones arteriovenosas durales craneales. Serie de seis casos / Surgical management of dural arteriovenous fistulae in six patients

Objetivos. En este artículo describimos la experiencia quirúrgica de nuestro centro en el manejo quirúrgico de las malformaciones arteriovenosas duralesintracraneales (MAVd´s).Material y métodos. Presentamos una serie de seis casos, dos mujeres y cuatro hombres, con edades comprendidas entre 40 y 68 años, en el periodo que transcurre entre los años 2001 y 2006, en el Hospital Clínico San Carlos de Madrid. Resultados. Cuatro de los seis casos fueron ingresados a través del servicio de Urgencias por clínica deficitaria (en dos casos) o disminución del nivel de conciencia (en dos pacientes); los dos restantes fueron remitidos desde consultas externas por cefalea de larga evolución y alteraciones en el estudio de neuroimagen sugerentes de FAVd o MAVd. En todos ellos el tratamiento quirúrgico fue definitivo. Conclusiones. A pesar las múltiples opciones terapéuticas, la cirugía es de elección en MAVd que presenta especial tendencia a comportarse de forma agresiva; fundamentalmente con riesgo de hemorragia intracraneal

Objetives. In this article, we describe our experience in surgical management of dural arteriovenous fistulae (dAVF).Materials and methods. From Agust 2001 to Febrery2006 a total of six patients, were admitted at our hospital, with ages between 40 and 68 years. Results. Four of the six cases were entered through the service of Emergency Service by neurological defecit (in two cases) or decrease in the level of consciousness(in two patients); the remaining two patients were refered by lengthy headache and alterations on neuroimagen studies suggestive of dAVF. All of them showed dAVF in different locations which were treated successfully with surgery of the unique mortality of treatment after angiographical studies. Conclusion. Although multiple therapeutic option sare avaible, surgery is in dAVF which shows aggressive clinical course, especially intracranial hemorrhage

Intrathecal opiates for chronic pain in cancer patients.

A total of 20 cancer patients suffering chronic pain were treated with morphine chloride by intrathecal administration through a subcutaneous implanted reservoir. Pain evaluation was done using our INO scale, McGill questionnaire and the visual analogue scale. A morphine intrathecal test was done previously to disclose if this method of administration would be effective. In nearly all patients the initial dose of morphine chloride was 2 mg/day and according to the pain relief the dose was modified if necessary. In 14/20 patients the initial dose was maintained during all treatment until their death. One patient treated during 370 days required a final dose of 6 mg/day. In all patients the analgesia obtained and evaluated with the INO scale was statistically significant using the t-Student (P less than 0.001) with a pretreatment mean value of 12.4 +/- 1.81 (mean +/- sigma) and 6.85 +/- 0.99 (mean sigma) in the final evaluation. The mean period of treatment was 62.8 days (range 10-370 days). Side effects are comparable with those described by others, and respiratory depression did not occur in our series. This method of treatment can alleviate pain in cancer patients not suitable to be treated by other methods, including ablative neurosurgical procedures, permitting home care which can be more comfortable to patients and their families.