Metástasis asintomáticas de la base craneal: evolución clínica y alternativas terapéuticas / Asymptomatic skull base metastases: clinical course and therapeutic alternatives

Introducción. Las metástasis sintomáticas de la base craneal (MBC) son una progresión infrecuente, tardía y de mal pronóstico en pacientes con tumores sólidos. Sus manifestaciones clínicas pueden agruparse en cinco síndromes característicos, y su tratamiento más frecuente es la radioterapia. Gracias a los progresos tecnológicos en las pruebas de imagen y al seguimiento estrecho de los pacientes con cáncer, las MBC pueden diagnosticarse incidentalmente. En este subgrupo no se conoce la evolución clínica ni se ha establecido la mejor modalidad de tratamiento. Objetivo. Analizar las características clínicas y la evolución de los pacientes diagnosticados incidentalmente de MBC. Pacientes y métodos. Entre enero de 2012 y diciembre de 2015, 31 pacientes con una neoplasia sólida diagnosticados de MBC fueron valorados por nuestro servicio. Resultados. Las MBC se diagnosticaron por la presencia de un síndrome de base craneal (n = 24) o incidentalmente (n = 7). Los pacientes sintomáticos fueron tratados con radioterapia. Todos los pacientes diagnosticados incidentalmente permanecieron sin síntomas relacionados con la afectación de la base craneal hasta la fecha del fallecimiento, aunque frecuentemente presentaron de forma concomitante otros tipos de progresión intracraneal de mal pronóstico. Se observó una diferencia estadísticamente significativa en la supervivencia a favor de los pacientes sintomáticos (p = 0,001). Conclusiones. Las MBC diagnosticadas incidentalmente se asociaron frecuentemente a otros tipos de progresión intracraneal, limitando las opciones terapéuticas (AU)

Introduction. Skull base metastases (SBM) are an infrequent and late type of cancer progression that are associated to poor prognosis. Its clinical manifestations may be grouped in fi ve clinical syndromes and radiotherapy is its more frequent treatment. Because of the improvement in imaging tests and the close follow up of cancer patients, SBM can be diagnosed incidentally. In this group the best option of treatment has not been established. Aim. To analyze the clinical features and outcomes of patients with SBM diagnosed incidentally. Patients and methods. Between January 2012 and December 2015, 31 patients with diagnoses of SBM from solid primary tumor were reviewed. Results. SBM were diagnosed due to skull base syndromes (n = 24) or incidentally (n = 7). Symptomatic patients were treated with radiotherapy. Patients diagnosed incidentally remained without symptoms of craneal base involvement during the follow up, although they frequently had other types of intracranial progression. A statistically significant difference in survival was observed between symptomatic and asymptomatic patients (p = 0.001). Conclusions. The incidentally diagnosed SBM were frequently associated to other types of intracranial progression, limiting the options of treatment (AU)

[Incidence and risk factors of endoleak in endovascular aortic aneurysm repair]. / Incidencia y factores de riesgo de endofugas en el tratamiento endovascular de los aneurismas aórticos.

BACKGROUND: endovascular aneurysm repair (EVAR) reduces morbidity and hospital stay compaired with open surgical repair. Endoleak is a common complication of the procedure. The resulting increase of pressure within the sac may expand the aneurysm with the following risk of rupture. The aim of this study was to recognize the incidence of endoleak in tomographic controls of the patients who underwent endovascular repair at our hospital as well as identify the risk factors associated with this complication. METHODS: all consecutive patients who underwent endovascular aneurysm repair at our hospital between 2008, February until 2012, February were restrospectively enrolled in the study, excluding those who were lost at follow-up. 43 patients were included, aged 70.5 ± 6 (men: 88%). The endpoint was endoleak incidence at 1, 6, 12th months after the intervention in the control tomography, and its association with underlying risk factors: hypertension, Smoking, chronic obstructive pulmonary desease and the diameter of the aneurysm. RESULTS: eleven (11%) patients developed endoleak (type I 9%, type III 2%). All were infrarrenal aortic aneurysms. The anteroposterior diameter of the aneurysm (more than 60 mm) showed a trend toward statistical significance as a risk factor (30% vs. 6%; p:0.073). No relationship was found with gender, age, COPD, smoking or hypertension. CONCLUSION: endoleak after endovascular aneurysm repair is a common complication. The size of the aneurysm might be a risk factor of the event.

Introducción: La reparación endovascular de la patología aneurismática de la aorta ha permitido una disminución de la morbilidad y una recuperación más precoz con respecto a la cirugía convencional. Entre las complicaciones más frecuentes del procedimiento se encuentra la endofuga, cuyo principal riesgo es el aumento de la presión dentro del saco aneurismático y rotura del aneurisma. El objetivo de este estudio es evaluar la incidencia global de endofugas en los controles tomográficos de los pacientes tratados mediante reparación aórtica endovascular en la institución y reconocer los factores de riesgo que predicen su presentación. Materiales y Métodos: En un diseño retrospectivo se incluyeron todos los pacientes (N: 43, hombres 88%) tratados por reparacion endovascular entre febrero de 2008 y febrero de 2012 (4 años), con seguimiento clínico y tomográfico en la institución. La edad promedio fue de 70,5 ± 6 años. El evento primario evaluado fue la presentación de endofugas en la tomografía computada de control a 1, 6 y 12 meses posteriores al procedimiento, y su asociación a distintos factores predisponentes: hipertensión arterial, tabaquismo, enfermedad pulmonar obstructiva crónica y diámetro del aneurisma. Resultados: La incidencia global de endofugas fue del 11% (9% tipo I y 2% tipo III), todas en aneurismas abdominales infrarrenales. Hubo tendencia a la significación, como factor de riesgo predisponente, en el diámetro de aneurisma mayor de 60 mm (30% vs. 6%; p:0,073), mientras que los demás factores analizados no presentaron relación con la complicación. Conclusión: La endofuga luego de la reparación endovascular de la aorta es frecuente. El diametro del aneurisma puede ser un factor predisponente para este tipo de complicación.

Incidencia y factores de riesgo de endofugas en el tratamiento endovascular de los aneurismas aórticos / [Incidence and risk factors of endoleak in endovascular aortic aneurysm repair].

BACKGROUND: endovascular aneurysm repair (EVAR) reduces morbidity and hospital stay compaired with open surgical repair. Endoleak is a common complication of the procedure. The resulting increase of pressure within the sac may expand the aneurysm with the following risk of rupture. The aim of this study was to recognize the incidence of endoleak in tomographic controls of the patients who underwent endovascular repair at our hospital as well as identify the risk factors associated with this complication. METHODS: all consecutive patients who underwent endovascular aneurysm repair at our hospital between 2008, February until 2012, February were restrospectively enrolled in the study, excluding those who were lost at follow-up. 43 patients were included, aged 70.5 ± 6 (men: 88

). The endpoint was endoleak incidence at 1, 6, 12th months after the intervention in the control tomography, and its association with underlying risk factors: hypertension, Smoking, chronic obstructive pulmonary desease and the diameter of the aneurysm. RESULTS: eleven (11

). All were infrarrenal aortic aneurysms. The anteroposterior diameter of the aneurysm (more than 60 mm) showed a trend toward statistical significance as a risk factor (30

; p:0.073). No relationship was found with gender, age, COPD, smoking or hypertension. CONCLUSION: endoleak after endovascular aneurysm repair is a common complication. The size of the aneurysm might be a risk factor of the event.

Incidencia y factores de riesgo de endofugas en el tratamiento endovascular de los aneurismas aórticos. / [Incidence and risk factors of endoleak in endovascular aortic aneurysm repair].

BACKGROUND: endovascular aneurysm repair (EVAR) reduces morbidity and hospital stay compaired with open surgical repair. Endoleak is a common complication of the procedure. The resulting increase of pressure within the sac may expand the aneurysm with the following risk of rupture. The aim of this study was to recognize the incidence of endoleak in tomographic controls of the patients who underwent endovascular repair at our hospital as well as identify the risk factors associated with this complication. METHODS: all consecutive patients who underwent endovascular aneurysm repair at our hospital between 2008, February until 2012, February were restrospectively enrolled in the study, excluding those who were lost at follow-up. 43 patients were included, aged 70.5 ± 6 (men: 88

). The endpoint was endoleak incidence at 1, 6, 12th months after the intervention in the control tomography, and its association with underlying risk factors: hypertension, Smoking, chronic obstructive pulmonary desease and the diameter of the aneurysm. RESULTS: eleven (11

) patients developed endoleak (type I 9

, type III 2

). All were infrarrenal aortic aneurysms. The anteroposterior diameter of the aneurysm (more than 60 mm) showed a trend toward statistical significance as a risk factor (30

vs. 6

; p:0.073). No relationship was found with gender, age, COPD, smoking or hypertension. CONCLUSION: endoleak after endovascular aneurysm repair is a common complication. The size of the aneurysm might be a risk factor of the event.