Outpatient treatment of cerebral aneurysms: A case series.

BACKGROUND: Major advances in the endovascular treatment of cerebral aneurysms have reduced the incidence of intra- and postprocedural complications. The length of stay after treatment for incidental aneurysms remains between early next-day discharge and 2 days. We hypothesized that discharging patients the same day would not be associated with any increase in the rate of postdischarge adverse events. METHODS: We retrospectively reviewed the charts of patients who underwent an elective coiling procedure between 2015 and 2020 at three centers and were discharged from hospital on the same day as the procedure. Patients were clinically evaluated 6 h, 1 week, and 6 months after the procedure, with repeat cerebral angiography performed 1 year after the procedure. RESULTS: Eleven eligible patients underwent outpatient treatment of 12 aneurysms treated through the wrist. No complications were identified within 1 week of the procedure. Clinical evaluation 6 months after treatment also failed to reveal any complication associated with the procedure. Only one of the seven patients who underwent 1 year angiography required retreatment. CONCLUSION: It is possible to safely perform coiled embolization of cerebral aneurysms in select outpatients with unruptured cerebral aneurysms.

Distal radial approach for neurointerventional diagnosis and therapy.

BACKGROUND: The transradial approach results in fewer complications at the puncture site, lower hospital costs, and greater comfort for patients. The distal transradial approach (dTRA) adds some benefits over the conventional radial approach. The objective is to describe initial experience with distal radial approach technique and the results obtained for neuroendovascular diagnostic and therapeutic procedures. METHODS: Description of distal radial approach technique and obtained data from the first 3 months experience using this approach as the first choice for neuroendovascular procedures in two neuroendovascular centers. RESULTS: Of the total of 94 procedures performed during 3 months, 67 were diagnostic and 27 were therapeutic. Eleven (16%) of the diagnostic procedures were performed through the dTRA. Of the 27 embolizations, eight (30%) were done using this approach. Every distal radial approach that was performed for diagnosis and therapeutics was successful. CONCLUSION: Puncture of the radial artery within the anatomical snuffbox is a radial approach variation option for diagnostic and therapeutic neuroendovascular procedures.

Chiari I: edema medular y aumento de la siringomielia luego de la descompresión cráneo espinal con plástica meníngea. reporte de un caso / Chiari I: medullary edema and increased syringomyelia after decompression spinal skull with meningeal plastic. report a case

Objetivo: Describir y analizar un caso de Chiari I con edema medular y aumento de la siringomielia (SM), luego de una descompresión cráneo espinal (DCE). Descripción: una mujer de 57 años consultó por cefaleas agravadas por maniobras de Valsalva, hipo, disfagia e hipoestesia distal del miembro superior izquierdo. La Resonancia Magnética (RM) mostró una malformación de Chiari tipo I con SM. Intervención: en abril del 2009 se efectuó una DCE (occipital + atlas) con plástica meníngea (dura artificial). En el postoperatorio inmediato notó aumento de su cefalea, y además se produjo una fístula de LCR que se trató con un drenaje lumbar externo. Como sus síntomas pre y postoperatorios mejoraron fue externada. En la RM realizada a los 15 días se observó un pseudomeningocele (PM) con edema medular. Los controles posteriores mostraron la desaparición del edema y el PM, con un aumento en el tamaño de la SM. En marzo del 2011 se hizo una laminectomía del axis sin reducción de la SM. Luego de un acceso de tos apareció un dolor neuropático en el brazo izquierdo. La nueva RM mostró que la SM no se había reducido y que la plástica meníngea se había retraído obstruyendo la cisterna magna. En diciembre del 2011 se realizó una nueva plástica meníngea con periostio y la RM de marzo del 2012 mostró una desaparición de la SM. Conclusión: en este caso, el edema medular y el PM se redujeron espontáneamente pero la SM no mejoró hasta eliminar todas las causas de obstrucción en la circulación del LCR a nivel del foramen magno.

Objective: To describe and analyze a Chiari I malformation with spinal cord edema and syrinx increase after craneospinal decompression (CED).Description: a 57 years-old female referred a history of headaches after Valsalva maneuvers, hiccup, dysphagia and left distal upper limb hypoesthesia. Magnetic Resonance Imaging (MRI) showed a Chiari I malformation with syringomyelia.Intervention: during April 2009 a CED (occipital + atlas) with a non autologous duraplasty were performed. In the immediate postoperative period headaches increased and also appeared an external CSF fistula that was treated successfully with an external lumbar drainage. As the pre and postoperative symptoms improved she was discharged. After 15 days MRI revealed a pseudomeningocele (PMC) with spinal cord edema. Further controls showed the disappearance of the PMC and the edema with syrinx increase. In March 2011 a laminectomy of the axis was performed without reduction of the syrinx. A few months later and after a cough attack a neuropathic pain developed in the left upper limb. MRI showed a larger syrinx with retraction of the duraplasty. In December 2011 a new duraplasty with autologous pericranium was performed. Three months latter a postoperative MRI showed syrinx resolution. Conclusion: in this case the spinal cord edema and PMC resolved spontaneously but syringomyelia improved only after removing all the causes that obstructed the normal CSF circulation at the foramen magnum.

Schwannoma de nervio facial intratemporal e intraparotídeo: reporte de un caso / Intratemporal and intraparotid schwannoma of facial nerve: case report

Objective: to describe and analyse a case of intrapetrous facial schwannoma, with intraparotid extension. Description: a 37-year-old female came to examination presenting a facial palsy consequent to a previous surgery of a tumor in the left parotid region. Pathology revealed a schwannoma. CT-scanning and MRI showed an intratemporal left region mass.Intervention: through a retro-auricular, transmastoid approach, it was observed that the tumor affected the labyrinthine and tympanic segments of the facial nerve. The intrapetrous mass lesion was removed but it was impossible to isolate a healthy portion of the nerve; intraparotid involvement was also observed. It was decided to perform a hypoglossal facial anastomosis using anautologous sural nerve grafting. Pathology of the intrapetrous lesion revealed a facial nerve schwannoma. Conclusion: the choice of a retro-auricular, transmastoid approach allowed us to remove the facial nerve schwannoma, at the intrapetrous level. Due to the simultaneous intratemporal and intraparotid nerve involvement, a hypoglossal facial anastomosis was performed to treat the patient’s facial palsy.

Signos útiles para identificar el surco central en resonancia magnética / Useful signs to identification of the Central Sulcus in MRI

Objetivo: describir la frecuencia de observación de los signos descriptivos en neuroimágenes para la localización del surco central. Material y método: se emplearon imágenes por resonancia magnética (IRM) de 60 pacientes adultos (18 a 83 años), de ambos sexos (34 mujeres y 26 varones) con cerebros normales, en cortes axiales rostralesponderadas en secuencias T1 y T2, realzadas en resonador Phillips 1.5 Tesla. En las IRM se buscaron los siguientes signos: la unión surco frontal superior con el surco precentral, el signo del omega invertido, la impronta de la rama marginal del surco del cíngulo en la convexidad (“pars Bracket”), el surco post central que se bifurca en su porción superior, el giro post central más fino que el giro precentral, la unión surco intraparietal con el surco post central y el surco central que alcanza la línea media. Se determino su frecuencia. Resultados: el surco frontal superior se une con el surco precentral en 95%. El signo del omega invertido se evidencia en 96.66% de los casos. El signo de “pars Bracket” esta presente en 95% de las observaciones. El surco post central es bífido en 65%. El giro post central es más estrecho que el giro precentral en 98.33%. El surco intraparietal intercepta con el post central en 83.33%. El surco central alcanza la línea media en 86.66% de las observaciones. Conclusión: los signos descriptos tienen una alta frecuencia de presentación, encontrándose en promedio en 89.28% de las URM observadas...