Manejo de la enfermedad aneurismática múltiple. Experiencia en un Hospital de Especialidades.

Objective: To establish the frequency and results in patients carriers with multiple aneurysms (MA) treated by microsurgery and/or neurological endovascular therapy (NET) in the Hospital of Specialties on The National Medical Center La Raza. Method: It is an ambispective, descriptive and longitudinal study that includes patients carriers of MA treated in the National Medical Center La Raza from March the 1st of 2009 to April the 30th of 2014. Results: 62 patients carriers of 151 aneurysms were treated. According to the type of treatment, 30 patients (49%) were included in the surgical group (GQ), 25 (40%) in the endovascular group (GE) and 7 (11%) in the combinated group (GC). The number of aneurysms was distributed this way: 69 (46%) in the GQ, 61 (40%) in the GE and 21 (14%) in the GC. At GQ, it was not possible to exclude all their aneurysms on 21% of the patients, while it was feasible in only 27%. In all GE patients (40%) the exclusion of all aneurysms was achieved. The GC, meaning surgical cases that were not completed by NET, formed 11% of the cases. At GQ there was a rate of 6% of complications, meanwhile at GE it was 0.5%.

Morphometric analysis of the foramen ovale in the Mexican population using computed tomography scan.

Background: The assessment of cranial foramina is an important part of the objective diagnostic and therapeutic study relevant to pathologies involving structures of the skull base. The study of the foramen ovale not only holds significance for anatomical development but also bears profound surgical importance, such as in trigeminal neuralgia, and diagnostic importance in tumors and various types of epilepsy. It becomes relevant in fine-needle aspiration techniques in perineural tumor procedures, for electroencephalographic analysis in seizures, and therapeutic procedures such as percutaneous trigeminal rhizotomy for trigeminal neuralgia. Methods: A cross-sectional study at the Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexico City, involved 70 patients aged >18 years who underwent a single skull computed tomography scan between July 2023 and March 2024. Patients with sufficient scan quality and optimal visualization of skull base foramina were included in the study. Measurements of tomographic images were taken using Inobitec's DICOM file viewer. Data analysis in Microsoft Excel yielded mean, standard deviation, and 95% confidence interval (CI) for morphometric parameters of the foramen ovale. Results: Analysis of tomographies from 70 patients revealed a total of 140 foramen ovale, evenly split between 25 males (35.7%) and 45 females (64.3%). The measurements for the maximum anteroposterior diameter, transverse diameter, and surface area of all foramina were as follows: 6.61 ± 0.25 mm (95% CI), 3.97 ± 0.21 mm (95% CI), and 20.84 ± 1.58 mm2 (95% CI), respectively. Specific measurements for the right and left sides were obtained: for the right side, 6.59 ± 0.26 mm (95% CI) and 3.89 ± 0.21 mm (95% CI) for the maximum anteroposterior and transverse diameters, respectively, and 20.38 ± 1.62 mm2 (95% CI) for the surface area. For the left side, the measurements were 6.63 ± 0.24 mm (95% CI), 4.05 ± 0.21 mm (95% CI), and 21.31 ± 1.55 mm2 (95% CI) for the maximum anteroposterior diameter, transverse diameter, and surface area, respectively. The maximum and minimum dimensions for anteroposterior and transverse diameters were 10.67 mm, 4.41 mm, 7.09 mm and 2.36 mm, respectively, with a corresponding range for the surface area of 10.16 mm2-44.13 mm2. The average minimum distance between the foramen ovale and the foramen spinosum was 2.32 ± 0.24 mm (95% CI). In males, the average size of the foramen ovale was 23.66 ± 1.61, which was 22% larger than the average size in females (19.28 ± 1.45) (P = 0.0001). Conclusion: The foramen ovale is one of the main anatomical structures of the skull base, and besides that, it is complex and not directly accessible for clinical evaluation, useful information can be obtained through morphometric analysis. The present study provides specific anatomical data with morphological patterns to increase the understanding of the characteristics of the foramen ovale in the Mexican population. These are intended to be helpful in the pursuit of acknowledging the morphometrics and thus being able to plan neurosurgical procedures in the middle cranial fossa.

Subdural drain with Nelaton catheter and latex glove, a low-cost alternative and how to make it.

Background: One of the most commonly encountered surgical pathologies in neurosurgical practice worldwide is subdural hematoma. The use of prefabricated drains following surgical procedures is widely recommended. However, their availability can be inconsistent due to various issues. Methods: An intensive search was conducted regarding the availability and cost of subdural drains. The Medtronic subdural evacuating port system costs between 100 and 150 USD, the Blake drain costs between 35 and 40 USD, and the Jackson-Pratt drain costs between 25 and 35 USD. We present a low-cost alternative and describe how it can be implemented using materials available in almost every hospital. Results: A simple step-by-step guide for crafting handmade subdural drains has been created, aiming to make this affordable alternative accessible to every surgeon who may need one due to the unavailability of prefabricated drains in developing countries. Conclusion: The benefits associated with using a subdural drain during the evacuation of subdural hematomas are well-documented. In cases where prefabricated drains are not available, a handmade alternative can always be utilized. Materials are often readily available in every hospital, and the cost may not exceed 100 MXN (5 USD), making it at least 5 times cheaper than the cheapest prefabricated alternative. This solution is particularly beneficial for developing countries without access to prefabricated drains.

[Epidermoid neoplasm of the fourth ventricle. Report of two cases]. / Tumor epidermoide del cuarto ventrículo. Informe de dos casos.

BACKGROUND: epidermoid neoplasm (EN) accounts for 1 % of whole intracranial neoplasms. Usually, it is found at the cerebello-pontine angle and the location in the fourth ventricle (FV) is rare. The aim was to report two cases of EN of the FV. CLINICAL CASES: case 1: a female 22 year old presented with an intense headache with a history of 3 months. At the hospital entry, symptoms and signs of high intracranial pressure were found. Tomography images showed hydrocephalus with high pressure in the FV. She was treated with a shunt from ventricular to peritoneal cavity. After that an encapsulated neoplasm was drawn. It had a pearled aspect. The histology report showed an EN originating in the FV. Case 2: a female 44 year old with a history of five years of dizziness; three years before admission she presented intermittent diplopia and disophagia. At the hospital admission the patient presented paresis of the 6th and 7th cranial nerve. The tomography and the magnetic resonance studies showed a mass in the FV. The neoplasm was extirpated. CONCLUSIONS: the EN of the FV is an infrequent benign lesion. Magnetic resonance is the standard diagnostic study, but it could lead to confusion with neurocisticercosis. The extirpation and the treatment of the hydrocephalus are indicated.

Introducción: los tumores epidermoides representan 1 % de las neoplasias intracraneales; el ángulo pontocerebeloso es la localización más frecuente y en el cuarto ventrículo son raros. Casos clínicos: caso 1: mujer de 22 años de edad con cefalea intensa de tres meses de evolución. Al ingreso se identificó hipertensión endocraneana. La tomografía mostró hidrocefalia con aumento del volumen del cuarto ventrículo. La paciente fue tratada con derivación ventrículo-peritoneal; posteriormente se extirpó tumoración encapsulada de aspecto perlado. El estudio histológico indicó tumor epidermoide en el cuarto ventrículo. Caso 2: mujer de 44 años de edad con vértigo ocasional de cinco años de evolución, así como con diploplía y disfagia intermitentes de tres años de evolución. Al ingresó se identificó paresia bilateral de los nervios craneales VI y VII. La tomografía computarizada y la resonancia magnética mostraron lesión en el cuatro ventrículo. El manejo fue quirúrgico. Conclusiones: la resonancia magnética es el estudio diagnóstico específico para el diagnóstico del tumor epidermoide del cuarto ventrículo que, sin embargo, puede confundirse con neurocisticercosis. Están indicados la exéresis del quiste y el tratamiento de la hidrocefalia.

[Brain aneurysms treatment with pCONus2 device. Initial experience at IMSS]. / Aneurismas cerebrales tratados con dispositivo pCONus2. Experiencia inicial en el IMSS.

Background: pCONus2 device has been used in some countries as coadyuvant in the treatment of wide-neck bifurcation aneurysms with coils. Objective: To present the first series of brain aneurysms treated with pCONus2 in the Mexican Institute for Social Security (IMSS). Material and methods: We retrospectively present the first 13 aneurysms treated from October 2019 to February 2022 with pCONus2 device at a third level hospital. Results: 6 aneurysms located at anterior communicating artery, 3 at middle cerebral artery bifurcation, 2 at internal carotid artery bifurcatión, and 2 at the tip of basilar artery were treated. Device deployment was performed without complications and it was possible to embolize aneurysms with coils in 12 patients (92%), while on an internal carotid bifurcation aneurysm (8%) there was an incident of a pCONus2 petal migration toward vascular lumen caused by coils mesh pressure, situation that was solved by placing an nitinol self-expandable microstent. In 7 cases (54%) we performed coiling technique after microcatheter passage through pCONus2, while in 6 cases (46%) we used the jailing technique without complications. Conclusions: pCONus2 is a useful device for wide-neck bifurcation aneurysms embolization. In Mexico our experience is yet limited; however, the first cases have been successful. Furthermore, we showed the first cases treated using jailing technique. Much more cases are required in order to carry out a statistically conclusive analysis and to establish the effectiveness and safety of the device.

Introducción: el dispositivo pCONus2 ha sido usado en algunos países como coadyuvante en el tratamiento con coils de los aneurismas de cuello ancho localizados en las bifurcaciones. Objetivo: presentar los primeros aneurismas tratados con pCONus2 en el Instituto Mexicano del Seguro Social (IMSS). Material y métodos: se exponen retrospectivamente 13 casos de pacientes tratados con pCONus2 de octubre de 2019 a febrero de 2022 en un hospital de tercer nivel del IMSS. Resultados: se trataron 6 aneurismas de la arteria comunicante anterior, 2 de la bifurcación de la arteria carótida interna, 3 en la bifurcación de la arteria cerebral media y 2 del tope de la arteria basilar. El uso del pCONus2 se hizo sin complicaciones ni incidentes en 12 pacientes (92%), mientras que en un aneurisma de la bifurcación de carótida interna (8%) ocurrió la migración de un pétalo del dispositivo hacia la luz vascular, motivado por la presión de la malla de coils, que se solucionó con un microstent. Siete aneurismas (54%) fueron embolizados con coils después del paso del microcatéter a través del pCONus2, mientras que en 6 (46%) se utilizó la técnica jailing, sin complicaciones ni incidentes. Conclusiones: el pCONus2 es un dispositivo útil en la embolización de aneurismas localizados en bifurcaciones arteriales. En México la experiencia todavía es poca, pero los primeros casos han sido exitosos. Mostramos, además, los primeros casos tratados con la técnica de jailing. Se requieren más casos en nuestro país para hacer un análisis estadísticamente concluyente y determinar la efectividad y seguridad del dispositivo.

[Device for percutaneous insertion of a distal catheter in ventriculo-atrial shunt. Technical report]. / Dispositivo para inserción percutánea del catéter distal en la derivación ventriculoatrial. Reporte técnico.

INTRODUCTION AND OBJECTIVES: A ventriculo-atrial shunt is indicated for the treatment of some hydrocephalus cases. The distal catheter is usually inserted into the right atrium through cervical venous dissection. Percutaneous insertion has been described with success; however its use is not widespread. The aim of this work is to describe modifications in the distal catheter of a ventriculo-atrial shunt, the technique for its percutaneous insertion and the clinical outcome of the process. MATERIAL AND METHODS: The distal catheter was modified after its use in 4 animal specimens. It was designed «over the wire¼, with its flexibility being reduced and accessories being added. The device was subsequently used in humans, with slight modifications of the jugular vein catheterization technique. We evaluated complications, surgical time and outcome during 6months. RESULTS: In the course of one year, 6adult patients in whom the peritoneum was no longer receiving cerebrospinal fluid were treated for hydrocephalus. The mean operating time was 34minutes (including proximal catheter insertion). There were no complications and ventricular size improved. CONCLUSIONS: The percutaneous technique has proved useful: it reduces surgical time and has a very low rate of complications. Apparently, modifications made in the distal catheter caused no complications and avoided the use of other materials designed for other purposes. More cases are required to perform a definitive analysis.

[Endovascular treatment of non-galenic pial arteriovenous fistulas]. / Tratamiento endovascular de las fístulas arteriovenosas piales no galénicas.

INTRODUCTION AND OBJECTIVES: Pial arteriovenous fistulas are infrequent vascular malformations. They are generally congenital and their natural history is ominous. The objective of this work is to describe our experience in their endovascular management and to review the existing literature. PATIENTS AND METHODS: This is a retrospective and descriptive study of patients treated by endovascular approach during 3 years at 3 Latin-American hospitals. RESULTS: The study included 6 patients with a mean age of 22 years. One case was caused by cranial trauma. In total, 50% suffered intracranial haemorrhage and 66% developed symptoms attributable to volume effect or retrograde blood flow. Intracranial varices were identified by CT and MRI scans in 83% of cases. Digital subtraction angiography showed arteriovenous fistulas from anterior circulation in 67% of cases and deep venous drainage in 50%. One endovascular procedure was performed in 5 cases (83%), while 2 procedures were required in one case. A single embolic agent was used to occlude fistulas in 67% of cases; whilst 33% required a combination. Coils were used in 4 cases (67%) and onyx was injected in another 4 (67%). One case required stent and balloon deployment. The fistulas were uneventfully occluded in all cases. The follow-up period was one year in 5 cases and 6 months in one case. All patients remained symptom-free. CONCLUSIONS: Endovascular management can be considered as the treatment of choice. It consists in the embolisation of arterial pedicles with one or more embolic agents and should be performed as close as possible to the drainage vein, avoiding migration of the embolic agent towards the venous side.

[Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation]. / Fístula arteriovenosa pial traumática que simula una fístula carotidocavernosa: una enfermedad infrecuente con una presentación excepcional.

Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.

[Endovascular approach in the management of intracranial aneurysms. Part 1: basic concepts and devices]. / Perspectiva endovascular en el manejo de los aneurismas intracraneales. Parte 1: Conceptos básicos y dispositivos.

Neurological endovascular therapy is a discipline that has shown effectiveness and safety in the management of intracranial aneurysms, however recanalization persists as one of the most important obstacles to overcome. Precise knowledge of the anatomy and hemodynamics of the aneurysm and the parent artery as well as currently available endovascular devices, are decisive in the analysis and to design a specific treatment plan for each case. In this manner we ensure, as long as possible, success and durability of the treatment.

[Endovascular approach in the management of intracranial aneurysms. Part 2: indications and therapeutic strategy]. / Perspectiva endovascular en el manejo de los aneurismas intracraneales. Parte 2: Indicaciones y estrategia terapéutica.

The success and stability of the occlusion of intracranial aneurysms can be achieved after an adequate conceptualization and implementation of current endovascular techniques, which in turn should be based on knowledge of available devices and the analysis of the specific characteristics the aneurysm and its parent artery to what we called aneurysmal complex.

Intracranial aneurysms in pediatric population treated with flow diverters: A single-center experience.

Background: Pediatric intracranial aneurysms (PIAs) are uncommon. Flow diverters (FDs) have shown to be effective on treatment of selected aneurysms. Methods: We describe 10 cases of PIAs treated with FDs at one medical center in Mexico, from April 2015 to April 2020. Results: Out of 230 patients treated with FDs, 10 (4.3%) were pediatric. Average age was 9.4 years old (R: 6-15). Two patients (20%) had subarachnoid hemorrhage, 3 had epilepsy (30%), 3 (30%) had clinical signs of cranial nerve compression, and 4 (40%) had only headache. Two patients were in 1a grade of Hunt and Kosnik scale. Out of the nonruptured aneurysms, 7 (70%) were in 15 points of Glasgow Coma Scale and 1 patient (10%) was in 13 points. Treatment was performed without complications; nevertheless, appropriate distal deployment was not achieved in one case. At discharge, nine patients had 5 points of Glasgow Outcome Scale. All patients underwent computed tomography angiography or digital subtraction angiography at 1, 3, 6, and 12 months, 2 patients (20%) had a 2-year follow-up, and 3 patients (30%) had a 3-year follow-up. According to Kamran grading scale, 9 patients (90%) were classified as Grade 4 and 1 patient (10%) as Grade 3. Conclusion: Even though it is a small series, as this is an uncommon disease, we may suggest that FDs are useful to treat properly selected PIAs. Our study has consecutive imaging assessment at least a year of follow-up in which aneurysm stable occlusion was observed in 90% of patients.

Intramedullary cervical spinal cord and cerebellar hemangioblastoma: A case report.

Background: Hemangioblastomas are benign tumors that develop in the central nervous system. They represent 1.5-2.5% of all intracranial tumors, and about 2-15% of all spinal cord tumors. They are highly associated with von Hippel-Lindau disease. Case Description: A 36-year-old female presented with a 4-year history of progressive right upper extremity distal weakness and cervical pain. The magnetic resonance imaging demonstrated a homogeneously, contrast enhancing intradural/intramedullary tumor at C6-C7 with perilesional edema and a syrinx accompanied by a cerebellar cyst with a mural nodule. Surgery included excision of the spinal lesion and decompression and excision of the cerebellar cyst and mural nodule (i.e., median suboccipital craniectomy and cervical C5-C7 laminectomy). Conclusion: Surgery is the gold standard treatment for symptomatic hemangioblastomas, and surgical approaches should minimize risk.

[Chronic nasal obstruction: ethmoidal encephalocele in an adult patient]. / Obstrucción nasal crónica: encefalocele nasoetmoidal en paciente adulto.

Nasal obstruction is a frequent cause of referral to the ear, nose and throat specialist. When this symptom is resistant to medical management and common causes have been ruled out, the presence of neural structures should be investigated In the nasoethmoidal meningoencephalocele, a congenital defect of the ethmoid lamina cribrosa allows the herniation of the intracranial contents into the nasal fossa. The key to clinical diagnosis is the presence of nasal obstruction with rhinorrhea and recurrent meningitis. We describe the case of a 33-year old female who was long treated for nasal polyposis and underwent a successful surgical treatment of ethmoidal meningoencephalocele.

[Endoscopic endonasal transsphenoidal approach for growth hormone-producing pituitary adenomas. Preliminary results]. / Abordaje endonasal endoscópico transesfenoida en adenomas hipofisiarios productores de hormona de crecimiento. Resultados preliminares.

BACKGROUND: An endoscopic endonasal transsphenoidal approach is reported as less invasive, allowing an earlier discharge. Published series have never focused on its use in acromegalic patients. OBJECTIVE: To assess the effectiveness of an endoscopic endonasal transsphenoidal approach in the management of growth hormone-secreting adenomas. PATIENTS AND METHODS: Nineteen consecutively operated patients were assessed with a prospective follow-up of one year. RESULTS: Sex ratio was 0.7/1 and gross total removal was obtained in 16 cases (84%), subtotal in three (16%). The only complication was a cerebrospinal fluid leak requiring spinal drainage. The median in-hospital stay was 2.5 days. Sixteen patients experienced clinical improvement (84%) and no changes were observed in three (16%). Residual tumor was seen in two cases (11%). Growth hormone levels < 2 ng/dl were seen in 17 cases (89%) and only two patients (11%) had a level >2 ng/dl. Insulin-like growth factor-1 levels were normalized in 16 cases (84%) and remained elevated in three patients (16%). One patient presented an isolated elevated level of insulin-like growth factor-1. Patients with residual tumor and elevated growth hormone and insulin-like growth factor-1 levels underwent complementary radiosurgery. CONCLUSIONS: The endoscopic endonasal transsphenoidal approach seems to be useful in acromegaly, with a high rate of clinical and biochemical cure among other benefits.

[Endovascular management of carotid atherosclerosis. Section I: basic considerations and diagnostic elements]. / Manejo endovascular de la aterosclerosis carotídea Parte I. Consideraciones básicas y elementos diagnósticos.

Carotid atherosclerosis accounts for about 25 % of all ischemic cerebrovascular events. A thorough knowledge of the pathophysiology of the plaque and its clinical consequences are fundamental elements for a well-balanced approach of the management of the disease. The evolution of the imaging techniques allow to visualize the plaque and the analysis of its structure and characteristics. The awareness of the physiopathology and the understanding of the imaging modalities are key issues when planning the treatment of the patient.

[Endovascular management of carotid atherosclerosis. Section II: current therapeutic approaches and limitations]. / Manejo endovascular de la ateroesclerosis carotídea Parte II. Criterios terapéuticos actuales y limitaciones.

Carotid endarterectomy has for long been regarded as the gold standard for the management of symptomatic atherosclerosis of the carotid bifurcation, and carotid angioplasty is merely considered a secondary alternative reserved to surgically high-risk patients. However, several studies have shown that the efficacy of carotid angioplasty has equaled that of carotid endarerectomy and additionally provides unshared advantages: local anesthesia is sufficient, the whole extracranial and intracranial carotid circulation are amenable to treatment and wound-related complications are not seen. Besides a thorough review of the main published studies comparing both techniques, we provide updated criteria for the endovascular management of carotid artery disease, discussing their benefits and limitations.

Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients.

OBJECT: The use of intracranial stents in stent-assisted coil embolization is now a current neurosurgical practice worldwide. The clinical utility of these stents in the sole stenting (SS) technique, however, has not been thoroughly described, and the published reports of this experience are scarce. This study was designed to evaluate SS treatment of dissecting and nondissecting aneurysms of the posterior circulation. METHODS: This prospective and descriptive study was conducted in 20 consecutive patients who harbored single aneurysms of the posterior circulation and who were treated using the SS approach in the last 3 years. The clinical and radiological assessment and follow-up of the patients were evaluated using the modified Rankin scale as well as with computed tomography angiography and digital subtraction angiography at discharge and at 1, 3, 6, and 12 months. RESULTS: Eleven of the 20 patients had subarachnoid hemorrhages, 3 presented with ischemia, 1 presented with brainstem compression, and the remaining 5 patients had incidentally discovered, asymptomatic lesions. Only 1 patient had a complication (occipital infarction) attributable to the SS procedure. One patient died of rebleeding 2 weeks after the procedure. At 1 month, 40% of the patients had a subtotal or total occlusion, which increased to 55% at 3 months and 85% at 6 months, with a final subtotal or total occlusion rate of 80% at 1 year. The SS procedure in 1 case was considered a failure at 6 months because no change had been noted since the 1-month follow-up. One case showed partial occlusion and 1 case showed recanalization. CONCLUSIONS: Use of SS for aneurysms in the posterior circulation complex is a safe and effective technique, demonstrating an occlusion rate of 80% at the 1-year follow up.

[Management of chronic subdural hematoma with twist-drill craniostomy. Report of 213 patients]. / Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.

[Invasive management of trigeminal neuralgia. 8 years experience]. / Manejo invasivo de la neuralgia del trigémino. Experiencia de 8 años.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by stereotyped repetitive, unilateral pain, referred as an electric shock, triggered by the stimulation of the rami of the trigeminy nerve. It presents more frequently in women. The aim is to know the efficacy of surgical treatment of TN against pain by means of microvascular decompressive technics (MDT) and balloon percutaneous microcompression (BPM). METHODS: A retrospective study was performed from January 2005 to January 2013, including 73 patients treated for TN. Sixty patients from group 1 (82 %) were treated with MDT, and 13 from group 2 with BPM. We evaluated the presence of pain in patients during the immediate postoperative period, and at 1, 3 and 5 years. RESULTS: 55 female patients and 18 male patients were included. The mean age of presentation for TN was 55 years. In group 1 there was pain remission in the immediate postoperative period in 95% of the cases, in 92% at one year, 91% at 3 years and 88% at 5 years; in group 2 in 85%, 84%, 84% and 70%, respectively. There were no lethal complications in 6.5% in group 1 and in 28% in group 2. CONCLUSIONS: The two therapeutic procedures reduced pain of TN in a long term in most patients. Our results show high and perdurable resolution of the pain with negligible morbimortality.

Introducción: la neuralgia del trigémino (NT) se caracteriza por un dolor estereotipado, repetitivo, unilateral referido como eléctrico, desencadenado por la estimulación de  ramas del nervio trigémino. Se presenta con mayor frecuencia en mujeres, 2:1 con respecto a sexo masculino. El objetivo fue conocer la eficacia del tratamiento quirúrgico de NT contra el dolor mediante las técnicas de descompresión microvascular (DMV) y microcompresión percutánea con balón (MPB). Métodos: estudio retrospectivo, en el periodo entre enero de 2005 y enero de 2013, de 73 pacientes tratados por NT. Los 60 pacientes del grupo 1 fueron tratados con DMV, y los 13 del grupo 2 con MPB. Se evaluó la presencia de dolor de los pacientes en el postoperatorio inmediato y a 1, 3 y 5 años. Resultados: se incluyeron 55 pacientes del sexo femenino y 18 hombres. La edad media de presentación de NT fue a los 55 años de edad. En el grupo 1 hubo remisión del dolor en el postoperatorio inmediato en 95 % de los casos, en 92 % al primer año, 91 % a los 3 años y 88 % a los 5 años y en el grupo 2: 85 %, 84 %, 84% y 70 % respectivamente. Conclusiones: los dos procedimientos terapéuticos redujeron el dolor de NT a largo plazo en la mayoría de los pacientes. Nuestros resultados muestran resolución alta y perdurable del dolor con escasa morbimortalidad.

[Endoscopic third ventriculostomy for chronic communicating hydrocephalus in adults]. / Tercer ventriculostomía endoscópica secundaria en hidrocefalia comunicante crónica en el adulto.

BACKGROUND: Shunt devices to treat hydrocephalus are associated with a malfunction of 81 % at 12 years and 10 % of infection. The objective was to assess safeness and efficacy of endoscopic third ventriculostomy (ETV) for the treatment of chronic communicating hydrocephalus. METHODS: Eight patients with chronic communicating hydrocephalus were included in a period between September, 2012 and April, 2013. X ray computed tomography scans were performed when patients were admitted, after the surgery, and at 30, 180 and 365 days. The follow-up was of 251 days (the biggest was of 459 days). The variables included were: age, sex, etiology, time of evolution, and the total number of shunt malfunctions. Conventional technique with a 30° rigid endoscope was performed, malfunctional shunt was removed, and a tied shunt device was placed. RESULTS: Four males and four females, with a mean age of 42 years (27-63 years); neurocysticercosis was identified in five patients (62.5 %); the evolution rate was of 18 years (15-30 years); the hospital stay rate was of 6.5 days (3-22 days); the mean of previous shunt malfunctions was 4 (1-6). COMPLICATIONS: neuroinfection in one patient, malfunction in three patients. None of them died. CONCLUSIONS: ETV is a safety procedure for treating chronic communicating hydrocephalus; it has a success rate higher than 60 %. Neurocysticercosis showed better results when previous shunt malfunctions were lower than three.

Introducción: la derivación valvular para tratar la hidrocefalia se asocia con disfunción del 81 % a 12 años y 10 % de infección. El objetivo es evaluar la seguridad y la eficacia clínica de la tercer ventriculostomía endoscópica secundaria (TVE) en pacientes con hidrocefalia comunicante crónica. Métodos: se incluyeron ocho pacientes adultos entre septiembre de 2012 y abril de 2013 con hidrocefalia por disfunción valvular de etiología comunicante. Se les hizo estudio de tomografía axial computarizada al ingreso, postoperatoria, y después de 30, 180 y 365 días. El seguimiento clínico fue de 251 días (el mayor fue de 459 días). Las variables incluidas fueron: edad, sexo, etiología, tiempo de evolución y número de sistemas valvulares fallidos. Se aplicó técnica convencional con endoscopio rígido 30°, retiro de catéter disfuncional, y colocación de sistema valvular ligado. Resultados: cuatro hombres y cuatro mujeres, con edad promedio de 42 años (27-63 años), neurocisticercosis en cinco pacientes (62.5 %), evolución promedio de 18 años (15-30 años), estancia hospitalaria promedio 6.5 días (3-22días), disfunciones valvulares previas promedio 4 (1-6). Complicaciones: hubo neuroinfección en un paciente y disfunción en tres pacientes. Ninguno murió. Conclusión: la TVE secundaria es un procedimiento seguro en el tratamiento de hidrocefalia comunicante crónica, con una eficacia mayor al 60 %. En neurocisticercosis se observaron mejores resultados con antecedente de dos o menos recambios valvulares.