Usted está aquí
Peruvian Journal of Neurosurgery
Embolization of ruptured giant aneurysm of the medium cerebral artery followed by surgical evacuation of intracerebral hematoma
JOSÉ LUIS URQUIZO R, RODOLFO RODRÍGUEZ V, WALTER DURAND C, RICARDO VALLEJOS T, DANTE VALER G, JESÚS FLORES Q, GIANCARLO SAAL Z.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Early endovascular therapy of a ruptured giant aneurysm associated with intracerebral hematoma avoids the need for clipping of the aneurysm, thereby avoiding the need for greater brain retraction, edema, transient clipping, as well as the possibility of intraoperative rupture, thus achieving timely and adequate management of this pathology.
Clinical case: We present the case of a 48-year-old woman with subarachnoid hemorrhage (SAH) and intracerebral hematoma (ICH) due to dysplastic giant aneurysm of the right middle cerebral artery bifurcation (MCA) who was treated by coils embolization followed by microsurgical evacuation of the hematoma achieving a good result and a favorable clinical outcome.
Conclusion: The combined treatment by embolization with coils of a giant ruptured aneurysm of the MCA followed by the microsurgical evacuation of the ICH during the acute phase is an effective and safe alternative to single surgical management.
Keywords: Aneurysm Ruptured, Subarachnoid Hemorrhage, Hematoma, Embolization Therapeutic. (Source: MeSH NLM)
Successful endovascular management of a ruptured cerebral aneurysm in an infant patient
JOHN VARGAS U, JESÚS FLORES Q, RODOLFO RODRÍGUEZ V, WALTER DURAND C, DANTE VALER G.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Cerebral aneurysms in pediatric age are rare. In early childhood, they appear before the age of 2 years and are related to a high incidence of injuries along the middle cerebral artery, in its distal part, and in the vertebrobasilar system. The etiology can be idiopathic, traumatic, and fungal. Aneurysm obliteration should be as early as possible in patients with low surgical risk.
Clinical Case: The case of a 5-month-old patient with no significant medical history is presented, with a 2-day illness time, signs of irritability, vomiting, and tension in the fontanelle. A cerebral tomography was performed showing a predominantly right subcortical frontal fine subarachnoid hemorrhage and an angio-tomography (Angio-TEM) that showed an aneurysm of the anterior cerebral artery. The cerebral angiography study revealed a dissecting aneurysm of the left A2-A3 segment that involved the division of the left anterior cerebral artery into a pericallosal and marginal callus artery. Embolization was performed using 4 coils and Histoacryl® to close the parental artery. He had a seizure crisis from a left marginal callus infarction that was medically controlled. The clinical evolution was good, being discharged on the 7th day of hospitalization.
Conclusion: Pediatric cerebral aneurysms are a rare pathology and in patients with low surgical risk, such as our patient, they should be treated as soon as possible to decrease morbidity and mortality.
Keywords: Intracranial Aneurysm, Cerebral Angiography, Infant, Embolization Therapeutic. (Source: MeSH NLM)
Endovascular treatment of a large, embolized, unruptured cerebral aneurysm that presented rechanneling
YHAKELIN ESPINOZA C, JOHN VARGAS U, RODOLFO RODRÍGUEZ V, WALTER DURAND C, JESÚS FLORES Q, DANTE VALER G, GIANCARLO SAAL Z.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Endovascular treatment of ruptured and non-ruptured brain aneurysms is an appropriate option in most patients. In narrow neck aneurysms, treatment with coils is sufficient, but in those with wide necks, the use of stent-assisted coils or flow diverters is necessary. Endovascular treatment of intracranial aneurysms is effective and provides complete occlusion in up to 85% of cases, however, there are cases of incomplete obliteration or recanalization that require treatment.Clinical Case: A 79-year-old woman with a history of high blood pressure and embolization with coils of an unruptured cerebral aneurysm of the left posterior communicating artery, 5 years ago, Raymond Roy I in the immediate postoperative period. She has been presenting with right hemiparesis and III left cranial nerve palsy for 1 year. An angiotomography (angioCT) showed recanalization of the aneurysm, so it was decided to perform an embolization with coils and stents, achieving complete occlusion of the aneurysm (Raymond Roy I). In the following weeks, the patient regained strength in the right hemibody and recovered function of the III left cranial nerve.Conclusion: Recanalization of aneurysms undergoing endovascular treatment is infrequent, less than 10%, and is associated with complex aneurysms. In these cases, the use of advanced or combined endovascular techniques is recommended to achieve total closure of the aneurysm and decrease the associated morbidity and mortality rate.Keywords: Intracranial Aneurysm, Endovascular Procedures, Stent, Embolization Therapeutic. (Source: MeSH NLM) |
Experience in diagnostic and treatment of central nervous system tumors in children less than 2 years at the Baca Ortiz Pediatric Hospital, Quito-Ecuador, 2016-2019
CARLOS FLORES E, ALICIA TORRES M, JOSE BERNAL C, JESUS CASTRO V.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
|
Introduction: Tumors of the central nervous system (CNS) in children between 0 and 2 years of age are infrequent, so their diagnosis and treatment constitute an important challenge for every pediatric neurosurgical center, to which is added the comorbidities typical of this age that condition the responsibility of improving therapeutics to obtain better survival. The objective of this study was to describe the diagnostic and therapeutic experience of a neurosurgical Department of national reference, in relation to neoplasms of the central nervous system in children under two years of age, as well as to establish comorbidity and prognosis.
Methods: Cross-sectional, retrospective and descriptive study that includes all patients under 2 years of age who were diagnosed with a neoplastic lesion of the central nervous system, attended from January 01, 2016 to July 01, 2019 at the Baca Ortiz Pediatric Hospital from the city of Quito in Ecuador.
Results: CNS tumors in children between 0 and 2 years old corresponded to 5.09%, with irritability being the most frequent reason for consultation with 62.5%. Also, 75% of the neoplasms were located at supratentorial level with a 1: 1 intra / extra-axial ratio. Neuroblastoma and choroid plexus tumors were the most frequent histopathological diagnoses. Mortality had a percentage of 50%.
Conclusions: CNS tumors in children between 0 and 2 years are not frequent, the location is predominantly supratentorial and the prognosis for life depends on the histopathological type. Radiation therapy is an option, although surgery for resection is the basis of treatment.
Keywords: Central Nervous System Neoplasms, Comorbidity, Prognosis. (Source: MeSH NLM)
|
Use of social media networks in Neurosurgery
EMIL ZHALMUKHAMEDOV
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
|
Neurosurgery as a medical discipline has always been on the cutting edge of technology and the latest advancements. It’s not a surprise why modern neurosurgeons actively utilize various social media platforms, in order to share the latest news or showcase interesting cases they face daily. From Twitter to LinkedIn neurosurgical professionals of the world share the knowledge and connect with each other in order to advance their skills to the next level. A thought-provoking content is constantly shared and spark many interesting conversations and contribute to the modern data of neurosurgical field. Keywords: Social Media, Neurosurgery, Graduate Medical Education (source: MeSH NLM)
|
Isolated intracranial Rosai-Dorfman disease: case report
JORGE ZUMAETA S, FERNANDO PALACIOS S, WILLIAM ANICAMA L, CLAUDIA BURGOS J.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Rosai-Dorfman disease is a pathology of histiocytic, proliferative, idiopathic and benign type characterized by sinus histiocytosis and massive lymphadenopathy. The most frequent clinical presentation is painless bilateral cervical lymphadenopathy. Extra-nodal involvement occurs in 43% of cases and central nervous system (CNS) involvement in 4%. CNS involvement is more common in men and manifests itself as a mass in the cranial dura, which may or may not be associated with lymph node involvement.
Clinical case: We present the case of a 51-year-old woman with a history of sinusitis, with a clinical picture of holo-cranial headache, associated with periods of disorientation and ideomotor apraxia. MRI showed a right parieto-occipital extra-axial lesion, contrast sensor with implantation in the cranial dura. A right parietal craniotomy was performed with subtotal resection of the lesion. The pathological anatomy was reported as Rosai-Dorfman disease of meninges. The evolution after surgery was favorable with remission of symptoms.
Conclusion: Rosai-Dorfman disease should be within the differential diagnosis of lesions based on implantation in the dura. Its diagnosis is eminently histological. Although there is no specific therapy, surgical removal is the most effective treatment. Adjuvant therapies such as steroids and radiation can help control residual or recurrent disease.
Keywords: Histiocytosis Sinus, Lymph Nodes, Dura Mater, Meninges, Craniotomy (source: MeSH NLM)
Enterogenous cyst of the posterior fossa: a case report
JOSÉ LEÓN P, FERNANDO ROMERO F, EUTEMIO MEDINA M, DIANA RIVAS F, LUIS ANTONIO T.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: The intracranial enterogenous cyst is a benign cystic tumor lesion of very rare frequency worldwide. These cysts can occur at any level of neuroaxis and their malignant transformation is rare. The case of a 32-year-old woman with a cystic lesion in the posterior fossa at the level of the occipitocervical junction is presented.
Clinical case: A 32-year-old woman with a history of tumor surgery in the posterior fossa 4 years ago, with a clinical picture of chronic headache and quadriparesis. The magnetic resonance imaging of the cranio-cervical junction showed a cystic lesion at the level of the posterior fossa. A suboccipital craniectomy was performed with removal of the posterior arch of C1 and excision of the tumor. The histopathological study confirmed the diagnosis of enterogenic cyst.
Conclusion: The enterogenic cyst of the nervous system is an uncommon, benign pathology that can recur. The definitive diagnosis will be made by biopsy of the tumor piece.
Keywords: Cysts, Biopsy, Craniotomy, Central Nervous System, Headache Disorders (source: MeSH NLM)
Minimally invasive surgery using Mini-pterional Interfascial Approach for the Clipping of a Ruptured Aneurysm of the right Carotid Bifurcation at the Dos de Mayo National Hospital, Lima-Peru
JOSÉ LUIS ACHA S, HÉCTOR YAYA-LOO, DAVID YABAR B, JULIO QUISPE-DEXTRE, DIANA HERRERA-ORELLANA, JESÚS PASACHE-JUAREZ
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
|
Introduction: Carotid bifurcation aneurysms represent 2 to 9% of intracranial aneurysms1. They can be treated by endovascular or microsurgical techniques3, the latter being the most complex1-4 and used with low frequency in this type of aneurysm7.
Clinical case: A 57-year-old woman with a ruptured aneurysm of the right carotid bifurcation, incidentally, another small unruptured aneurysm of the left posterior communicating was found. She underwent a mini-pterional interfascial approach and aneurysm clipping with satisfactory results and a favorable evolution.
Conclusion: Aneurysms of the carotid bifurcation are not frequent; this is a non-common case due to the age of 57 years. The technique performed allowed the identification of the aneurysm, as in the classical pterional approach, but trying to minimize morbidity. The patient did not present post-surgical complications despite the risk factors presented, such as unbroken contralateral aneurysm, edema due to subarachnoid hemorrhage and arterial hypertension.
Keywords: Aneurysm, Ruptured, Subarachnoid Hemorrhage, Hypertension. (Source: MeSH NLM)
|
Minipterional interfascial approach for microquirurgical treatment of ruptured and unruptured anterior circulation aneurysms. Initial experience in the Dos de Mayo National Hospital in Lima - Peru
JOSÉ L. ACHA S, HÉCTOR YAYA-LOO, DAVID YABAR B, RITA LOPEZ C
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
|
Objective: To provide information on the experience in the management of ruptured and non-ruptured aneurysms of the anterior circulation through the minipterional interfascial approach, to describe the technique, clinical, surgical results, complications and advantages.
Methods: A retrospective observational study was conducted, from January to December 2018. Of 59 patients with ruptured and non-ruptured aneurysms, 33 were using a minipterional craniotomy. Clinical variables, location, complications and surgical results were analyzed.
Results: In total, there were 33 patients operated by a minipterional craniotomy, 35 aneurysms were clipped: 14 MCA (40%), 13 PComA (37%), 6 AComA (17%), 1 bifurcation of ICA (2%), 1 Choroid artery (2%). Of the total, 11 were men (33%), 22 women (66%). The Hunt and Hess of admission: I in 16 cases (48%), II in 11 cases (33%) and III in 6 cases (18%). There were 3 intraoperative ruptures and 8 radiological clinical vasospasms. Rankin's scale at discharge was: Rankin 0 in 2 patients (6%), Ranking 1 in 11 patients (33%), Rankin 2 in 10 patients (30%), Rankin 3 in 2 patients (6%), Rankin 4 in 1 patient (3%), Rankin 5 in 1 patient (3%) and Rankin 6 in 1 patient (3%).
Conclusions: The Minipterional craniotomy is reliable, less invasive, it maintains the advantages of the pterional approach but avoids greater exposure of the parenchyma and tissue manipulation. Aneurysms of the anterior circulation, ruptured and unruptured, can be treated safely and effectively with limited bone extraction, good cosmetic results and good temporomandibular function.
Keywords: Intracraneal Aneurysm, Craniotomy, Surgical Instruments. (source: MeSH NLM
|
Pituitary abscess: A case review
MARCO CHIPANA S, SANDY CABALLERO M, MANUEL CUEVA N, PEDRO SOTO P.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
|
Introduction: Pituitary abscess is an intrasellar infection that generates a clinical picture like any pituitary tumor. Its origin can be of hematogenous origin or by infection of a nearby site or pre-existing lesion.
Clinical case: The case of a 38-year-old male patient with progressive headache, vomiting and visual impairment is presented. It was evaluated with magnetic resonance of the sellar region. Transsphenoidal surgery was performed and the infusion of intravenous antibiotic therapy continued.
Conclusion: Pituitary abscess is an uncommon infectious pathology whose diagnosis requires clinical and radiological evaluation. Surgery is usually necessary for diagnostic confirmation and treatment.
Keywords: Brain Abscess, Pituitary Neoplasms, Pituitary Disease (source: MeSH NLM)
|
Single-session curative embolization of a ruptured supratentorial arteriovenous malformation: Case report
ROMMEL RODRIGUEZ B, JESUS FLORES Q, WALTER DURAND C, GIANCARLO SAAL-ZAPATA, RODOLFO RODRIGUEZ V.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Microsurgery has been the gold standard for the treatment of arteriovenous malformations (AVM), however, endovascular therapy has emerged as an option in recent years.
Clinical case: We present the case of a previously healthy 45-year-old woman that presented with a ruptured AVM treated successfully with curative embolization.
Conclusion: Endovascular treatment is a feasible and safe option for the treatment of arteriovenous malformations.
Keywords: Arteriovenous Malformations, Embolization, Therapeutic, Cerebral Hemorrhage. (source: MeSH NLM)
Aqueductoplasty with stent placement by neuroendoscopy for the management of a cyst of the IV ventricle in a case of neurocisticercosis
JOHN VARGAS U, JERSON FLORES C, JAIME ROJAS V, FERNANDO PALACIOS S.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: The most common parasitic infection of the central nervous system is neurocysticercosis which in 20% of cases is intraventricular, the fourth ventricle being one of the most frequent locations. These lesions cause obstructive hydrocephalus that requires the placement of a ventricle-peritoneal shunt (DVP) whose dysfunction rate is high due to the presence of adhesions and the formation of multiple compartments being the cyst isolated from the IV ventricle one of the most difficult treatment.
Clinical Case: We present the case of a 34-year-old patient with a history of neurocysticercosis who received antiparasitic treatment and the placement of a DVP, presenting multiple dysfunction with severe dilatation of the IV ventricle. It was decided to perform an aqueductoplasty and the placement of a stent in the Silvio aqueduct followed by the placement of a new left frontal DVP, after removing the DVP with parietooccipital “Y” connector and left posterior fossa. Tomographic control at week showed a decrease in ventricular size, catheters in an adequate position, clinical improvement and good patient evolution.
Conclusion: Endoscopic aqueductoplasty with stent placement in the Silvio aqueduct is an effective measure in cases of isolated cyst in the fourth ventricle, achieving good clinical and imaging evolution compared to other therapeutic options.
Keywords: Neurocysticercosis, Hydrocephalus, Fourth Ventricle, Cerebral Aqueduct, Stents. (source: MeSH NLM)
Endovascular management of non-ruptured intracranial aneurysms with flow diverter devices. First experience in Peru.
GIANCARLO SAAL-ZAPATA, WALTER DURAND S, RICARDO VALLEJOS T, DANTE VALER G, JESÚS FLORES Q, RODOLFO RODRIGUEZ V.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Endovascular treatment of non-ruptured intracranial aneurysms with flow diverter devices is a technique that currently has many indications for its use.
Objectives: Determine the clinical characteristics of patients, angiographic characteristics of the aneurysms, occlusion rate at 6 months and 1 year follow-up and complications associated to the deployment of flow diverter devices in the treatment of non-ruptured intracranial aneurysms.
Methods: We present a retrospective review of consecutive cases treated with flow diverters at our institution.
Results: Since October 2012 to April 2017, twenty-one patients were treated with a total of 29 non-ruptured aneurysms. Twenty six aneurysms (90%) were located in the anterior circulation and three aneurysms were located in the posterior circulation (10%). We employed 22 flow diverters (SILK = 9, FRED = 13). Fifty percent of the aneurysms were located in the paraclinoid segment of the internal carotid artery, followed by 28% located in the cavernous segment.
Globally, fifty eight percent of the patients were cured. There were three patients with persistence of the aneurysms and five complications: three carotid thrombosis, one migration and one mal-apposition of the stent. All this complications were and remain asymptomatic. Mortality rate in this series was zero percent.
Discussion: The use of flow diverter devices is a new technique for the treatment of non-ruptured intracranial aneurysms at our institution, with adequate rates of aneurysm occlusion.
Keywords: Intracranial Aneurysm, Stents, Cerebral Angiography. (source: MeSH NLM)
Curative embolization of dural arteriovenous fistula using Onyx. Case report
GIANCARLO SAAL-ZAPATA, WALTER DURAND C., RODOLFO RODRIGUEZ V.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Dural arteriovenous fistulas (DAVF) are vascular lesions that require a high suspicious index for its diagnosis, because of their wide variety of clinical manifestations, moreover, invasive procedures such as digital subtraction angiogram (DSA) is the gold standard and is required for its diagnostic confirmation.
Clinical presentation: We report the case of a previously healthy 44-year-old young woman coming from the highlands of Peru, with the diagnosis of spontaneous intracranial hemorrhage, not treated at her local hospital. She was transferred to the capital city for complementary studies and possible treatment. DSA revealed a dural arteriovenous fistula, with feeder from the middle meningeal artery and venous cortical reflux, being catalogued as a Cognard grade IV/Borden III DAVF, we decided to perform an embolization of the fistulous communication with the non-adherent liquid embolic agent Onyx, with good clinical evolution. Immediate post embolization DSA and 6-month follow-up control DSA showed total absence of the fistula, being the patient catalogued as cured.
Conclusion: Initial diagnostic suspect, digital subtraction angiogram confirmation, an accurate study of the anatomy and the exact location of the fistulous communication are factors that favor the cure in these patients. The treatment in a specialized center that counts with the adequate infrastructure and with trained staff is vital to achieve cure.
Endovascular management of craniospinal junction arteriovenous fistula: Case report
JAFETH LIZANA T, GIUSEPPE ROJAS P, RODOLFO RODRIGUEZ V, WALTER DURAND C, GIANCARLO SAAL Z.
Abstract (Spanish) ||
Full Text ||
PDF (Spanish) ||
PDF (English)
ABSTRACT
Introduction: Craniocervical arteriovenous fistulas are rare entities. A high index of suspicious is required for its diagnosis. Surgery, embolization or both are available treatments.
Clinical case: Herein, we present the case of a young woman who presented with syncope. Additional studies revealed the presence of a craniocervical junction AVF. Endovascular treatment was performed in two opportunities achieving the obliteration of the fistulous communication.
Conclusion: Embolization is a safe and feasible treatment in cases of craniospinal AVFs, with good clinical and radiological results.
