Introduction: Coiling is the most common endovascular technique used for the treatment of aneurysms. Different types are available and Penumbra coils are a new option in the endovascular armamentarium.

Case report: We report the case of 63year-old female with a ruptured type IA paraclinoid aneurysm according to Barami classification, treated with 3 Penumbra coils successfully.

Conclusion: Penumbra coils seems to be an adequate option in cases of large and ruptured aneurysms of anterior circulation.

     Keywords:  Aneurysm Ruptured, Endovascular Procedures, Female (source: MeSH NLM)

Introduction: The most frequent brain tumors in adults are high-grade gliomas and meningiomas. Having a discouraging prognosis of high-grade gliomas and knowing that the prognosis improves depending on the degree of tumor resection, is that new therapeutic strategies are sought, one of them is the use of 5-aminolevulinic acid (5-ALA) thanks to the fluorescence it produce in the tumor it allows to improve the rate of tumor resection, finally improving the prognosis of the patients. We presented the first experience in Almenara Hospital of the use of 5-ALA in a patient with a diagnosis of high-grade glioma.

Clinical Case: Presents itself the case of a 48-year-old male patient with clinical evidence of motor and sensory deficit contralateral to the lesion, without alteration of the state of consciousness. The magnetic resonance of the encephalon with contrast, a right frontal lesion is evidenced compatible with high-grade glioma. Therefore, it is programmed for guided surgery with fluorescence, where 5-ALA is used, and a total resection of the tumor is performed, obtaining an anaplastic ependymoma as pathological anatomy. The patient presented an increase in the motor deficit, which he later recovered. In the tomographic control with contrast at 4 months, complete tumor resection is evident.

Conclusion: 5-aminolevulinic acid is a drug that helps to properly delimit the edges of a high-grade glioma, by using a modified microscope, and thus increases the degree of tumor resection, ultimately improving the prognosis of the disease.

     Keywords: Glioma, Aminolevulinic acid, Ependymoma, Fluorecense, Prognosis. (source: MeSH NLM)

Objective: To determine the validity, sensitivity and specificity of multislice spiral CT angiography (ATEM) with a 16-Multislice CT scanner detector lines in the diagnosis of cerebral aneurysms and their most frequent localizations. 

Patients and Methods: We selected 51 patients with nontraumatic subarachnoid hemorrhage due to suspected intracranial aneurysm who underwent surgery in the Hospital Daniel A. Carrión, Callao, for the period May 2004 to November 2007. 

Results: The sensitivity of the ATEM for the detection of intracranial aneurysms in this study was 100%. The resulting specificity was 50%. The positive predictive value (PPV) of ATEM for the diagnosis of cerebral aneurysms was 98%, with 87.8% accuracy of the method for determining the location of the aneurysm and 12.2% of uncertainty in the determination of the location of this anomaly. The average size of the aneurysm at surgery was 11.33 + / - 6.9 mm. While the average size of the aneurysm by ATEM was 8.60 + / - 5.75 mm. The difference between the means of these measurements was significant (p = 0.027). 70.3% of aneurysms in this study were found in posterior communicating segment of both internal carotid and middle cerebral arteries both. 

Conclusion: CT angiography is an excellent noninvasive test for the detection of intracranial aneurysms and to determine its location.                                                            

      Key words: Intracranial aneurysm, CT Angio (ATEM), aneurysm surgery

We present the case of a 32 year old patient with spinal cord compression syndrome of 10 months of evolution. Magnetic resonance imaging showed signal voids causing myelopathy that spinal angiography showed to be a type IVb spinal arteriovenous malformation (perimedular arteriovenous fistula type II) supplemented by a posterior spinal artery that originated next to the Adamkiewicz artery from the segmental artery T11 left. The fistula was successfully eradicated by transarterial embolization with cyanoacrylate and the patient experienced progressive improvement. The relevant literature is reviewed. The endovascular approach is the treatment of choice in spinal arteriovenous malformations types IVb and IVc.