The reduction of intracranial pressure (ICP) is a cornerstone in the management of patients with severe head injury, ICP monitoring remains very important as it helps to optimize treatment and improve prognosis. Decompressive craniectomy (DC) has proved to be an effective method in reducing intracranial pressure when other treatments have failed. ICP monitoring studies in the pre and post operative show that this reduction is immediate and sustained within 48 hours. However, little is known about the variation of the ICP during the performance of decompressive craniectomy and the contribution of each of its stages, as the removal of bone, dural opening and duraplasty in the final result. We report the case of a patient with severe TBI who underwent intracranial pressure monitoring during the performance of decompressive craniectomy in the Guillermo Almenara Hospital in 2009.
 

Objective: Traumatic intracranial hypertension is the major pathophysiological issue of traumatic brain injury and its treatment usually demands general and specific measures; nevertheless decompressive craniectomy is an extreme resource available for refractory cases, current data are not enough to define its indications and long term results.
Patients and Methods: This study evaluates a cohort of 32 patients with refractory traumatic intracranial hypertension submitted to decompressive craniectomy as a randomized method of treatment between 2004 and 2008.
Results: The most remarkable characteristics of the procedure were: execution period < 72 hours, wide and extensive bone platelet, and complete specific surgical technique (craniectomy + durotomy / duroplasty ± resection/evacuation); whereas the most relevant results demonstrated: reduction of the ICP value in a great proportion of patients, short period of time until normalization of the ICP and lower hospitalization period at the Neurosurgical ICU, with an index of complications close to 34% (mainly early) and rate of mortality about 18% (mainly neurological). Functional prognosis was favorable at discharge in 25% and at 6 months in 54%, with a quality of life defined as independent or low dependency.
Conclusion: Although traumatic intracranial hypertension has a heterogeneous course, descompressive craniectomy is a useful option for its control and a better outcome of the traumatic brain injury in the long term.

Among the symptoms that most affect the man, for sure the pain is more frequent, and by far the most important. It jeopardizes the quality of life the daily activities and hence their productivity. The disc protrusion, is among the diseases that have this symptom, as the main complication. So it is to bring medical relief to the patient. You should immediately try a treatment, and when you do not get resolution with this conduct, it is for surgery.
Objective: It is exactly these patients with surgical indication, to demonstrate a broad casuist (2000 cases), the advantages of spinal anesthesia when anesthetic induction in compitum general, with regard the outcome. So that we can bring a greater contribution to those who
suffer this nosology.
Patients and Methods: In our series, the study included patients who had surgical treatment, with clinical diagnosis and through examination of images of disc herniation, and who agreed to participate in the study, which excluded only those who did not wish to participate in the study. The follow-up
from each patient and compared with data available in the literature so that we could see the gravy of our work.
Results: showed to be extremely favorable with regard to postoperative pain, a good development (99.72% of cases), only two patients had fistulas (0.11%), two cases had infection (0.11% ) and one had to go for general surgery in Trendelenburg position, inappropriate (0.06%).
Conclusion: Therefore it is concluded that this is an aspect that should be exploited by those who take care of this condition, the major advantages of this measure.

Objective: The aim of this study is to know the clinical and epidemiological characteristic of patients with hydrocephalus secondary to subarachnoid hemorrhage during the period April 2007-2008. There is no a complete knowledge about this pathology in our country.
Patients and Methods: We reviewed medical records of 110 patients who underwent surgical clipping of cerebral aneurysm. Of these we selected those who developed hydrocephalus secondary to subarachnoid hemorrhage and placed ventricle-peritoneal shunts corresponding to 23 patients .
Results: It was found that the hydrocephalus secondary to subarachnoid hemorrhage with a 43% of cases. It was found that the hydrocephalus secondary to subarachnoid hemorrhage occurred in 21% and most often from first to second month of the event of a subarachnoid hemorrhage with a 43 % of cases . Besides is more frequent in women over 50 years and disturbance of consciousness is the main clinical sintomatolgy . These findings are consistent with Anglo-Saxon literature available.
Conclusion: Surely a judicious indication of a VPS greatly influences the patient's recovery. However, it should be noted that the recovery of patients with subarachnoid hemorrhage is multifactorial.
 

Objective: Pituitary adenomas are benign tumors that occur in approx. 10 to 15% of all intracranial tumors. Treatment can be carried by transsphenoidal resection (TSR) or transcranial resection (TCR). The aim of this study is to present the results of surgical treatment in a series of 403 patients operated at the Almenara Hospital between 2000 and 2008.
Patients and Methods: We performed a retrospective descriptive study of patients operated on pituitary adenomas from January 2000 to December 2008. It were reviewed medical records and operative reports, and gathered data on sex, age, type of adenoma, type of approach, complications, recurrence and mortality.
Results: 403 patients were operated of which 51% were female and 49% men. The most affected age group was 50-59 years (24.3%) followed by 40-49 years (21.2%). The most common type of adenoma was the normally functioning (60.5%). Transsphenoidal approach was used in 63%, followed by transcranial (32%) and combined (5%). TSR predominated in ACTHproducing adenomas (89%), while the TCR in prolactin-producing (70%). The most common complication was transient diabetes insipidus (50.1%). The recurrence rate was 12.9% being more frequent in the ACTH-producing tumor (21.6%) and the mortality rate was 5.2% with higher frequency in the TCR (7.0%)
Conclusions: The transsphenoidal approach the method of choice in the vast majority of pituitary tumors. The transcranial approach has specific indications and should be reserved for cases of difficult access by transsphenoidal. The adoption of new techniques, proper equipment, training and multidisciplinary working are essential to further decrease complications and mortality.