We did not find national reports on ruptured aneurysms treated in the context of the pandemic, this being one of the first studies that demonstrate the impact of the COVID-19 pandemic in patients with ruptured intracranial aneurysm. The population should be educated on how to act in case of specific symptoms such as sudden intense headache, neurological deficit, or acute chest pain, which should receive timely care, immediate referral, and priority of treatment in referral hospitals in order to reduce morbidity and mortality of complex neurological pathologies.

The alteration at the anatomical and/or functional level, both motors, sensory and cognitive, a product of the sudden exchange of mechanical energy caused by an external force on the skull, is what defines a traumatic brain injury (TBI). Clinical observation in mild TBI includes observing children under 2 years of age with trauma without fracture or admission criteria clinically for 2 to 4 hours and observing children with symptoms or mechanism of fall for 4 to 6 hours not known. We studied mild TBI at Baca Ortiz Pediatric Hospital, Ecuador, from January 2016 to December 2019.

Traumatic Brain Injury (TBI) is the disruption of brain function and architecture. The Glasgow Coma Scale (GCS) is the most widely used TBI severity classification; however, it assesses the functional status of the brain resulting from highly heterogeneous lesions and has little accuracy. The Neurological Severity Classification System (NSC System), a clinical-tomographic instrument designed to overcome lesion heterogeneity, assesses brain function and structure in determining the severity of BTI.

Petroclival meningiomas constitute 3 to 10% of meningiomas of the posterior fossa, they originate in the petroclival fissure, in the upper part of the clivus, petrosal apex, and medial to the trigeminal nerve. Resection of these tumors is a neurosurgical challenge. The combined partial petrosectomy approach associated with a sub-temporal approach is a technique described by various authors; however, its performance is considered highly complex. We report the case of a petroclival meningioma operated successfully in our hospital using this combined approach. 

Orbital schwannoma is a rare pathology, which constitutes approximately 1 to 6.5% of orbital tumors, and can originate from the ophthalmic branch of the 5th cranial nerve or from perioptic sympathetic nerves. The first-line treatment is surgery, and total resection provides a good prognosis.  We presented a case of 12-year-old woman, with a 9-year illness, characterized by a progressive decrease in right visual acuity until reaching amaurosis.

True fetal or fetal type posterior communicating artery aneurysms (PComA) are a technical challenge for the neurosurgeon in both endovascular and microsurgical treatment. Microsurgical clipping using minimally invasive approaches is a safe and optimal alternative solution. We presented a case of a 53-year-old patient who had subarachnoid hemorrhage from a true fetal PComA.

Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. We present a 38-year-old male patient who suffers trauma from a pyrotechnic explosion.