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Background and Objectives: The prevalence of unruptured intracranial aneurysms is 1-3%. The annual rupture rate increases in patients with multiple aneurysms that presented a previous hemorrhage from another aneurysm., Objectives: To evaluate outcomes of clipping unruptured aneurysms, comparing patients with single or multiple aneurysms clipped, describe the complications related to surgery and to identify risk factors predicting an unfavorable outcome., Materials and Methods: Retrospective study including patients who underwent clipping of unruptured aneurysms between 2020-2023 at our center. Occlusion rate, complications, and functional outcome were analyzed. Risk factors for poor prognosis are identified using univariate model., Results: 82 patients with 114 aneurysms were treated with microsurgery. Multiple aneurysms were clipped in 22 patients. A mini-open approach was used in 86,5% of cases. Complete occlusion in angio3D was found in 78.6% of clipped aneurysms. Complication rate was 12.2%, including asymptomatic cases. Mortality was 0%. The probability of 1 point mRS worsening was 7.3% and 2 or more points was 1.2%, with a good functional outcome in 98.9%. Clipping multiple aneurysms, miniopen approaches, or surgery in patients with previous subarachnoid hemorrhage did not increase the risk of complications. Posterior circulation aneurysms surgery increased the risk of ischemia., Conclusions: The management for unruptured intracranial aneurysms should be multimodal and based on clinical and radiological outcomes. Microsurgery is a valid and safe technique, with 0% mortality and bleeding rates and 1,2% rate of severe morbidity in our series., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; The development of these lesions may be related to the presence of hemodynamic factors created by the presence of the arteriovenous shunt, for this reason, most aneurysms are proximal to the arteries afferent to the malformation. Endovascular embolization by stages in large cerebral arteriovenous malformations is often performed to gradually reduce flow and prevent abrupt hemodynamic changes. Aneurysms of the alimentary artery have been associated with an increased risk of hemorrhage, that's why decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular and endovascular neurosurgeons. In the present manuscript, we report the case of a 51-year-old patient with multiple aneurysms associated with arteriovenous malformation, as well as her neurosurgical management, with a comparative analysis what has been published in the medical and scientific literature in the last 20 years. a comprehensive review on various platforms and databases such as PUBMED, NCBI, Medline and Ovid. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Se realizó un estudio prospectivo y descriptivo de 112 pacientes, atendidos en el Hospital Universitario "Dr. Ambrosio Grillo Portuondo" de Santiago de Cuba, desde junio de 2011 hasta diciembre de 2012, a fin de mostrar la efectividad de la cirugía mínimamente invasiva en los afectados. En la casuística predominaron el sexo femenino (75,9 %), las operaciones electivas y la litiasis vesicular como la afección más frecuente (73,2 %). La presencia de cicatrices por cirugía anterior, la edad y las enfermedades asociadas no constituyeron limitantes para la selección de los pacientes; solo en 3 de ellos se empleó la conversión a técnica convencional, debido a dificultades técnicas anatómicas. No hubo fallecidos. La complicación más significativa fue la lesión del conducto hepato-colédoco en 2 colecistectomías.

A prospective and descriptive study was carried out in 112 patients, attended in "Dr. Ambrosio Grillo Portuondo" University Hospital of Santiago de Cuba, from June 2011 to December 2012, in order to demonstrate the effectiveness of minimally invasive surgery in those affected. Female sex (75.9%), elective surgeries and vesicular lithiasis as the most frequent condition (73.2%) prevailed in the case material. The presence of scars from previous surgery, age and associated diseases did not constitute limitations for selecting patients, and only in 3 of them the conversion to conventional technique was used due to anatomical technical difficulties. There were not deaths. The most significant complication was the injury of hepatocholedochal duct in 2 cholecystectomies. [ABSTRACT FROM AUTHOR]

Objetivo: establecer un enfoque técnico común para el clipaje, elección intraoperatoria de la técnica y el tipo de aplicación del clip para abordar estos aneurismas al igual que evaluar la utilidad de la técnica adaptándose a este segmento logrando un cierra adecuado de los aneurismas en la arteria cerebral media. Antecedentes: el concepto de la línea de cierre ideal se puede aplicar a aneurismas en cualquier ubicación, ya que se supone que la base patológica del origen y el crecimiento es la misma para todos los aneurismas. Sin embargo, los aneurismas en lugares más profundos que los aneurismas de la arteria cerebral media se asocian con más problemas en su abordaje, así como limitaciones en el ángulo de aproximación. Por lo que el presente trabajo se enfoca en los aneurismas de la arteria cerebral media ya que es la localización más común y en los que la técnica se facilita. Métodos: Se revisaron expedientes y videos quirúrgicos de pacientes que fueron sometidos a clipaje de aneurisma de la arteria cerebral media con técnica de cierre ideal, tratados en el Instituto Nacional de Neurología y Neurocirugía evaluando así la efectividad de dicha técnica.Núm. de registro del protocolo: 106/20. Resultados: se revisaron 28 expedientes de pacientes con diagnóstico de aneurismas de la arteria cerebral media de los cuales fueron clipados con la técnica del cierre ideal de los cuales 27 se concluye con un adecuado cierre completo del aneurisma aplicando esta técnica (96.42%) por lo tanto es una adecuada técnica para el manejo de estos aneurismas, el paciente restante 1 (3.58%) se realizó un cierre incompleto debido a la complejidad, sin embargo en el seguimiento no se evidencia nuevo crecimiento. Conclusiones: la técnica es efectiva con un alto porcentaje de éxito, aplicable para cierre ideal de aneurisma en cualquier posición. [ABSTRACT FROM AUTHOR]

Aneurysms arising from the PICA are uncommon, with a reported incidence ranging between 0.49 and 3% of all intracranial aneurysms. The majority arises at the VA-PICA junction, and a smaller frequency arises from the more peripheral PICA segments. The infrequency and complexity of the PICA anatomy has limited our understanding of the underlying pathology, natural history, and clinical management of distal PICA lesions. These lesions are divided between saccular and fusiform aneurysms, and often develop in association with small AVMs; the treatment should be administered early, depending on the PICA segment that was affected, variation in clipping strategies and surgical exposures aimed at de PICA branch and main trunk preservation were major contribution to good results. [ABSTRACT FROM AUTHOR]

Objective: to compare the cost and outcome of embolization or clipping of intracranial aneurysms at University Hospital of Nuevo León. Material y method: prospective study of 22 patients with Hunt-Hess equal or less to three, between Jan 2005 and Jan 2006. All of them was realized pre and postoperative angiography (AngioTC, AngioMRI or femoral puncture). Eight patients was treated by embolization and 14 clipping. Results: the average of age was 50 years in endovascular group and 47 in clipping group. All the aneurysms was there in anterior circulation. In endovascular group, had less three times in operative room, intensive care, general ward and total postprocedure length of stay. All the aneurysms was successfully obliterated. The morbidity was 12% in embolization group and no mortality. In the clipping group, with 15% of morbi-mortality. Conclusion: the embolization of intracranial aneurysms, despite of more expensive in term of cost of materials, would be compensated by less time in surgical room, intensive care and total length stay, without to sacrifice the effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous subarachnoid haemorrhage is a rare cause of stroke, but it causes great socioeconomic impact and high morbidity and mortality. The aim of this study is to describe the clinical profile and evolution of a series of patients with SAH admitted to a tertiary hospital, as well as the diagnostic and therapeutic management., Material and Methods: Retrospective study of 536 patients diagnosed with SAH admitted to the ICU of the Hospital Universitario de A Coruña between 2003 and 2013 (Age: 56.9±14.1 years, female/male ratio: 1.5:1). Demographic characteristics, risk factors, aetiologies and clinical signs, prognostic scales, diagnostic tests and treatment were collected. A comparative analysis was made between the general series and subgroups of patients with aneurysmal (SAH-A) and idiopathic (SAH-I) subarachnoid haemorrhage., Results: There were 49.0±15.1 patients/year (2013 incidence: 4.3/100,000 inhabitants). 60.3% presented Glasgow Coma Scale 14-15, with scarce symptomatology (Hunt-Hess I-II 61.9%, World Federation Neurosurgeons Scale I-II 60.4%). 50.7% presented Fisher IV. SAH-A was diagnosed in 78.3% (n=396); perimesencephalic subarachnoid haemorrhage (SAH-PM) in 3.2%; and SAH-I in 17.9%. During the study period there was an increase in the prevalence of aneurysms, causing an increased number of surgeries in recent years. Both SAH-A and SAH-I presented greater severity upon admission. Patients with SAH-A had higher percentage of complications and mortality, with lesser degree of independence at 6 and 12 months., Conclusions: The incidence of SAH appears to have decreased in recent years, with SAH-I comprising 17.9% of the cases. Patients with SAH-I have better prognosis and lower risk of complications, highlighting the benignity of SAH-PM., (Copyright © 2020 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the impact of introducing endovascular therapy for patients with aneurysmal subarachnoid haemorrhage (aSAH) in a medium-low volume centre., Material and Methods: A retrospective observational study was conducted by comparing the clinical outcome of patients with aSAH before and after introducing endovascular therapy in our centre. The main variables analysed were: type of treatment, hospital and late mortality, intra-procedural morbidity, rate of re-bleeding and vasospasm, and clinical outcome according to the Glasgow Outcome Score (GOS)., Results: Seventy-one patients were treated in two periods: 2010-2011 (32 patients; 19 clipped, 6 coiled, 7 untreated), and 2012-2013 (39 patients, 3 clipped, 34 coiled, 2 untreated). No significant differences were found in age, sex, clinical grade at admission, type and location of aneurysm, Fisher score, or in hospital mortality (28.1% vs 25.6%, P=.35), GOS (except for GOS 5: 43.37% vs 53.8%, P=.045), rate of hydrocephalus and rate of vasospasm. The second cohort obtained better results for aggregated GOS 1+2+3 (36.3% vs 43.75%, P=.034) and for GOS 4+5 (61.5% vs 56.25%, P=.078). The percentage of patients left untreated was significantly lower in the second period (5.1% vs 21.8%, P<.01), as well as the rate of re-bleeding (0% vs 9.4%, P<.01). Patients were treated earlier (2.51 vs 3.95 days), and hospital and total stay were lower (15.2 and 24.6 vs 10.3 and 18 days) in the second period, these differences not reaching statistical significance., Conclusions: Endovascular therapy allowed treating more patients with aSAH, and with a lower re-bleeding rate. This led to a modest reduction in morbidity and mortality., (Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)