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Introduction Pathological processes in the arterial wall that result in vessel dilation are the cause of intracranial aneurysms (IAs), and the risk factors for their formation and progression are not well established. Ferritin is associated with inflammation and angiogenesis; it has protective antioxidative activity, and controls cell differentiation. Vitamin B12 is related to neurological and hematological disorders; it can be used as differential diagnosis tool, and acts in the control of homocysteinemia, a predictor of worse prognosis. The present article aims to assess the correlation between serum ferritin and B12 levels and the patient's functional outcome. Materials and Methods In the present cohort study, we assessed the serum levels of ferritin and B12, as well as the scores on the modified Rankin and Glasgow Outcome Scales at 6 months, of 2 groups, one with 19 and the other with 49 individuals, out of 401 patients treated for IA at Universidade de São Paulo from 2018 to 2019. We performed a statistical analysis, using logistic regression, to determine the aforementioned correlation. Results In the univariable analysis, the serum levels of ferritin showed no significant impact on the functional outcome (odds ratio [OR]: 0.96 for every 100 pg/mL increase; 95% confidence interval [95%CI]: 0.761­1.210; p » 0.732); neither did the serum levels of B12 (OR: 0.998 for every 100 pg/mL increase; 95%CI: 0.826­1.206; p » 0.987). Moreover, no significant impact on the functional outcome was observed in the multivariable analysis regarding the serum levels of B12, age, hypertension, and aneurysm rupture (OR: 1.086 for every 100 pg/mL increase; 95%CI: 0.847­1.392; p » 0.513). Conclusion We were not able to confirm a statistical correlation regarding the serum levels of ferritin and B12, and functional outcome of IA patients. These variables might be linked to other determinants of the pathophysiology of IAs, like inflammation and homocysteinemia.

Introdução Processos patológicos na parede arterial, que resultam em dilatação dos vasos, são a causa dos aneurismas intracranianos (AIs), e os fatores de risco para a sua formação e evolução não estão bem estabelecidos. A ferritina está associada a inflamação e angiogênese, tem atividade antioxidante, e controla diferenciação celular. A vitamina B12 está relacionada a distúrbios neurológicos e hematológicos, é utilizada como ferramenta de diagnóstico, e atua no controle da homocisteinemia. Este artigo visa avaliar a correlação entre os níveis séricos de ferritina e B12 e o desfecho funcional do paciente. Materiais e Métodos Neste estudo de coorte, analisamos os níveis séricos de ferritina e B12, assim como as pontuações nas escalas de desfechos de Rankin modificada e Glasgow aos 6 meses de 2 grupos, um com 19 e o outro com 49 indivíduos, dos 401 pacientes com AI tratados na Universidade de São Paulo de 2018 a 2019. Para determinar a já mencionada correlação, realizamos análise estatística usando regressão logística. Resultados Na análise univariada, a ferritina sérica não resultou em impacto significativo sobre o desfecho funcional (razão de possibilidades [RP]: 0,96 para cada aumento de 100 pg/mL; intervalo de confiança de 95% [IC95%]: 0,761­1,210; p » 0,732), nem a B12 sérica (RP: 0,998 para cada aumento de 100 pg/mL; IC95%: 0,826­1,206; p » 0,987). Tampouco observou-se impacto significativo sobre o desfecho na análise multivariada usando B12 sérica, idade, hipertensão e ruptura de aneurisma (RP: 1,086 para cada aumento de 100 pg/mL; IC95%: 0,847­1,392; p » 0,513). Conclusão Não foi confirmada a correlação estatística entre os níveis séricos de ferritina e de B12 e o desfecho funcional de pacientes com AI. Essas variáveis podem estar ligadas a outros determinantes da fisiopatologia do AI, como inflamação e homocisteinemia.

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BACKGROUND: Cerebral aneurysms in pediatrics represent < 4% of the total of this condition, and their rupture represents 10-23% mortality. Aneurysms have been associated with infections, head injuries, sickle cell anemia, cardiovascular diseases, autoimmune diseases, immunodeficiencies, and connective tissue diseases. Their clinical presentation includes severe headache, seizures, motor-sensory deficits, and death due to subarachnoid and intraparenchymal hemorrhage. CASE REPORT: We describe the case of a 12-year-old female patient who presented with a sudden intense headache; after 72 hours, generalized tonic-clonic seizures were observed. At the hospital, she was stabilized with antiepileptic drugs and analgesics. A simple head computed tomography scan showed intraparenchymal hemorrhage in the right frontal lobe and subarachnoid hemorrhage. The study was complemented with a cerebral angiotomography, which revealed an aneurysm of the anterior communicating artery. The pediatric neurosurgeon evaluated the case, and management in the pediatric intensive care unit was decided. Two weeks after the stroke, the aneurysm was clipped and excluded. The patient developed adequate clinical evolution and resolution of initial symptoms, resuming her daily activities. CONCLUSIONS: Pediatric cerebral aneurysms differ from their adult counterparts, mainly in their etiology and evolution. In addition, pediatric patients have a longer life expectancy. Aneurysm clipping and neurological endovascular therapy have shown similar results.

INTRODUCCIÓN: Los aneurismas cerebrales en pediatría representan menos del 4% del total de estos padecimientos, aunque su rotura tiene una mortalidad del 10-23%. Se han asociado con infecciones, traumatismos craneoencefálicos, anemia de células falciformes, enfermedades cardiovasculares, enfermedades autoinmunitarias, inmunodeficiencias y enfermedades del tejido conectivo. Su presentación clínica se manifiesta con cefalea intensa, crisis convulsivas, déficit motor-sensitivo y muerte debida a la hemorragia subaracnoidea e intraparenquimatosa. CASO CLÍNICO: Se describe el caso de una paciente de 12 años que presentó cefalea súbita intensa; a las 72 horas se agregaron crisis convulsivas tónico-clónicas generalizadas. En el hospital se estabilizó con fármacos antiepilépticos y analgésicos. Se le realizó una tomografía de cráneo simple que evidenció hemorragia intraparenquimatosa en el lóbulo frontal derecho y hemorragia subaracnoidea. El estudio se complementó con una angiotomografía cerebral, la cual reveló un aneurisma de la arteria comunicante anterior. Fue valorada por el neurocirujano pediatra y se decidió su manejo en la unidad de terapia intensiva pediátrica. A las 2 semanas de iniciado el evento se realizó clipaje y exclusión del aneurisma. La paciente tuvo una adecuada evolución clínica y resolución de los síntomas iniciales, retomando sus actividades de la vida diaria. CONCLUSIONES: Los aneurismas cerebrales en pediatría difieren de su contraparte en los adultos, principalmente en su etiología y evolución, ya que los pacientes pediátricos tienen mayor expectativa de vida. El clipaje del aneurisma y la terapia endovascular neurológica han mostrado resultados similares.

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O potencial de ruptura é inerente a todos os aneurismas cerebrais e traz consigo sérias complicações como o acidente cerebrovascular hemorrágico, situação clínica crítica conhecida como hemorragia subaracnoidea que representa uma das mais severas causas de mortalidade. Estima-se que os aneurismas cerebrais estejam presentes em aproximadamente 5% da população, manifestando-se geralmente na fase adulta, quando o risco de ruptura aumenta. As duas principais formas de tratamento dos aneurismas cerebrais rotos e não rotos, cuja finalidade consiste na exclusão do aneurisma da circulação cerebral, são a embolização e a microcirurgia cerebral. Objetivo: Comparar as hospitalizações para tratamento de aneurismas cerebrais rotos (hemorragia subaracnoidea não traumática) e não rotos quanto ao uso das tecnologias de embolização ou de microcirurgia cerebral no Sistema Único de Saúde (SUS) no período 2009 - 2018. Métodos: Análise de dados do Sistema de Informações Hospitalares (SIH)/SUS disponibilizados publicamente. Os procedimentos estudados foram: (i) Grupo 01 Neurocirurgias vasculares ­ código SUS: 040304003-5, 040304004-3, 040304007-8, 040304009-4, 040304010-8, 040304011- 6, e 040304012-4; e (ii) Grupo 02 Tratamento neuro endovascular ­ códigos SUS: 040307002-3, 040307003-1, 040307004-0, 040307005-8, 040307006-6, 040307007- 4, 040307014-7, 040307015-5 e 040307016-3. Considerou-se para o estudo sexo, faixas etárias, macrorregião de residência, tempo de permanência, utilização de unidade de tratamento intensivo (UTI), ocorrência ou não de óbito do paciente, gasto e letalidade hospitalar conforme realização de embolização ou de microcirurgia cerebral. Resultados: Ocorreram 43.927 internações no período 2009 - 2018, sendo 21.305 (48,5%; 10,6/milhão hab./ano) para realização de embolização e 22.622 (51,5%; 11,2/milhão hab./ano) para microcirurgias cerebrais. O sexo feminino apresentou os maiores coeficientes de internação para embolização (15,5/milhão hab./ano) e microcirurgia (15,5/milhão hab./ano) em relação ao masculino (5,5 e 6,8/milhão hab./ano respectivamente). Para embolização, o maior coeficiente foi registrado na faixa etária de 60 a 64 anos (35,5/milhão hab./ano) enquanto para a microcirurgia na de 55 a 59 anos (36,3/milhão hab./ano). Foram observados maiores coeficientes de internação na macrorregião Sul (36,8/milhão hab./ano) independentemente do procedimento adotado. Hemorragia subaracnoidea não traumática foi a principal causa de internação representando 62,6% do total de hospitalizações. Para embolização, o tempo médio de permanência foi de 7,7 dias, 59% utilizaram UTI, a letalidade foi de 5,9% e 77% dos óbitos foram relacionados à hemorragia subarac- noidea. Para microcirurgia cerebral, o tempo médio de permanência foi de 16,2 dias, 85% utilizaram UTI, a letalidade foi de 10,9% e 74% dos óbitos foram relacionados à hemorragia subaracnoidea. O gasto total com ambas as técnicas foi de R$ 551 mi- lhões (66,8% com embolização) e o gasto médio por internação atingiu R$ 17.286,00 para embolização e R$ 8.077,35 para microcirurgia. A letalidade hospitalar para embolização foi menor nos hospitais filantrópicos e federais enquanto para microcirurgia cerebral foi menor nos hospitais federais. Conclusão: A embolização apresentou número menor de procedimentos, maior gasto total e médio por internação, e menores tempo de permanência, percentual de utilização de unidade de tratamento intensivo (UTI) e de óbitos quando comparada a microcirurgia cerebral na rede pública de saúde do Brasil.

The potential for rupture is inherent to all cerebral aneurysms and brings with it serious complications such as hemorrhagic cerebrovascular accident, a critical clinical situation known as subarachnoid hemorrhage, which represents one of the most severe causes of mortality. It is estimated that cerebral aneurysms are present in ap- proximately 5% of the population, usually manifesting in adulthood, when the risk of rupture increases. The two main forms of treatment for ruptured and unruptured cerebral aneurysms, whose purpose is to exclude the aneurysm from the cerebral circulation, are embolization and cerebral microsurgery. Objective: To compare hospitalizations for treatment of ruptured cerebral aneurysms (non-traumatic subarachnoid hemorrhage) and non-ruptured cerebral aneurysms regarding the use of embolization or brain microsurgery technologies in the Unified Health System (SUS) in the period 2009 - 2018. Methods : Analysis of publicly available data from the Hospital Information System (SIH)/SUS. The procedures studied were: (i) Group 01 Vascular Neurosurgeries ­ SUS code: 040304003-5, 040304004-3, 040304007-8, 040304009- 4, 040304010-8, 040304011-6, and 040304012-4; and (ii) Group 02 Neuro endovascular treatment - SUS codes: 040307002-3, 040307003-1, 040307004-0, 040307005-8, 040307006-6, 040307007-4, 040307014-7, 040307015-5 and 040307016-3. For the study, gender, age groups, macroregion of residence, length of stay, use of the intensive care unit (ICU), occurrence or not of patient death, hospital expenses and lethality were considered according to embolization or cerebral microsurgery. Results: From 43,927 hospitalizations, 21,305 (48.5%; 10.6/million inhab./year) were for embolization and 22,622 (51.5%; 11.2/million inhab./year) for microsurgery in the period 2009 - 2018. Females had the highest rates of hospitaliza- tion for embolization (15.5/million inhab./year) and microsurgery (15.5/million inhab./year) compared to males (5.5 and 6.8/million inhab./year, respectively). For embolization, the highest coefficient was registered in the age group of 60 up to 64 years (35.5/million inhab./year) while for microsurgery in the age group from 55 up to 59 years old (36.3/million inhab./year). Higher hospitalization rates were observed in the southern macroregion (36.8/million inhab./year) regardless of the procedure adopted. Non-traumatic subarachnoid hemorrhage was the main cause of hospitalization, representing 62.6% of all hospitalizations. For embolization, the mean length of stay was 7.7 days, 59% used ICU, lethality was 5.9% and 77% of deaths were related to subarachnoid hemorrhage. For brain microsurgery, the mean length of stay was 16.2 days, 85% used ICU, lethality was 10.9% and 74% of deaths were related to subarachnoid hemorrhage. The total expense with both techniques was R$ 551 million (66.8% with embolization) and the average expense per hospitalization reached R$ 17,286.00 for embolization and R$ 8,077.35 for microsurgery. Lethality for embolization was lower in philanthropic and federal hospitals while for microsurgery was lower in federal hospitals. Conclusion: Embolization had a smaller number of procedures, higher total and average expenditure per hospitalization, and shorter length of stay, percentage of intensive care unit (ICU) use and deaths when compared to cerebral microsurgery in the public network of health in Brazil.

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La patogénesis de los aneurismas intracraneales asociados a malformaciones arteriovenosas cerebrales no es bien entendida y es aún objeto de discusión. Las decisiones sobre cuándo y cómo tratar los aneurismas intracraneales de estas características siempre han sido un reto terapéutico tanto para neurocirujanos vasculares como para terapistas endovasculares neurológicos. Reportamos el caso de una paciente de 51 años con aneurismas múltiples asociados a una malformación arteriovenosa, así como su manejo neuroquirúrgico, con un análisis comparativo con lo publicado en la literatura médica y científica en los últimos 10 años.The pathogenesis of intracranial aneurysms associated with arteriovenous malformations is not well understood and is still under discussion; the decisions about when and how to treat intracranial aneurysms of these characteristics have always been a therapeutic challenge for both, vascular neurosurgeons and endovascular neurological therapists. 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 10 years.

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Se presenta un caso del primer Bypass cerebro vascular realizado en Bolivia por un aneurisma gigante de arteria carotida interna derecha, en segmento cavernoso tratado mediante bypass de alto flujo de arteria carótida externa a arteria cerebral media derecha, con injerto de arteria radial y posterior oclusión y exclusión del aneurisma. Se desciben los pasos de la cirugia y se destacan las dificultades de la tecnica y los beneficios de la cirugia. SE discuten los elementos a considerar en la toma de decisiones para la indicación y realización del bypass en el tratamiento de los aneurismas gigantes de la ACI.

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RESUMEN Introducción: Diversos factores pueden estar asociados al desarrollo de hidrocefalia en pacientes operados de aneurismas cerebrales que luego son dependientes de derivación ventrículo peritoneal, pueden estar dados por obstrucción mecánica o inflamatoria con disminución de la absorción del líquido cefalorraquídeo (LCR). Objetivo: Determinar factores asociados al desarrollo de hidrocefalia dependiente de derivación ventrículo peritoneal en pacientes con aneurismas cerebrales que han recibido tratamiento quirúrgico para clipaje. Metodología: Estudio observacional, descriptivo, retrospectivo de corte transversal de expedientes clínicos de 171 pacientes operados de aneurismas cerebrales en el Hospital de Clínicas desde el año 2013 hasta febrero del 2020. Resultados: Se han analizado 171 casos operados de aneurismas cerebrales, la mayoría del sexo femenino (71%), con un rango de edad de 17-77 años (mediana 53 años). El 7,6 % desarrolló hidrocefalia con requerimiento de derivación ventrículo peritoneal. De estos pacientes el 61,5 % tuvieron antecedentes de craniectomía descompresiva (p< 0,001). El 84,6 % presentó vasoespasmo tanto clínico como radiológico (p < 0,001). Las localizaciones más frecuentes fueron en las arterias carótida interna y cerebral media con 38,9 % para ambos. La escala de Fisher IV fue la más frecuente con 76,9%, luego Fisher II con 15,3 % (p= 0,14). El 62,2 % fueron operados durante la fase aguda (p= 0,03). Conclusión: Se ha observado en este estudio factores con asociación estadísticamente significativas con el desarrollo de hidrocefalia como la presencia de vasoespasmo y los operados de craniectomía descompresiva los cuales están acordes a la literatura, respecto a la fase de la enfermedad en la que se realizó la cirugía, en este estudio se observó predominio en la fase aguda, en contraste a lo que se observa en varias fuentes bibliográficas.

ABSTRACT Introduction: Various factors may be associated with the development of hydrocephalus in patients operated on for cerebral aneurysms that are later dependent on peritoneal ventricular shunt, may be due to mechanical or inflammatory obstruction with decreased absorption of cerebrospinal fluid (CSF). Objective: To determine factors associated with the development of peritoneal ventricular shunt-dependent hydrocephalus in patients with cerebral aneurysms who have received surgical treatment for clipping. Methods: Observational, descriptive, retrospective cross-sectional study of clinical records of 171 patients operated on for cerebral aneurysms at the Hospital de Clínicas from 2013 to February 2020. Results: 171 cases operated on for cerebral aneurysms have been analyzed, most of the female sex (71%), with an age range of 17-77 years (median 53 years). 7.6 % developed hydrocephalus with a peritoneal ventricle shunt requirement. Of these patients, 61.5% had a history of decompressive craniectomy (p <0.001). 84.6% presented both clinical and radiological vasospasm (p <0.001). The most frequent locations were in the internal carotid and middle cerebral arteries with 38.9% for both. The Fisher IV scale was the most frequent with 76.9%, then Fisher II with 15.3% (p = 0.14). 62.2% underwent surgery during the acute phase (p = 0.03). Conclusion: Factors with a statistically significant association with the development of hydrocephalus have been observed in this study, such as the presence of vasospasm and those undergoing decompressive craniectomy, which are in accordance with the literature, unlike what occurs with the phase of the disease in the that surgery was performed, which in our study showed a predominance in the acute phase, in contrast to what is observed in various bibliographic sources.

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Introducción: La Hemorragia Subaracnoidea es el sangrado en el espacio subaracnoideo. La causa espontánea en la mayoría de las veces se debe a ruptura de un aneurisma cerebral. Objetivo: Describir la casuística, manejo y resultados de los aneurismas cerebrales en el Hospital de Clínicas. Pacientes y método: Estudio observacional, descriptivo, transversal, incluyendo pacientes operados de aneurismas cerebrales, mayores de 17 años, en el Hospital de Clínicas del 2011 al 2019. Las variables descriptas fueron: edad, sexo, motivo de consulta, estudios radiológicos, escala de Glasgow y Hunt y Hess, localización, segmento, cantidad, fase, clipado temporario, vasoespasmo e hidrocefalia. Resultados: Se incluyó 249 pacientes; 45% masculino, 65% femenino, con edad promedio de 47,5 años. El motivo de consulta más frecuente fue cefalea. Al ingreso tuvieron predominantemente Hunt y Hess 2, y, Glasgow 15. El 43,2% eran Fisher 4. El Glasgow de egreso fue mayor o igual a 14 en 82,1%. Se diagnosticó el 51,7% con arteriografía; el 50,9% de los aneurismas en la carótida interna y, fueron múltiples en 10,84%. Se operaron en fase aguda 28,3%, 65% en fase tardía y, el 6,7% de los aneurismas fue de hallazgo casual. En 36,44% de los casos se realizó clipado temporario y, en el 70,4% se perforó la lámina terminalis. La mortalidad fue de 4,2%. Presentaron vasoespasmo radiológico en un 46% y, vasoespasmo clínico en 24,5 %. El 11% fue sometido a craniectomía descompresiva y, 5,5% desarrolló hidrocefalia dependiente de VDVP. Conclusión: El clipado de los aneurismas cerebrales es una técnica con buenos resultados y la única accesible en el sector público.

Introduction: Subarachnoid hemorrhage is bleeding in the subarachnoid space. The spontaneous is caused most of the time by rupture of a cerebral aneurysm. Objective: Describe the casuistry, management and results of cerebral aneurysms at the Hospital de Clínicas. Patients and methods: Observational, descriptive, cross-sectional study including patients operated for cerebral aneurysms, older than 17 years, at the Hospital de Clínicas from 2011 to 2019. The variables described were: age, sex, reason for consultation, radiological studies, Glasgow and Hunt and Hess scale, location, segment, quantity, phase, temporary clipping, vasospasm and hydrocephalus. Results: 249 patients were included; 45% male, 65% female, average age 47.5 years. The most frequent reason for consultation was headache. At admission they had predominantly Hunt and Hess 2, and Glasgow 15. 43.2% were Fisher 4. The Glasgow of discharge was greater than or equal to 14 in 82.1%. 51.7% were diagnosed with arteriography; 50.9% internal carotid aneurysms, multiple 10.84%. 28.3% were operated in acute phase, 65% late phase, 6.7% were a casually found. In 36.44% of cases a temporary clipping was performed and in 70.4% the lamina terminalis was perforated. Mortality was 4.2%, radiological vasospasm 46%, clinical vasospasm 24.5%, 11% underwent decompressive craniectomy and 5.5% developed VDVP-dependent hydrocephalus. Conclusion: The clipping of cerebral aneurysms is a technique with good results and the only one in the public sector.

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RESUMEN Introducción: la hemorragia subaracnoidea por sí misma puede dar lugar a un daño cerebral, por esto, en pacientes sin complicaciones los trastornos cognitivos pueden estar presentes. Objetivos: analizar las alteraciones neuropsicológicos en los pacientes operados de aneurismas cerebrales y los factores que se asocian a su desarrollo. Metodología: estudio analítico, observacional, ambispectivo, 2013-2020, que incluyó pacientes operados de aneurismas cerebrales rotos en el Hospital de Clínicas. La evaluación cognitiva se realizó con el mini examen cognitivo de Lobo. Se consideró alterado cuando la puntuación fue menor a 27. Se analizaron 12 variables asociando las mismas con el tema de estudio. Los datos fueron analizados con Epiinfo 7.2. Resultados: La edad mayor a 60 años se asoció al déficit cognitivo de forma significativa, así como también la lateralidad a izquierda, el uso de clipado temporario durante la cirugía, la ruptura del aneurisma en el intraoperatorio, el vasoespasmo y la hidrocefalia. No se asoció significativamente con el desarrollo de un trastorno cognitivo; el sexo, el nivel de escolaridad, la cantidad de sangre cisternal, la localización del aneurisma, el Glasgow de ingreso ni la fase en la cual se realzó la cirugía. Discusión: en general los hallazgos coinciden con la literatura. Llamó la atención que la escala de Fisher en la muestra estudiada no demostró tener una asociación significativa con el trastorno cognitivo, sin embargo, hay datos en la literatura que sostienen que la cantidad de sangre cisternal al ingreso es un fuerte predictor del estado cognitivo del paciente al alta.

ABSTRACT Introduction: subarachnoid hemorrhage itself can lead to brain damage, so in uncomplicated patient's cognitive disorders may be present. Objective: To analyze the cognitive impairments in patients following clipping of ruptured aneurysms and the factors that are associated with their development. Methodology: analytical, observational, ambispective study, 2013-2020, including patients operated for ruptured aneurysms at the Hospital de Clínicas. The cognitive evaluation was performed with the Lobo mini cognitive exam. It was considered altered when the score was less than 27. Twelve variables were analyzed associating them with the study topic. The data was analyzed with Epiinfo 7.2. Results: Age over 60 years was significantly associated with cognitive deficit, as well as left laterality, the use of temporary clipping during surgery, intraoperative aneurysm rupture, vasospasm, and hydrocephalus. It was not significantly associated with the development of a cognitive disorder; sex, level of education, amount of cisternal blood, location of the aneurysm, admission Glasgow, and the timing in which the surgery was performed. Discussion: In general, the findings coincide with the literature. It was noteworthy that the Fisher scale in the studied sample did not show to have a significant association with cognitive disorder, however, there are data in the literature that maintain that the amount of cisternal blood on admission is a strong predictor of the patient's cognitive state at discharge.

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Introducción: El tratamiento microquirúrgico de los aneurismas cerebrales no rotos, ha demostrado ser seguro en distintas series, la indicación quirúrgica en estos casos es discutible y generalmente esta en relación a su riesgo de sangrado por características morfológicas y ubicación del aneurisma. Este trabajo tiene como objetivo, determinar si en nuestra región, el tratamiento microquirúrgico de los aneurismas cerebrales no rotos es seguro y así poder dar una recomendación de tratamiento a nuestros pacientes. Materiales y métodos: Treinta y un pacientes, 33 aneurismas cerebrales no rotos fueron tratados, En clínica Elqui y Hospital San Pablo de la Región de Coquimbo, entre mayo del 2017 y marzo del 2019, se hizo un seguimiento al total de los pacientes y se evaluó su resultado neurológico según la escala de Rankin modificado. Resultado: 97% de los pacientes obtuvieron un resultado neurológico favorable (Rankin < 3), solo un 3% de los pacientes, un caso, obtuvo un resultado desfavorable (Rankin > 2). Conclusión: El tratamiento microquirúrgico de los aneurismas cerebrales no rotos en nuestra región es seguro, obteniendo una muy baja morbilidad y 0% de mortalidad

Introduction: The microsurgical treatment of unruptured cerebral aneurysms has been shown to be safe in different series, the surgical indication in these cases is debatable and is generally related to the risk of bleeding due to morphological characteristics and location of the aneurysm. The objective of this work is to determine if in our region the microsurgical treatment of unruptured cerebral aneurysms is safe and thus be able to give a recommendation of treatment to our patients. Materials and methods: 31 patients, 33 unruptured cerebral aneurysms were treated. At the Elqui clinic and San Pablo Hospital in the Coquimbo Region, between may 2017 and March 2019, the total number of patients was monitored and their Neurological outcome according to the modified Rankin scale. Result: 97% of the patients obtained a favorable neurological outcome (Rankin <3), only 3% of the patients, one case, obtained an unfavorable outcome (Rankin> 2). Conclusion: The microsurgical treatment of unruptured cerebral aneurysms in our region is safe, obtaining a very low morbidity and 0% mortality

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Resumen: El presillamiento de aneurismas cerebrales sigue siendo una cirugía bastante compleja aun con los avances en las neurociencias. El objetivo de este tipo de cirugía es evitar su ruptura y ocasionar daños colaterales en la misma, al tratar de exponer al máximo tanto el cuello del aneurisma para su manipulación como la oclusión temporal de la arteria proximal a éste. El uso de paro cardíaco transanestésico en el presillamiento de aneurismas cerebrales es una técnica empleada para cierto tipo de aneurismas cerebrales y existen varios métodos para realizarlo, desde la hipotermia profunda o severa, estimulación ventricular rápida hasta llegar al paro circulatorio con el uso de adenosina. En esta revisión de la literatura se darán las bases enfocadas en el uso de adenosina para el presillamiento de aneurismas cerebrales y, aunque parezca un método inocuo y que no requiere mucha preparación y logística, sólo debe realizarse por personal experto en neuroanestesiología para lograr obtener un mejor resultado para el paciente.

Abstract: The clipping of cerebral aneurysms remains a very complex surgery even with advances in neurosciences. The goal of surgery in the clipping of cerebral aneurysms is to prevent rupture and cause collateral damage in the same, trying to expose both the neck of the aneurysm to its maximum for clipping as well as temporary occlusion of the artery proximal to it. The use of trananesthetic cardiac arrest in the clipping of cerebral aneurysms is a technique used for certain types of cerebral aneurysms and there are several methods to perform it, from deep or severe hypothermia, passing through ventricular pacemaker at high frequencies until it reaches the circulatory arrest with the use of adenosine. This review of the literature will focus on the use of adenosine for the clipping of cerebral aneurysms and, although it seems a safe method and does not require much logistical preparation, it should only be performed by expert personnel in neuroanesthesiology to achieve a better result for the patient.