RESUMO
OBJECTIVE: The minipterional craniotomy (MPTc) has been widely accepted as a minimally invasive alternative to the pterional approach for the treatment of certain small non-ruptured anterior circulation aneurysms. The aim of this study was to determine the effectiveness and safety of the MPTc in the context of a complex and potentially harmful scenario: acute onset of subarachnoid hemorrhage (SAH) in patients harboring multiple intracranial aneurysms (MIA). METHODS: Patients harboring MIA clipped through a unilateral MPTc were selected from four retrospective databases of four high-volume neurosurgical centers. Patients with a Hunt & Hess score 4 or 5 were not considered candidates for clipping through a MPTc. Medical records and radiological images were retrospectively reviewed. Epidemiological, clinical and radiological data, as well as short-term outcome (modified Rankin scale at 6 month-follow-up) were analyzed. RESULTS: 16 patients harboring 33 aneurysms (16 ruptured, 17 non ruptured) met the inclusion criteria. Each aneurysm size was 5.7 ± 2.1 mm (range 3-11). 12 out of 33 aneurysms were located in the middle cerebral artery (MCA). Anterior communicating (ACom) and MCA aneurysms were the aneurysm locations most commonly ruptured (5 each, 62 %). Complete occlusion was achieved in 32 aneurysms (97 %) and near-complete occlusion in 1 (3%). 13 patients (93 %) were independent at 6 month-follow-up. Mortality rate was 0%. Complications included 1 cerebrospinal-fluid leakage. CONCLUSION: When indicated (Hunt Hess < 4), performing a MPTc is safe and effective in aSAH cases with multiple aneurysms.
Assuntos
Revascularização Cerebral/métodos , Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Instrumentos Cirúrgicos , Doença Aguda , Adulto , Idoso , Revascularização Cerebral/instrumentação , Chile/epidemiologia , Craniotomia/instrumentação , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Resultado do TratamentoRESUMO
Long-awaited positive trial data have shown the efficacy of endovascular treatment in patients with ischemic stroke who arrive at the hospital within the first 6 hours with large-vessel occlusion of the anterior circulation. With the introduction of stent retrievers (SRs) for mechanical thrombectomy, efficient and safe large-artery recanalization treatment can be achieved. However, sometimes there are patients who do not attain complete flow restoration following attempts with traditional maneuvers. The authors present the case of a 57-year-old man with acute ischemic stroke due to an M1 embolus that extended into both M2 trunks. This patient was successfully treated with an innovative technique in which a Solitaire SR (Covidien) and a Catch SR (Balt) were used in a "Y" configuration, for which the authors coined the term "Y-stent retriever."
Assuntos
Isquemia Encefálica/cirurgia , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Stents , Acidente Vascular Cerebral/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Revascularização Cerebral/instrumentação , Revascularização Cerebral/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagemRESUMO
BACKGROUND: The arachnoid knife is a useful instrument when performing a variety of neurosurgical procedures, for example, while opening the sylvian fissure or basal arachnoid bridges in the pterional approach or during the peripheral delimitation and excision of a cortical AVM. At present, there exists a wide variety of arachnoid knives made from different materials (stainless steel, titanium, or diamond-tipped); however, most of these instruments are expensive and may become dull with continuous use or bad handling. METHODS: In this article, we report the use and advantages of an arachnoid knife from a simple hypodermic needle. RESULTS: In the last 6 years, we have used this technique to open the arachnoid layer in more than 350 neurosurgical procedures. Furthermore, it can be used to perform sharp arteriotomies during bypass procedures or to open the dura mater over bone structures. To date, no complication arising from this simple technique has been documented. CONCLUSIONS: A standard hypodermic needle can be used in the operating room as a practical arachnoid knife. It has the characteristics of being effective, low-cost, and available worldwide.
Assuntos
Aracnoide-Máter/cirurgia , Revascularização Cerebral/instrumentação , Agulhas , Procedimentos Neurocirúrgicos/instrumentação , Revascularização Cerebral/métodos , Humanos , Procedimentos Neurocirúrgicos/métodosRESUMO
A tecnica de reconstrucao vascular com ponte venosa de alto fluxo para aneurismas cerebrais complexos é apresentada. As indicacoes, complicacoes e resultados de uma serie de 27 pacientes operados no periodo de 1992 a 1997 sao discutidos. Do total de pacientes 71 por cento possuiam aneurismas gigantes da arteria carotida interna intracavernosa. Cinco pacientes foram submetidos a pontes venosas como medida de profilaxia contra isquemia transoperatoria (bypass profilatico) no tratamento de aneurismas gigantes supraclinoideos. Obtivemos 75 por cento de patencia nos enxertos apos controle angiografico. Nossos resultados mostraram-se bons em 85,7 por cento dos pacientes; nossa morbidade isquemica foi de 3,6 por cento e nossa morbidade nao-isquemica de 7,1 por cento a mortalidade na serie foi de 3,6 por cento.