El hematoma subdural crónico (HSDC) es una patología neuroquirúrgica frecuente, con una recurrencia de hasta el 30% de los casos. La embolización de la arteria meníngea media (AMM) es una estrategia de manejo adyuvante para disminuir la recidiva, especialmente en pacientes con factores de riesgo para recurrencia, y tiene una baja tasa de complicaciones. Presentamos el caso de unvarón de 83 años con antecedente de anticoagulación, que es admitido en centro sanitario por presentar hemiparesia derecha, disartria y alteración de la marcha, con un tiempo de enfermedad de una semana. Se realizó trepanación y evacuación del HSDC sin complicaciones. Un mes después retornó por recidiva del HSDC, por lo que se realizó trepanación y evacuación adecuada del HSDC, seguida de embolización de la AMM ipsilateral. El control a los dos meses mostró ausencia de recidiva, con mejoría neu...

Introducción: Los aneurismas tipo blíster son aneurismas pequeños, complejos, menores de 3mm, con alta tasa de morbilidad y mortalidad, así como de resangrado y recurrencia. Son difíciles de tratar y se han propuesto técnicas microquirúrgicas y endovasculares, siendo estas últimas las de menor tasa de complicaciones. Caso Clínico: Mujer de 74 años, ingresa con 6 horas de evolución de trastorno de sensorio brusco. La tomografía muestra hemorragia subaracnoidea difusa a predominio izquierdo. Se le realiza una angiografía cerebral que evidencia un aneurisma blíster de la trifurcación de la arteria cerebral media izquierda. Se emboliza con técnica de remodeling y coils, logrando obliterar la totalidad del aneurisma. Conclusión: Los aneurismas tipo blíster son aneurismas complejos y raros, siendo la terapia endovascular una alternativa segura y eficaz con menor tasa de compl...

La neuralgia del glosofaríngeo es una patología rara donde hay dolor agudo y punzante en la fosa amigdalina, ángulo de la mandíbula y base de la lengua. Su principal causa es la compresión neurovascular la cual se puede diagnosticar con una resonancia cerebral. Su manejo es médico, principalmente; con fármacos, especialmente, carbamazepina y oxcarbazepina; y si no hay respuesta, va a cirugía mediante descompresión microvascular e interposición de material blando (politetrafluoroetileno), con o sin transección del IX par craneal. Se presenta el caso de una mujer de 64 años, hipertensa controlada, con dolor característico, que con 5 fármacos antineuropáticos y 1 derivado de opioides no cedía el dolor. La resonancia cerebral con secuencia FIESTA muestra una compresión neurovascular del IX PC con la PICA izquierda. Se le realiza descompresión microvascular del IX PC, con re...

Los hemangiomas del seno cavernoso son considerados como malformaciones vasculares o tumores vasculares, se desarrollan extraaxiales, pero son histológicamente distintos a la malformación cavernomatosa cerebral. Su clínica puede ser cefalea, alteraciones visuales o paresia de pares craneales. Los métodos diagnósticos son la tomografía, pero principalmente la resonancia contrastada. El tratamiento puede ser mediante microcirugía o radioterapia. Se presenta el caso de un varón de 30 años, sin antecedentes, con 3 años de evolución de cefalea, y 7 meses de diplopía por paresia del VI par craneal. La resonancia contrastada evidencia un proceso expansivo en el seno cavernoso derecho, bordes regulares, hipointensa en T1, hipercaptador de contraste, hiperintensa en T2 y FLAIR, que no restringe en difusión. Se le realizó una craneotomía más resección total de la tumoración con a...

Introducción: El complejo C0-C1-C2 es responsable de la transición de la carga axial, con función biomecánica única, siendo afectada por múltiples patologías, que por lo general la literatura no las considera como un solo ítem, sino que lo desarrolla según su etiología, pero en nuestro estudio se ha considerado en 5 grupos: traumática, congénita, inflamatoria reumática, neoplásica y degenerativa. Objetivo: Determinar las características epidemiológicas, clínicas y del tratamiento en la patología cervical alta. Materiales y métodos: Se incluyeron a todos los pacientes con diagnóstico clínico radiológico de alguna patología cervical alta que hayan sido sometidos a tratamiento quirúrgico entre 2016 y 2021 en el Hospital Almenara. Se usó el test “t” de student y de chi cuadrado. Se dividió a los pacientes en alguno de los 5 grupos antes mencionados. Resultados: ...

Objetivo: Determinar los resultados clínicos y angiográficos en pacientes con aneurismas intracraneales múltiples tratados endovascularmente en una única sesión. Materiales y Métodos:Se incluyó a todos los pacientes mayores de 18 años con aneurismas múltiples (≥2), rotos o no rotos, tratados con terapia endovascular en una única sesión entre 2019 y 2021. Se recolectaron los datos clínicos y angiográficos. Se determinó la tasa de oclusión inmediata y del seguimiento. La escala de Rankin modificado se usó para valorar el resultado clínico. Resultados: Se trataron 25 pacientes, de los cuales 14 se presentaron con hemorragia subaracnoidea. Se diagnosticaron un total de 78 aneurismas, de los cuales 59 aneurismas fueron tratados. La localización más frecuente fue el segmento oftálmico. La altura máxima promedio fue de 5.2mm, lo cual tuvo diferencia estadística significa...

Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition, which may develop recurrence in up to 30% of all cases. Embolization of the middle meningeal artery (MMA) is an adjuvant management strategy for reducing recurrence, especially in patients with risk factors, and it has a low complication rate. We present the case of an 83-year old male with history of anticoagulation, who was admitted in a healthcare facility because of right hemiparesis, dysarthria and gait impairment, and he had been sick for one week. A trepanation and CSDH evacuation were uneventfully performed. One month later, the patient was brought back because of CSDH recurrence, so another trepanation and adequate CSDH evacuation were performed, followed by embolization of the ipsilateral MMA. A control assessment after two months revealed absenceof recurrence and neurological improvement. We conclude that ...

Glossopharyngeal neuralgia is a rare pathology, with a sharp and stabbing pain in the tonsillar fossa, angle of the jaw and base of the tongue. Its main etiology is neurovascular compression, which can be diagnosed with a brain MRI. Its management is mainly medical with drug, especially carbamazepine and oxcarbazepine, and if there is no response, surgery is performed through microvascular decompression and interposition of soft material (polytetrafluoroethylene) with or without transection of IX cranial nerve. We present the case of a 64-year-old woman, with controlled hypertension, with classic pain, who did not relieve pain with 5 antineuropathic drugs and 1 opioid derivative. Brain MRI with FIESTA sequence shows a neurovascular compression of the glossopharyngeal nerve with the left PICA. Microvascular decompression of the glossopharyngeal nerve was performed, with resolution of the ...

Introduction: Blister-like aneurysms are small, complex, smaller than 3mm, with high rate of morbidity and mortality, as well as rebleeding and recurrence. They are difficult to treat and microsurgical and endovascular techniques are current treatment modalities. Endovascular technique has the lowest rate of complications. Clinical case: 74-year-old woman, admitted with 6 hours of sudden sensory disorder. The CT scan shows diffuse subarachnoid hemorrhage predominantly on the left side. A cerebral angiography showed a blister-like aneurysm of the left middle cerebral artery trifurcation. The patient was treated with coiling and remodeling technique, achieving a complete occlusion. Conclusion: Blister-like aneurysms are complex and rare, whereas endovascular therapy is a safe and effective alternative with low complication rate.

Introduction: The C0-C1-C2 complex is responsible of axial load transition, and its biomechanical function is unique, it is affected by multiple pathological conditions; and generally speaking, the literature does not consider these conditions as a single item, it describes them according to etiology. For our study we considered five groups: trauma-related, congenital, rheumatic-inflammatory, neoplastic, and degenerative. Objective: To determine epidemiological, clinical, and therapy-related characteristics in upper cervical pathological conditions. Materials and methods: All patients with a clinical-radiological diagnosis of any upper cervical pathological condition that had undergone surgery between 2016 and 2021 in Guillermo Almenara Hospital were included. Student’s t test and chi square methods were used. Patients were divided into five groups: congenital, trauma-related, rheumati...

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for...

Cavernous sinus hemangioma is considered as a vascular malformation or as a vascular tumor. It is usually extra-axially located, but it is histologically different from cavernomatous cerebral malformations. Clinical features may include headache, visual alterations or cranial nerve palsy. Diagnostic methods include CT scans, but the best is contrast-enhanced magnetic resonance imaging (MRI). Therapy may be microsurgery or radiotherapy. We present the case of a 30-year-old male, with no relevant past history, who had suffered with headache for three years, and diplopia for the last seven months, due to paresis affecting the sixth cranial nerve. Contrast-enhanced MRI showed an expansive lesion in the right cavernous sinus, with regular borders, T1 hypointense, with significant contrast uptake, T2 and FLAIR hyperintense, with no diffusion restriction. A craniotomy plus total resection of th...

Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition, which may develop recurrence in up to 30% of all cases. Embolization of the middle meningeal artery (MMA) is an adjuvant management strategy for reducing recurrence, especially in patients with risk factors, and it has a low complication rate. We present the case of an 83-year old male with history of anticoagulation, who was admitted in a healthcare facility because of right hemiparesis, dysarthria and gait impairment, and he had been sick for one week. A trepanation and CSDH evacuation were uneventfully performed. One month later, the patient was brought back because of CSDH recurrence, so another trepanation and adequate CSDH evacuation were performed, followed by embolization of the ipsilateral MMA. A control assessment after two months revealed absenceof recurrence and neurological improvement. We conclude that ...

La neuralgia del glosofaríngeo es una patología rara donde hay dolor agudo y punzante en la fosa amigdalina, ángulo de la mandíbula y base de la lengua. Su principal causa es la compresión neurovascular la cual se puede diagnosticar con una resonancia cerebral. Su manejo es médico, principalmente; con fármacos, especialmente, carbamazepina y oxcarbazepina; y si no hay respuesta, va a cirugía mediante descompresión microvascular e interposición de material blando (politetrafluoroetileno), con o sin transección del IX par craneal. Se presenta el caso de una mujer de 64 años, hipertensa controlada, con dolor característico, que con 5 fármacos antineuropáticos y 1 derivado de opioides no cedía el dolor. La resonancia cerebral con secuencia FIESTA muestra una compresión neurovascular del IX PC con la PICA izquierda. Se le realiza descompresión microvascular del IX PC, con re...

Introduction: Blister-like aneurysms are small, complex, smaller than 3mm, with high rate of morbidity and mortality, as well as rebleeding and recurrence. They are difficult to treat and microsurgical and endovascular techniques are current treatment modalities. Endovascular technique has the lowest rate of complications. Clinical case: 74-year-old woman, admitted with 6 hours of sudden sensory disorder. The CT scan shows diffuse subarachnoid hemorrhage predominantly on the left side. A cerebral angiography showed a blister-like aneurysm of the left middle cerebral artery trifurcation. The patient was treated with coiling and remodeling technique, achieving a complete occlusion. Conclusion: Blister-like aneurysms are complex and rare, whereas endovascular therapy is a safe and effective alternative with low complication rate.

Introduction: The C0-C1-C2 complex is responsible of axial load transition, and its biomechanical function is unique, it is affected by multiple pathological conditions; and generally speaking, the literature does not consider these conditions as a single item, it describes them according to etiology. For our study we considered five groups: trauma-related, congenital, rheumatic-inflammatory, neoplastic, and degenerative. Objective: To determine epidemiological, clinical, and therapy-related characteristics in upper cervical pathological conditions. Materials and methods: All patients with a clinical-radiological diagnosis of any upper cervical pathological condition that had undergone surgery between 2016 and 2021 in Guillermo Almenara Hospital were included. Student’s t test and chi square methods were used. Patients were divided into five groups: congenital, trauma-related, rheumati...

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for...

Cavernous sinus hemangioma is considered as a vascular malformation or as a vascular tumor. It is usually extra-axially located, but it is histologically different from cavernomatous cerebral malformations. Clinical features may include headache, visual alterations or cranial nerve palsy. Diagnostic methods include CT scans, but the best is contrast-enhanced magnetic resonance imaging (MRI). Therapy may be microsurgery or radiotherapy. We present the case of a 30-year-old male, with no relevant past history, who had suffered with headache for three years, and diplopia for the last seven months, due to paresis affecting the sixth cranial nerve. Contrast-enhanced MRI showed an expansive lesion in the right cavernous sinus, with regular borders, T1 hypointense, with significant contrast uptake, T2 and FLAIR hyperintense, with no diffusion restriction. A craniotomy plus total resection of th...