Biomedical subjects

A Varela-Hernández

Publications and source records attributed to A Varela-Hernández.

4 recordsLinked to original sources

PubMed2003

[Giant supratentorial intracranial aneurysms. Analysis of 22 cases].

INTRODUCTION: Giant intracranial aneurysms represent 2 to 5% of all aneurysms. They are well characterized from the anatomical and clinical point of view. Their natural history shows its potential lethality. Surgical treatment of giant aneurysms is a challenge for neurosurgeons. MATERIAL AND METHODS: Twenty-two patients were operated on through pterional craniotomy, specialized neuroanesthesia and microneurosurgical technics. Auxiliary methods like transitory clipping and retrograde decompression-suction technique were applied. Patients were followed at intensive care units and they were evaluated three months after the operation. Nineteen patients were in the fourth and sixth decade of life. Seventeen were females. Aneurysms were located at middle cerebral artery bifurcation; paraclinoidal carotid artery; proximal anterior cerebral artery and carotid bifurcation. Ninety one percent of aneurysms were clipped. Retrograde decompression-suction technique was performed in thirteen cases. RESULTS: Seventeen patients had good outcome and one patient died (4.5%). There were 6 postoperative complications and in four disappeared three months later. CONCLUSIONS: Giant aneurysms were operated on following main neurosurgical rules helped by auxiliar procedures to reduce aneurysms size and wall, aneurysms tension. New knowledge about giants aneurysms and the development of new techniques will permit better results.

Adolescent↗

PubMed2002

[Aneurysms surgery in the patients aged seventy to eighty years].

Elderly patients are a growing population group in developing countries because of optimal health care. 13% of Cuba population is older than sixty years and it is expected to grow to 20% in 2005. Subarachnoid hemorrhage secondary to ruptured aneurysms in geriatric patients carries a high mortality but a few patients are selected for surgical treatment. Manuel Ascunce Domenech Hospital attended 1112 patients older than 60 years between January 1994 and December 2001. Of these there were 96 patients with symptomatic intracranial aneurysms and we selected 30 for surgical treatment. They were all in clinical grades I and II of the WFNS scale. They had good health to face surgery and familiar consent. The size and location of the aneurysms were not considered among the exclusion criteria. Aneurysms were mainly localized at posterior communicating and middle cerebral arteries. There were two deaths, one due to a medical cause an the other to the surgical procedure. 74% of the patients obtained satisfactory outcome six month after the operation. The clue is to not consider age as a negative point for surgery. Surgical procedures can be performed in patients with good clinical grade (WFNS). New technical advances, stroke units, accurately selected patients and minimal invasive surgical methods will help to obtain good results.

Age Factors↗

PubMedDate not supplied

[Simultaneous cephalic migration of a ventriculoperitoneal shunt into the intraventricular and subdural spaces. A case report].

INTRODUCTION: Hydrocephaly is defined as a hemodynamic disorder in which the production, circulation or reabsorption of cerebrospinal fluid is involved. Migration, in a cephalic direction, into the subdural and intraventricular spaces of the proximal ends (shunt malfunction), is very unusual and perhaps not yet reported. It probably involves movement of the craniospinal region of the patient which leads to a follow on effect due to an underlying disorder. CLINICAL CASE: We report the case of a polytraumatized baby (non hospital birth, subarachnoid hemorrhage, porencephaly and subsequent hydrocephaly), who had had multiple shunts inserted. On her most recent admission the shunt was not working properly, as confirmed on plain radiological examination. This showed migration of the catheter, in cephalic direction, into the intraventricular and subdural space. CONCLUSIONS: In order that such migration could occur, conditioning factors would be necessary: such as detachment of the shunt at the distal end (technical fault), underlying disease (porencephaly), dynamic factors causing expulsion (abdominal peristaltic movements) dynamic translocation factor (neck movements), dynamic attraction factor (increased CSF reabsorption) and unishunt catheter (offering no resistance to passage through the trepanation orifice).

Cerebral Ventricles↗

PubMedDate not supplied

[Endocranial hypertension].

INTRODUCTION AND OBJECTIVE: The endocranial hypertension syndrome is one of the commonest and most feared neurological complications in clinical practice. This encourages its continued study, and is the subject of this review. DEVELOPMENT: Endocranial hypertension is the common pathway for the presentation of many neurological and non neurological disorders. An increase in the volume of one or more intracranial structures causes secondary lesions of the brain and even the death of the patient, although this may frequently be avoided by prompt recognition and suitable action by the doctor involved. General, non specific therapeutic measures should be instituted to achieve a normal endocranial pressure. The clinical presentation and complementary investigations should be correctly interpreted to determine the aetiology of the condition so that specific treatment may be given. Continuous monitoring of the intracranial pressure and other neuromonitorization techniques are essential for correct decisions as to treatment. CONCLUSIONS: Understanding the physiopathology, diagnosis and treatment of the syndrome of endocranial hypertension are still essential in modern medicine. In recent years there have been advances in the use of well known treatments and new drugs have been introduced. Use of the different neuromonitoring techniques permits optimum use of the treatment available.

Brain Edema↗