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G Gonzales-Portillo

Publications and source records attributed to G Gonzales-Portillo.

7 recordsLinked to original sources
PubMed1999

Distal internal carotid artery pseudoaneurysms: technique and pitfalls of surgical management: two technical case reports.

OBJECTIVE AND IMPORTANCE: Small, irregular aneurysms of the internal carotid artery (ICA) that are not related to arterial divisions are rare and have characteristics similar to pseudoaneurysms: they do not appear to have well-formed sacs, they are surrounded by clot, and they avulse readily. We report two patients whose treatment demonstrates the surgical technique and important points concerning the management of distal ICA pseudoaneurysms. CLINICAL PRESENTATION: Both patients presented with diffuse subarachnoid hemorrhage. The initial angiographic results were unremarkable in each case. A week after presentation, however, a growing outpouching in the distal ICA was seen. INTERVENTION: At surgery, the aneurysms were found to be on the medial wall of the ICA and were not related to arterial divisions. Quantitative blood flow measurements of the efferent vessels at risk (ICA, M1 and A1 segments) were obtained using a perivascular microflowprobe before and after clipping. In each patient, the aneurysm avulsed entirely during clip application, despite careful placement of the clip parallel to the parent vessel. An encircling clip was then used. Pathological sectioning of the aneurysms revealed loose connective tissue and/or clot with no defined aneurysmal sac. CONCLUSION: Aneurysms of the distal ICA that are not related to arterial divisions are difficult to visualize on angiograms immediately after subarachnoid hemorrhage. They are frail, avulse easily, and may be pseudoaneurysms, necessitating the use of encircling clips. The base of the aneurysm or clot must be trimmed to prevent it from buckling inside the clip sleeve and compromising the ICA lumen. Measuring distal blood flow quantitatively provides valuable information about the patency of the ICA inside the metallic sleeve, since this segment cannot be demonstrated with angiography.

Aneurysm, False↗
PubMed1999

Quantitative assessment of vessel flow integrity for aneurysm surgery. Technical note.

Quantitative measurement of blood flow in cerebral vessels during aneurysm surgery can help prevent ischemic injury and improve patient outcome. The authors report a case of a superior cerebellar artery (SCA) aneurysm in which perivascular microflow probes were used to measure blood flow quantitatively in both the SCA and the posterior cerebral artery before and after aneurysm clipping. Following aneurysm clipping, blood flow in the SCA was reduced to less than 25% of its initial baseline value. Prompt detection of compromised blood flow gave the surgeon the opportunity to adjust the clip and restore SCA flow to its preclipping value within 5 minutes of initial clip placement. Quantitative vessel-flow measurements were integral to the safe progression of the operation and may have prevented an adverse neurological outcome in this patient. The recommended surgical technique and the principle of operation are described.

Aged↗
PubMed1998

The syndrome of inappropriate secretion of antidiuretic hormone: an unusual presentation for childhood craniopharyngioma: report of three cases.

OBJECTIVE AND IMPORTANCE: Childhood craniopharyngiomas may present with variable endocrine dysfunctions. However, hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone has never been reported. We describe three children with craniopharyngioma who presented with hyponatremia. CLINICAL PRESENTATION: Three children had hyponatremia at presentation, two of whom had experienced generalized seizures. Urine sodium levels measured in two patients were abnormally high. Neuroimaging tests, including computed tomography and magnetic resonance imaging, showed a large partially calcified and partially cystic craniopharyngioma in the sellar/suprasellar location. INTERVENTION: Intake of fluids was restricted for each patient, with improvement of hyponatremia, and each patient subsequently underwent a successful tumor resection. Postoperatively, all patients developed panhypopituitarism, including diabetes insipidus, and needed multiple hormonal replacement therapy. CONCLUSION: Endocrine dysfunctions at diagnosis are commonly associated with childhood craniopharyngiomas, but the association of the syndrome of inappropriate secretion of antidiuretic hormone with craniopharyngioma has never been reported. Craniopharyngiomas should be included as a possibility in making the differential diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone in children.

Child↗