%0 Journal Article
%T Tratamiento microquir迆rgico de los aneurismas de la bifurcaci車n de la car車tida interna Microsurgical treatment of internal carotid bifurcation aneurysms
%A J.M. Gonz芍lez-Darder
%A P. Gonz芍lez-L車pez
%A L. Botella-Maci芍
%J Neurocirug赤a
%D 2010
%I Scientific Electronic Library Online
%X Se presentan los hallazgos cl赤nicos y de imagen de una serie de 14 aneurismas de bifurcaci車n de la arteria car車tida interna tratados microquir迆rgicamente. Un total de 10 lesiones no se hab赤an roto y las 4 restantes se presentaron con hemorragia subaracnoidea y hematoma frontobasal. El diagn車stico se realiz車 con t谷cnicas de neuroimagen (TAC, angio-TAC-3D; angio-RNM, angiograf赤a), aunque los pacientes con aneurismas rotos fueron intervenidos con los hallazgos proporcionados por el angio-TAC-3D. El tama o medio del saco era de 8.4mm (3-13.3) y el del cuello 6.8mm (3-9.6), con una relaci車n saco/cuello de 1.32 (0.46-2.05). Las lesiones se trataron por v赤a pterional sin incidencias y con ayuda de clipaje temporal en todos los casos. Se utilizaron t谷cnicas peroperatorias de neuroprotecci車n, neuromonitorizaci車n y determinaci車n de flujo vascular con micro-doppler. Los resultados cl赤nicos han sido excelentes, con 13 pacientes con GOS 5 y uno con GOS 4 a partir de los tres meses del alta y exclusi車n del aneurisma en los controles angiogr芍ficos postquir迆rgicos realizados en los pacientes con aneurisma roto. Clinical and imaging findings of a series of 14 internal carotid artery bifurcation aneurysms microsurgically treated are presented. A total of 10 lesions were diagnosed before rupture and 4 patients presented with subarachnoidal hemorraghe and frontobasal intracerebral bleeding. Diagnosis was done using neuroimaging (CT scan, angio-CT-3D, angio-MRI, angiography) but patients with ruptured aneurysms were treated with the sole information provided by the angio-CT-3D. The average fundus size was 8.4mm (3-13.3) and the average neck size was 6.8mm (3-9.6), being the fundus-to-neck ratio 1.32 (0.46-2.05). All lesions were microsurgically treated through a pterional approach with the help of temporary clipping of the aferent vessesl in all cases. We used peroperative neuroprotective, neuromonitorization and micro-doppler cerebral flow measurement. Clinical results were excellent with 13 patients GOS grade 5 and one grade 4 three month afterwards of hospital discharge and complete exclusion of the lesion in angiographic controls done solely in patients with ruptured lesions.
%K Aneurisma cerebral
%K Hemorragia subaracnoidea
%K Craneotom赤a
%K Cerebral aneurysm
%K Subaracnoid hemorraghe
%K Craniotomy
%U http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-14732010000300001