Neurocirugia
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Idiopathic subarachnoid haemorrhage (ISAH) represents approximately 15-30% of all subarachnoid haemorrhages. On the basis of the diagnostic CT and depending on the location of the subarachnoid bleeding, patients with ISAH may be classified into three groups: a) Patients with normal CT and diagnosis made by lumbar puncture (ISAHNCT); b) patients with a pure perimesencephalic pattern (ISAHPM) and c) patients with a bleeding pattern resembling that of aneurismatic rupture (ISAHA). This classification could permit the establishment of differences in the management and prognosis. ⋯ This study confirms that the frequency of ISAH in our environment reaches the higher limit of that shown previously in the literature, replicating the results previously published by our group. Patients with ISAH have a better prognosis and a smaller risk of complications than patients with ASAH, the prognosis of patients with ISAHCTN and ISAHPM being particularly good. Patients with ISAHA present initially with a severe clinical situation, probably related to the bigger amount of bleeding, as well as a higher frequency of systemic complications, cerebral ischemia and hydrocephalus. However, if the absence of vascular lesions is confirmed, the long term prognosis is similar to that of the other subgroups of ISAH.
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Review
[Retropleural paraspinal approach in the treatment of anterolateral thoracic spinal diseases].
The personal experience in the treatment of the spinal and paraspinal thoracic pathology using the paraspinal retropleural approach is presented. A total of 18 patients with neoplastic, traumatic and discal lesions were operated on. Improvement of neurological disturbances and pain was noted in all patients. ⋯ The paraspinal retropleural approach is compared with the anterior transthoracic approach. The advantages of the paraspinal retropleural approach are: low rate of complications; allows a very wide decompression of the neurological elements as well as an anterior and/or posterior stabilization of the spine by a single approach; and it can be easily tailored for each lesion. These advantages are enhanced in the management of lesions located in the upper thoracic or thoracocervical levels.
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Epidural hematoma is an uncommon but serious complication of epidural anaesthesia. The use of low molecular weight heparin (LMWH) as thromboprophylaxis has increased the occurrence of this pathology. ⋯ He improved after surgical evacuation, and no neurological deficit was present. We comment the association of LMWH, epidural anaesthesia and epidural haematoma.
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Arachnoid cysts account for only 1% of all intracranial space-occupying lesions. In adults suprasellar cysts represent 9% of all the arachnoid cysts while in pediatric population this percentage reaches 15%. In spite of being a problem relatively common in daily neurosurgical practice there are still a number of questions to be solved concerning pathogenesis and evolution, natural history and treatment. ⋯ Preoperative symptoms improved in all the patients and five out of seven remain shunt free. One patient maintains a cystoperitoneal shunt and another one, previously shunted, remains shunt dependent. The clinical presentation and postoperative evolution are commented with discussion on the alternative therapeutic options from the endoscopic point of view.
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Case Reports
[Endoscopic fenestration as a treatment for asymmetrical hydrocephalus due to obstruction of the foramen of Monro].
Unilateral dilatation of the lateral ventricle is a rare condition. The most common causes are tumors of the lateral ventricles or in the area of the third ventricle, acute or chronic inflammatory gliosis, cysticercosis or congenital atresia of the foramen of Monro. We report a case of asymmetrical dilatation of the lateral ventricle in an adult patient presenting with a raised intracranial pressure syndrome caused by narrowing of the foramen of Monro which was occluded by a thin membrane. The patient underwent successful endoscopic fenestration of the Foramen of Monro.