Publique un comentario 
Descargar aquí
Aneurismas intracraneales, no rotos en pacientes de la provincia Sancti Spiritus
Resumen
Fundamento: Los aneurismas intracraneales cuando se fisuran provocan una hemorragia subaracnoidea. No obstante, no todos se rompen y algunos pueden ser encontrados de manera casual en un estudio imaginológico y se les denomina incidentales o asintomáticos según el paciente presente, o no, historia previa de otro saco que se haya roto con anterioridad.Tratar un aneurisma intracraneal no roto es un desafío para líderes clínicos y quirúrgicos.
Objetivo: Describir las características y evolución de una serie de 91 aneurismas intracraneales incidentales y asintomáticos en pacientes atendidos en el Hospital General Camilo Cienfuegos de Sancti Spíritus entre los años 2010 y 2020.
Metodología: Estudio descriptivo y cuantitativo con una muestra no probabilística de 91 aneurismas incidentales y asintomáticos encontrados en 72 pacientes mediante estudios imaginológicos. Las variables estudiadas fueron: edad, sexo, dimensiones, forma irregular, sitio de localización, método de tratamientos empleados, mortalidad y morbilidad.
Resultados: Predominaron los pacientes con edad entre 45 y 65 años y hubo un predominio del sexo femenino. Fue mayoritario el aneurisma de mediano tamaño y la localización más frecuente fue la comunicante anterior. Se detectaron variables clínicas y morfológicas predictivas de complicaciones. Los pacientes no intervenidos quirúrgicamente evolucionaron mejor. Se detectaron varios pacientes con familiares de primer y segundo grado afectados por aneurismas intracraneales.
Conclusiones: Los aneurismas intracraneales no rotos predominan en mujeres de la quinta y sexta década de la vida. Factores morfológicos como el tamaño del saco, la altura máxima del domo y la razón de aspecto se relacionaron con la aparición de complicaciones en los pacientes operados. El síndrome de aneurisma intracraneal familiar debe tenerse en cuenta en pacientes con antecedentes de familiares de primer y segundo grado con aneurismas intracraneales.Palabras clave
Referencias
Rhoton AL. Aneurysms. Neurosurgery [Internet]. 2002 [cited 2022 Jun 28];Oct;51(4 Suppl):S121-58. PMID:12234448. Available from: https://docer.com.ar/doc/ee5n55
Lantigua H, Ortega-Gutierrez S, Schmidt JM, Lee K, Badjatia N, Agarwal S, Claassen J, Connolly ES, Mayer SA. Subarachnoid hemorrhage: who dies, and why? Crit Care [Internet]. 2015 Aug 31 [cited 2002 Jun 28];19(1):309. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556224/
Inagawa T, Hirano A. Autopsy study of unruptured incidental intracranial aneurysms, Surgical Neurology. [Internet]. 1990 [cited 2022 Jul 23];34(6):361-5. Available from: https://www.sciencedirect.com/science/article/pii/009030199090237J. https://doi.org/10.1016/0090-3019(90)90237-J
Milet LE. Historia natural de los aneurismas intracraneales: Aneurismas sin ruptura. Rev argent neurocir [Internet]. 2006 Mar [citado 23 Ago 2022];20(1):19-24. Disponible en: http://www.scielo.org.ar/pdf/ranc/v20n1/v20n1a05.pdf
Ito H, Kawaminami T, Asano K, Fukubaga T, Karai C, Okuma S, et al. The Prevalence of Unruptured Cerebral Aneurysms in Okinoerabu: A Japanese Hospital-Based Study. J Neurol Neurosci [Internet]. 2018 [cited 2022 Jul 29];9(5):273. Available from: https://www.jneuro.com/abstract/the-prevalence-of-unruptured-cerebral-aneurysms-in-okinoerabu-a-japanese-hospitalbased-study-23649.html
Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol [Internet]. 2016 Dec [cited 2022 Jul 29];12(12):699-713. Available from: https://doi.org/10.1038/nrneurol.2016.150
Rajabzadeh-Oghaz H, Wang J, Varble N, Sugiyama SI, Shimizu A, Jing L, Liu J, Yang X, Siddiqui AH, Davies JM, Meng H. Novel Models for Identification of the Ruptured Aneurysm in Patients with Subarachnoid Hemorrhage with Multiple Aneurysms. AJNR Am J Neuroradiol [Internet]. 2019 Nov [cited 2022 Jul 29];40(11):1939-46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6871507/
Zhu W, Li W, Tian Z, Zhang M, Zhang Y, Wang K, Zhang Y, Yang X, Liu J. Nomogram for Stability Stratification of Small Intracranial Aneurysm Based on Clinical and Morphological Risk Factors. Front Neurol [Internet]. 2021 Jan 15 [cited 2022 Jul 29];11:598740. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2020.598740/full
Feng X, Tong X, Peng F, Niu H, Qi P, Lu J, et al. Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study. Stroke Vasc Neurol [Internet]. 1 de September de 2021 [cited 2022 jul 29];6(3):433-40. Available from: https://svn.bmj.com/content/svnbmj/6/3/e000480.full.pdf
The international study of unruptured intracranial aneurysms investigators. Unruptured intracranial aneurysms - risk of rupture and risks of surgical intervention. N Engl J Med [Internet] 1998 [cited 2022 Jul 29];339(24):1725-33. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJM199812103392401?articleTools=true
UCAS Japan Investigators. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med [Internet] 2012 [cited 2022 Jul 29];366:2474-82. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1113260?articleTools=true
Mayer TE, Etminan N, Morita A, Juvela S.. The unruptured intracranial aneurysm treatment score a multidisciplinary consensus. Neurology [Internet] 2016 [cited 2022 Jul 29];86(8):792. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560059/ https://doi.org/10.1212/01.wnl.0000481228.68055.71
Molyneux A. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet [Internet]. 2002 [cited 2022 Jul 29];360(9342):1267-74. Available from: https://pubmed.ncbi.nlm.nih.gov/16139655/ https://doi.org/10.1016/S0140-6736(02)11314-6 https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(02)11314-6.pdf
David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg [Internet]. 1999 Sep [cited 2022 Jul 29];91(3):396-401. Available from: https://doi.org/10.3171/jns.1999.91.3.0396.
Watt J, Watt C, Van Schoor A. Gender-Based Comparative Aneurysm Study Regarding Age at Presentation, Location,and Possible Causative Factors. Anatol J Family Med [Internet] 2020 [cited 2022 Jul 29];3(3):211-21. Available from: https://anatoljfm.org/jvi.aspx?un=ANATOLJFM-52297
Ujiie H, Tachibana H, Hiramatsu O, Hazel AL, Matsumoto T, Ogasawara Y, Nakajima H, Hori T, Takakura K, Kajiya F. Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms. Neurosurgery [Internet]. 1999 Jul [cited 2022 Jul 29];45(1):119-29. Available from: https://doi.org/10.1097/00006123-199907000-00028
Tremmel M, Dhar S, Levi EI, Mocco J, Meng H. Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study. Neurosurgery [Internet]. 2009 [cited 2022 Jul 29];(64):622-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775481/
Mohd Nazri NN, Uzair Matalif M, Mohd Adib MAH. Effects of blood flow patent and cross-sectional area on hemodynamic into patient-specific cerebral aneurysm via fluid-structure interaction method: A review. Mater Sci Eng [Internet]. 2020 [cited 2022 Jul 29];788. Available from: https://iopscience.iop.org/article/10.1088/1757-899X/788/1/012022/pdf
Bor ASE, Rinkel GJE, Adami J, Koffijberg H, Ekbom A, Buskens E, et al. Risk of subarachnoid haemorrhage according to number of affected relatives: a population based case–control study. Brain [Internet]. 1 de octubre de 2008 [cited 2022 Jul 29];131(10):2662-5. Available from: https://doi.org/10.1093/brain/awn187
Etminan N, Dörfler A, Steinmetz H: Unruptured intracranial aneurysms pathogenesis and individualized management. Dtsch Arztebl Int [Internet]. 2020 [cited 2022 Jul 29];117:235-42. Available from: https://doi.org/10.3238/arztebl.2020.0235 https://www.aerzteblatt.de/pdf.asp?id=213348
Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, et al. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 [cited 2022 Jul 29];46(8):2368-400. Available from: https://doi.org/10.1161/STR.0000000000000070 https://www.ahajournals.org/doi/epub/10.1161/STR.0000000000000070
Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC, Brott T, et al. Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms. Stroke [Internet]. 1 de noviembre de 2000 [cited 2022 Jul 29];31(11):2742-50. Available from: https://www.ahajournals.org/doi/epub/10.1161/01.STR.31.11.2742 https://doi.org/10.1161/01.STR.32.3.815
Guglielmi G, Viñuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg [Internet]. 1992 [cited 2022 Jul 29];77(4):515-24. Available from: https://doi.org/10.3171/jns.1992.77.4.0515
Brinjikji W, Rabinstein AA, Nasr DM, Lanzino G, Kallmes DF, Cloft HJ. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. AJNR Am J Neuroradiol [Internet]. 2011 Jun-Jul [cited 2022 Jul 29];32(6):1071-5. Available from: http://www.ajnr.org/content/ajnr/32/6/1071.full.pdf https://doi.org/10.3174/ajnr.A2453
Yang H, Jiang H, Ni W, Leng B, Bin X, Chen G, et al. Treatment Strategy for Unruptured Intracranial Aneurysm in Elderly Patients: Coiling, Clipping, or Conservative?. Cell Transplant [Internet]. 2019 Jun [cited 2022 Jul 29];28(6):767-74. Available from: https://doi.org/10.1177/0963689718823517 https://journals.sagepub.com/doi/epub/10.1177/0963689718823517
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.
