Hernández-Aldama MA , Flores-Bocanegra DI, Ramos-Pacheco VH, Graniel-Palafox LE, Guerrero-Avendaño G, Avendaño-Pradel R

Language: Spanish
References: 18
Page: 377-388
PDF size: 871.49 Kb.

ABSTRACT

The subarachnoid space, located between the pia mater and the arachnoid membrane, is divided by trabeculae which in turn form cisterns, containing vascular and nervous structures; when they are damaged, as in the case of an aneurysmatic rupture, the hematic content is distributed in the cisterns peripheral to the affected arterial territory. The study of such cisterns was first described in 1875 by Key and Retzius, and one hundred years later was adapted and confirmed in microsurgery by Yasargil.
Objective: Prove that anatomical knowledge of the circle of Willis and basal cisterns, associated with an emergency single-phase computed tomography, helps to identify the probable site of lesion.
Material and methods: Twenty-eight clinical and radiological files of patients with subarachnoid hemorrhage who underwent single-phase tomography and then digital subtraction pan-angiography to identify the site of lesion (in the period from March 2013 through May 2015) were examined. Three patients in whom the site of lesion could not be defined were excluded.
Results: Fischer grade 2 hemorrhage was found in 5 cases, and grades 3 and 4 in 10 patients. The most extensively affected basal cisterns were the Sylvian cisterns, which suggests that the affected vascular territory was in the terminal segments of the internal carotid artery. Other anatomical sites corresponding to the anterior cerebral artery affected the straight gyrus recto and the adjacent interhemispheric subarachnoid space. The affected perimesencephalic cisterns corresponded to the posterior circulation. This localization was achieved by digital subtraction angiography.
Discussion: In subarachnoid hemorrhage it is important to know the system of cisterns and their communication because it helps to identify the affected vascular region, in an emergency single-phase tomography, to ensure correct evaluation and appropriate treatment.

REFERENCES

1. Yasargil MG. Microsurical. ED. 1. New York. Thieme Stratton Inc. Vol 1. 1984. Pág. 25-53

2. Roldan EV, Osorio SP. Facha MT. Anatomía Radiológica del Espacio Subaracnoideo. Las cisternas. Revisión. Anales de Radiología México 2005.

3. Care of the Patient whit Aneurismal Subarachnoid Hemorrage. Aann. Clinical Practice Guideline Series. 2007-2009.

4. Rocca U, Rosell A, Dávila A et al. Aneurismas Cerebrales. Revista De Neuropsiquiatría de Perú Tomo 64 Nº 4 Diciembre 2001.

5. Pereira C. Tomografía Axial Computada. XIII Seminario de Ingeniería Biomédica 2004. Universidad de la República Oriental de Uruguay.

6. Jung SW, Young CH, Tim MB et al. The Relationship Between Subarachnoid Hemorrhage Volumen And Development Of Cerebral Vasospasm. Journal of Cerebrovascuar y Endovascular Neurosurgery 2012;14(3):186-191.

7. Willinsky RA, Taylor SM, Terbrugge K et al. Neurologic Complications of Cerebral Angiography: Prospective Analysis of 2,899 Procedures and Review of the Literature. Radiology 2003;227:522-528.

8. Osborn AG. Neurorradiologia Diagnostica. ED. 2. Estados Unidos de América. Mosby. 1993 pp. 248-268.

9. Chappell Et, Moure Fc, Bueno Mc. Comparación De La Angiografía Por Tomografía Computarizada Con La Angiografía Por Sustracción Digital En El Diagnóstico De Los Aneurismas Cerebrales: Un Meta-Análisis. Neurocirugía, 52 (2003), pp. 624-631 [Discusión 630-31]

10. Philip M. White, Frcr, y Cols. Can Noninvasive Imaging Accurately Depict Intracranial Aneurysms? A Systematic Review. Radiology, November 2000 Volume 217, Issue 2. 217(2000), pp. 361-370

11. Martínez F., Spagnuolo E. Calvo A. Aneurismas del sector distal de la arteria cerebral anterior (Arteria pericallosa. Neurocirugía V.16 N.4 Murcia Ago. 2005

12. Galzio Rj, Di Cola F, Raysi Dehcordi S y Cols. Endoscope- Assisted Microneurosurgery For Intracranial Aneurysms. Front Neurol. 2013 Dec 18;4:201. Dol: 10.3389/Fneur.2013.00201. Ecollection 2013.

13. Lagares, Gómez P.A., J.F. Alén; F. Hemorragia Subaracnoidea Aneurismática: Guía de Tratamiento del Grupo de Patología Vascular de la sociedad Española de Neurocirugía. Neurocirugía Vol.22 No.2 Murcia Abr. 2011.

14. Guía de introducción a los aneurismas cerebrales y su tratamiento. South Boston, Massachusetts.2006 The Brain Aneurysm Foundation.

15. González-Pérez Mª.I. Resultado del Tratamiento de la Hemorragia Subaracnoidea debida a Rotura de Aneurismas Cerebrales. Neurocirugía V.17 N.5 Murcia Oct. 2006.

16. Grille P, Gallo J., Panzardo H. Hemorragia Subaracnoidea en la Unidad de Cuidados Intensivos: Análisis de 97 Casos Clínicos. Rev Med Uruguay 2001;17:114-118.

17. Birgitta K. Maarten S. Van Leeuwen, y Cols. Surgical Anatomy of the Cerebral Arteries in Patients with Subarachnoid Hemorrhage: Comparison of Computerized Tomography Angiography and Digital Subtraction Angiography. Journal of Neurosurgery. August 2001 / Vol. 95 / No. 2 / Pages 206-212

18. MV Jayaraman, WW Mayo-Smith. Multi-Detector CT Angiography of the Intra-Cranial Circulation: Normal Anatomy and Pathology with Angiographic Correlation. Clin Radiol 59 (2004), pp. 690–698.