The dysplastic giant aneurysm with wide neck is a difficult complex aneurysm surgery, the use of endovascular therapy in this pathology is promising and waffle cone technique is very useful in those in wich when we use a Stent and it is impossible to exceed the distal end of the aneurysm neck. A woman patient of 73y,  housewife with disease duration of 5 days, headache associated with neck stiffness and cranial nerve VI paresis of the left was studied. The brain CT showed subarachnoid hemorrhage in the left sylvian valley and an image suggestive of a giant aneurysm of left carotid siphon. The angiographic study concluded giant-ophthalmic aneurysm ruptured left and right paraoftálmic large aneurysm not broken.

The treatment of choice for aneurismal disease is still under discussion, but in the case of giant aneurysm endovascular techniques may achieve optimal results without major complications, endovascular technique waffle cone through the use of Stents is very useful and should extend its use in those dysplastic giant aneurysm with wide neck do not allow the stent to achieve beyond the distal aneurismal neck and both nest in the pouch is able to embed a Neuroform Stent-in the neck of the aneurysm to proceed to use coils of different dimensions to completely embolize the aneurysm. The disadvantages of this technique are the potential for drilling and higher rate of recanalization caused by changes in arterial blood flow. Waffle cone technique is particularly useful in those dysplastic giant aneurysms with wide neck in wich the structure of the aneurysm does not allow the location of the stent at the distal end of its neck.

Subarachnoid hemorrhage (SAH) is defined as the presence of blood in the subarachnoid space and cisterns of the base. The source is variable and may be due to rupture of intracranial aneurysms (80%), arteriovenous malformations (AVMs), tumors and trauma cranoencefálicos. The HSA is a relatively common disease with an incidence is 5% of cerebral vascular disease. The estimated prevalence of 10 new cases per 100,000 people each year. The proportion of HSA varies with age, being the most prevalent group between 50 and 60. It is a pathology with high morbidity and mortality, since a high percentage of patients (10-15%) did not reach the hospital and the remaining group of about 15% die. Angiography is the standard diagnostic procedure, although angiography is an important alternative. Treatment should be administered as soon as possible within 72 hours, both surgical and endovascular techniques to prevent complications such as rebleeding, vasospasm and hydrocephalus, being the most widely used surgical approach is the pterional craniotomy. The prognosis depends on careful handling and the degree of the initial hemorrhage.

          Key words:  Subarachnoid hemorrhage, Intracraneal aneurysm, Craniotomy.

Objective: To determine the clinical outcome in patients undergoing dynamic stabilization in the neurosurgery spine service at HNERM during the period January 2012 to October 2013.
Methods: 25 patients with unstable spine that met the inclusion criteria for the placement of dynamic spine stabilization were selected.
Results: The average age of patients 46.4 years, minimum 6 and maximum 78 years. Sex: Male 16 (64%) Female 09 (36%) total 25 (100%). No previous lumbar 23 (92%), discectomy 02 (08%): prior lumbar surgery Sick time (months) 25.8 average, minimum 3 and maximum 72. Surgical approach Wiltse Total 15 (60%), medial approach 9 (36%) type, Hoober 1 (4%) 25 Instrumentation levels; 2 level 4 (16%), three levels 21 (84%). Days in hospital: average 3.72 min 3 max 5. Preoperative clinical features: EVA average 7.92 min 6 max 10 mod 8. Pain intensity mod 13 (52%), severe12 (48%). Postoperative clinical features: EVA average 4.16 min 3 max 8 fashion: 3. Pain intensity: mild 19 (76%), moderate 05 (20%) and severe 04 (14%).
Conclusions: Dynamic stabilization has demonstrated efficacy in pain control with a minimum length of hospitalization.