Objective: To determine the validity, sensitivity and specificity of multislice spiral CT angiography (ATEM) with a 16-Multislice CT scanner detector lines in the diagnosis of cerebral aneurysms and their most frequent localizations. 

Patients and Methods: We selected 51 patients with nontraumatic subarachnoid hemorrhage due to suspected intracranial aneurysm who underwent surgery in the Hospital Daniel A. Carrión, Callao, for the period May 2004 to November 2007. 

Results: The sensitivity of the ATEM for the detection of intracranial aneurysms in this study was 100%. The resulting specificity was 50%. The positive predictive value (PPV) of ATEM for the diagnosis of cerebral aneurysms was 98%, with 87.8% accuracy of the method for determining the location of the aneurysm and 12.2% of uncertainty in the determination of the location of this anomaly. The average size of the aneurysm at surgery was 11.33 + / - 6.9 mm. While the average size of the aneurysm by ATEM was 8.60 + / - 5.75 mm. The difference between the means of these measurements was significant (p = 0.027). 70.3% of aneurysms in this study were found in posterior communicating segment of both internal carotid and middle cerebral arteries both. 

Conclusion: CT angiography is an excellent noninvasive test for the detection of intracranial aneurysms and to determine its location.                                                            

      Key words: Intracranial aneurysm, CT Angio (ATEM), aneurysm surgery

We present the case of a 32 year old patient with spinal cord compression syndrome of 10 months of evolution. Magnetic resonance imaging showed signal voids causing myelopathy that spinal angiography showed to be a type IVb spinal arteriovenous malformation (perimedular arteriovenous fistula type II) supplemented by a posterior spinal artery that originated next to the Adamkiewicz artery from the segmental artery T11 left. The fistula was successfully eradicated by transarterial embolization with cyanoacrylate and the patient experienced progressive improvement. The relevant literature is reviewed. The endovascular approach is the treatment of choice in spinal arteriovenous malformations types IVb and IVc.

Objective: Traumatic brain injury (TBI) is the leading cause of morbidity and mortality mainly in young people, and also one of the most common neurosurgical diseases in daily practice. The surgical management is a fundamental part of TBI. The aim of this study is to present the results in 76 patients operated on at Almenara Hospital in 2008 and 2009.
Patients and Methods: We conducted a descriptive study of patients undergoing BTI during 2008 and 2009. We reviewed the medical records and operative reports, and pooled data on sex, age, disease duration, degree of BTI, location, type of medical management and use of ICP, type of surgery, hospital stay, GOS and Glasgow discharge, complications and mortality.
Results: 76 patients were operated of which 76% were male and 24% female. The most affected age group was 20-29 years (18.4%) followed by the under-10 years (15.8%). Patients admitted to hospital more frequently (38.3%) among 13-24, with moderate TBI most common grade (63.3%). Regarding treatment, the hypertonic solution was the most used in the ICP management, using intracranial pressure monitoring in 15.8% of cases. The patients were operated on by craniotomy (78.9%) and decompressive craniectomy (21.1%). The average Glasgow Coma Scale at admission increased from 10.9 to 14 at discharge, being higher in the EH and lower in contusion. The most common discharge GOS was V (36.8%) and IV (35.6%). The most common complication was pneumonia (27.6%) and overall mortality rate was 11.8% being higher (21%) in the ASDH.
Conclusions: The BTI treatment has evolved in recent years, the use of hypertonic solutions and intracranial pressure monitoring are essential in the medical management of moderate and severe TBI, the classic craniotomy is the cornerstone of surgical management but decompressive craniectomy being increasingly especially common in cerebral contusion. Medical and surgical optimal treatment are essential to achieving shorter hospital stay, good Glasgow scale and GOS, reduce complications and mortality rate.

The reduction of intracranial pressure (ICP) is a cornerstone in the management of patients with severe head injury, ICP monitoring remains very important as it helps to optimize treatment and improve prognosis. Decompressive craniectomy (DC) has proved to be an effective method in reducing intracranial pressure when other treatments have failed. ICP monitoring studies in the pre and post operative show that this reduction is immediate and sustained within 48 hours. However, little is known about the variation of the ICP during the performance of decompressive craniectomy and the contribution of each of its stages, as the removal of bone, dural opening and duraplasty in the final result. We report the case of a patient with severe TBI who underwent intracranial pressure monitoring during the performance of decompressive craniectomy in the Guillermo Almenara Hospital in 2009.
 

Objective: Traumatic intracranial hypertension is the major pathophysiological issue of traumatic brain injury and its treatment usually demands general and specific measures; nevertheless decompressive craniectomy is an extreme resource available for refractory cases, current data are not enough to define its indications and long term results.
Patients and Methods: This study evaluates a cohort of 32 patients with refractory traumatic intracranial hypertension submitted to decompressive craniectomy as a randomized method of treatment between 2004 and 2008.
Results: The most remarkable characteristics of the procedure were: execution period < 72 hours, wide and extensive bone platelet, and complete specific surgical technique (craniectomy + durotomy / duroplasty ± resection/evacuation); whereas the most relevant results demonstrated: reduction of the ICP value in a great proportion of patients, short period of time until normalization of the ICP and lower hospitalization period at the Neurosurgical ICU, with an index of complications close to 34% (mainly early) and rate of mortality about 18% (mainly neurological). Functional prognosis was favorable at discharge in 25% and at 6 months in 54%, with a quality of life defined as independent or low dependency.
Conclusion: Although traumatic intracranial hypertension has a heterogeneous course, descompressive craniectomy is a useful option for its control and a better outcome of the traumatic brain injury in the long term.

Among the symptoms that most affect the man, for sure the pain is more frequent, and by far the most important. It jeopardizes the quality of life the daily activities and hence their productivity. The disc protrusion, is among the diseases that have this symptom, as the main complication. So it is to bring medical relief to the patient. You should immediately try a treatment, and when you do not get resolution with this conduct, it is for surgery.
Objective: It is exactly these patients with surgical indication, to demonstrate a broad casuist (2000 cases), the advantages of spinal anesthesia when anesthetic induction in compitum general, with regard the outcome. So that we can bring a greater contribution to those who
suffer this nosology.
Patients and Methods: In our series, the study included patients who had surgical treatment, with clinical diagnosis and through examination of images of disc herniation, and who agreed to participate in the study, which excluded only those who did not wish to participate in the study. The follow-up
from each patient and compared with data available in the literature so that we could see the gravy of our work.
Results: showed to be extremely favorable with regard to postoperative pain, a good development (99.72% of cases), only two patients had fistulas (0.11%), two cases had infection (0.11% ) and one had to go for general surgery in Trendelenburg position, inappropriate (0.06%).
Conclusion: Therefore it is concluded that this is an aspect that should be exploited by those who take care of this condition, the major advantages of this measure.