Objective: To evaluate the impact on the outcome of patients with a ruptured aneurysm, who are admitted to the Dos de Mayo National Hospital in the context of the COVID-19 pandemic. Methods: 42 operated for ruptured aneurysms were included in the context of the COVID-19 pandemic between March 1 and December 31, 2020 (group A), and a control group of 44 patients operated on between March 1 and December 31, 2019 (group B). Upon admission, the poor neurological status defined by the WFNS> 3, the Fisher IV high-grade tomographic status with intracerebral hematoma or acute hydrocephalus, which required external ventricular drainage (EVD), and the presence of vasospasm were evaluated. The Modified Rankin Scale was evaluated at discharge. Statistical analysis was performed to compare both groups. Results: The rates of poor neurological presentation and complications during the presurgical evolution (intracerebral hemorrhage and acute hydrocephalus that required EVD) were higher in group A (p = 0.002 and p <0.05, respectively). The delay in the admission of the patient to the emergency room to receive treatment was 7.5 days in group A and 4.95 days for group B. All these factors contributed to a lower possibility of recovery in group A, which was correlated with higher Values on the Modified Rankin Scale at discharge for this group (p = 0.04). Conclusion: We did not find national reports on ruptured aneurysms treated in the context of the pandemic, this being one of the first studies that demonstrate the impact of the COVID-19 pandemic in patients with ruptured intracranial aneurysm. The population should be educated on how to act in case of specific symptoms such as sudden intense headache, neurological deficit, or acute chest pain, which should receive timely care, immediate referral, and priority of treatment in referral hospitals in order to reduce morbidity and mortality of complex neurological pathologies. Keywords: Intracranial Aneurysm, Aneurysm, Ruptured, Cerebral Hemorrhage, Pandemics, COVID-19. (Source: MeSH NLM)
Introduction: Fluorescein sodium (FNa) is a fluorescent substance used to evaluate cerebral blood flow. We present our first cases of vascular microsurgery using microscope-integrated intraoperative fluorescein video angiography. We review the practical applications and benefits of this technique in vascular microsurgery. Clinical cases: A 63-year-old woman, Glasgow: 9 on admission, with subarachnoid hemorrhage (SAH) Fisher IV. A ruptured anterior communicating aneurysm was diagnosed. After stabilization in the ICU, she underwent surgery, undergoing microsurgical clipping guided by intraoperative videoangiography. The postoperative evolution was favorable. A 33-year-old man with a history of epilepsy on carbamazepine treatment. After suspension and irregular treatment 2 years ago, seizures reappear. An angiography and magnetic resonance imaging were performed, and he was diagnosed with a left posterior temporal arteriovenous malformation (AVM) close to Wernicke's area, for which he underwent surgery using tractography and videoangiography in real-time integrated into Neuronavigation. In both cases, the benefits of using the integrated microscope were observed thanks to the vascular anatomical assessment in real-time with fluorescein. Conclusion: Videoangiography with FNa allows examining afferent and efferent vessels during surgery for arteriovenous malformations, checking the persistence of flow in a microvascular anastomosis, and evaluating flow during clipping of an aneurysm. It has the advantages of being able to be repeated during surgery, allowing surrounding anatomical visualization, as well as allowing any surgical correction in real-time. Keywords: Fluorescein Angiography, Microsurgery, Aneurism, Arteriovenous Malformations (Source: MeSH NLM)
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