The increase in intrathoracic pressure was immediately transmitted to the brain by the rise of cerebrospinal fluid, while brain swelling attributable to vascular congestion showed a brief delay. The Valsalva manoeuvre and coughing caused abrupt morphological changes in the tentorial hiatus neighbouring structures because of the distension of the basal cisterns. These movements could play a role in the pathophysiology of the syndrome of trephined.

No abstract

La punción ventricular transorbitaria (PTO) es una técnica rápida y sencilla aunque poco conocida. Como puede realizarse en la cama del enfermo, resulta ideal en pacientes con hidrocefalia aguda rápidamente evolutiva o con enclavamiento transtentorial inminente o reciente, en quienes el acceso expeditivo a las cavidades ventriculares puede salvarles la vida. Revisamos aquí el desarrollo histórico de la técnica desde su descripción original en 1933. Por último presentamos el caso de una paciente con hidrocefalia aguda secundaria a edema cerebeloso, en quien el empleo de la PTO dio tiempo para implementar el tratamiento definitivo. La técnica utilizada por nosotros consistió en un ingreso transpalpebral, por detrás del reborde orbitario superior y a nivel mediopupilar, con una trayectoria dirigida hacia la sutura sagital, dos a tres traveses de dedo por detrás de la sutura coronal.

No abstract

The authors found that aneurysm rebleeding after subarachnoid hemorrhage (SAH) has specific characteristics in the preoperative, intraoperative, and postoperative periods, involving aneurysm size, heart disease, aneurysm location, family history, clipping, coiling, etc. According to Horie and colleagues, their study is the first to assess the characteristics and predictors of aneurysmal SAH rebleeding in the preoperative, intraoperative, and postoperative periods. We would like to express our respect for their achievements and to share some comments with the authors.Firstly, and most importantly, the data were collected from 1 university hospital and 10 affiliated hospitals. The authors did not consider the role of these medical institutions in their analysis. Depending on the different medical levels of doctors in these hospitals, different degrees of surgical instruments and equipment, and different management methods after operation, these factors could affect the probability of aneurysm rupture during and after surgery. Therefore, it is difficult to control bias in data collected from 11 hospitals.Secondly, their article does not provide inclusion criteria for the study subjects but simply describes exclusion criteria. It only rules out subjects younger than 18 years of age and nonaneurysmal SAH including dissection. However, patients with intracranial hemorrhage and on the verge of death, patients with vital organ diseases, and older patients (> 75 years of age) should also be excluded because the rate of postoperative mortality and disability is probably high in these patients, and it is difficult for surgical intervention to improve the survival rate.Thirdly, the evaluation of aneurysm rebleeding after operation was defined as new SAH on postoperative CT scans. We think there are some flaws in this definition because postoperative hemorrhage on CT can have false-negative results and will affect the clinical outcome of different aneurysm surgeries (clipping vs endovascular coiling) in terms of postoperative rebleeding.