Treatment of unruptured intracranial aneurysms based on critical size and predictive risk factors is generally accepted, but several factors contribute to the clinical outcome in a patient with subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm. We decided to evaluate other parameters that might contribute to the clinical outcome of patients with a ruptured posterior communicating artery aneurysm. A retrospective review of the medical records of patients diagnosed and/or treated of cerebral aneurysms at our institution was carried out. We selected patients with Pcom aneurysms that presented with SAH and reviewed conventional and tridimensional angiographic images to determine its anatomical orientation and correlated the data with amount of SAH and clinical presentation and outcome. A total of 112 Pcom aneurysms presented with SAH and were included in this study. 92 patients were women and 20 were men, with a mean age of 57 years (range 25–81). According to anatomical orientation, 43 were inferolateral, 30 lateral, 13 superolateral, three inferomedial, two in medial location, two superomedial, 11 inferoposterior, five posterior and three superoposterior. Aneurysms in superolateral location are to be watched carefully, it is likely that this location joins several conditions for these aneurysms to grow faster or have a higher hemodynamic stress which makes them more at risk of rupture and contribute to a worse clinical outcome.

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Introducción: la presión intracraneal depende del equilibrio de tres componentes, el parénquima cerebral, el líquido cefalorraquídeo y la sangre, la elevación de la misma por causa traumática genera una descompensación, que suele estar asociada con un aumento en la mortalidad y mal pronóstico neurológicoObjetivo: describir las principales consideraciones necesarias en el uso de la craniectomía descompresiva ante la hipertensión intracraneal en el trauma craneoencefálico grave. Métodos: se realizó una revisión bibliográfica, se seleccionaron estudios acerca de la fisiopatología de la hipertensión intracraneal y características de la craniectomía descompresiva. Para la búsqueda se usaron los motores: presión intracraneal, craniectomía descompresiva, traumatismo craneoencefálico, injuria cerebral; en las fuentes: Google Scholar, PubMed, Scielo y Dialnet. Así, se seleccionaron 25 artículos y una tesis de maestría. Más del 60 % de la bibliografía es de los últimos 5 años. Desarrollo: el uso de la craniectomía descompresiva está regido por las recomendaciones de la Brain Trauma Foundation, que en 2020 no sugiere realizar la misma secundaria para elevación refractaria temprana de la presión intracraneal, en aras de mejorar la mortalidad y los resultados favorables. La evidencia sobre el uso de la misma está sustentada en dos principales estudios nivel I de evidencia científica: DECRA y RESCUEicp, con resultados contradictorios. Conclusiones: el empleo de la craniectomía descompresiva es un tema con resultados y perspectivas variables, los principales estudios refutan su uso basado en los defectos a largo plazo que genera en los pacientes, aunque en Cuba posee resultados alentadores.

Introduction: Brain abscess is a focal infection of the brain parenchyma, in which different treatment methods are used, most authors agree that conservative methods with antibiotic therapy are effective in the cerebritis phase, while in the encapsulated phases the Minimally invasive surgery is the best option. Objective: To describe the clinical, imaging and surgical characteristics in patients with multiple brain abscesses. Case Report: Male, white, 20-year-old, right-handed patient, with a history of molar infection 3 months prior, comes to the emergency department of our hospital due to intense headache and tonic-clonic seizures. widespread. Tomography and cranial resonance studies were performed, which demonstrated the presence of multiple brain abscesses that were successfully treated using an occipital approach with endoscopic support and trans-surgical ultrasonographic guidance. Discussion: In the international literature consulted, the largest number of patients with brain abscesses are treated by conservative measures, in cases in late encapsulation phases where drugs do not penetrate the capsule, surgical alternatives are the most recommended, which depend on size, location, proximity to the ventricular system and number of lesions. Conclusion: Brain abscess is a neurosurgical entity, in which surgery by minimally invasive methods associated with exact localization techniques and antibiotic therapy is the most effective treatment alternative.