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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is commonly used as an adjunct to resuscitation and bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It has also been performed for patients with neurogenic shock to support the central aortic pressure necessary for cerebral, coronary and spinal cord perfusion. Although volume replacement and vasopressors are the cornerstones of the management of neurogenic shock, we believe that a REBOA can be used as an adjunct in carefully selected cases to prevent prolonged hypotension and the risk of further anoxic spinal cord injury. This manuscript aims to propose a new damage control algorithmic approach to refractory neurogenic shock that includes the use of a REBOA in Zone 3. There are still unanswered questions on spinal cord perfusion and functional outcomes using a REBOA in Zone 3 in trauma patients with refractory neurogenic shock. However, we believe that its use in these case scenarios can be beneficial to the overall outcome of these patients.

Carotid artery trauma carries a high risk of neurological sequelae and death. Surgical management of these injuries has been controversial because it entails deciding between repair or ligation of the vessel, for which there is still no true consensus either way. This article proposes a new management strategy for carotid artery injuries based on the principles of damage control surgery which include endovascular and/or traditional open repair techniques. The decision to operate immediately or to perform further imaging studies will depend on the patient's hemodynamic status. An urgent surgical intervention is indicated if the patient presents with massive bleeding, an expanding neck hematoma or refractory hypovolemic shock. An altered mental status upon arrival is a potentially poor prognosis marker and should be taken into account in the therapeutic decision-making. We describe a step-by-step algorithmic approach to these injuries, including open and endovascular techniques. In addition, conservative non-operative management has also been included as a potentially viable strategy in selected patients, which avoids unnecessary surgery in many cases.

La craneosinostosis es el segundo tipo de malformaciones craneofaciales más frecuente, se caracteriza por el cierre prematuro de una o más suturas del cráneo. Resulta en un cambio en la morfología del cráneo que restringe el crecimiento y desarrollo normal del cerebro, con una posible afectación del desarrollo cognitivo del individuo. Puede ser clasificada según la etiología, la presencia de otras alteraciones sindrómicas asociadas y la cantidad de suturas afectadas. La craneosinostosis no sindrómica representa el 75% de los casos de esta patología, siendo frecuentemente la sutura sagital la más afectada. Su diagnóstico es predominantemente clínico y debe hacerse de forma temprana para poder dar un tratamiento oportuno que permita un desarrollo cerebral normal. El manejo de esta patología debe ser multidisciplinario. Se presenta una revisión actualizada no sistematizada sobre la epidemiología, clasificación, fisiopatología, abordaje diagnóstico y terapéutico de la craneosinostosis.