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Comentario al trabajo: La cirugía de los aneurismas grado 0. Análisis de 22 casos de E. Spagnoulo Dondero y cols
,A CIRUG¤A DE LOS ANEURISMAS GRADO !NÖLISIS DE CASOS
#URRENT MANAGEMENT OF CEREBRAL ANEURYSMS %D ) !WAD !!.3 CHAP PP ,ONGSTRETH 74 .ELSON , - +OEPSELL 4 $ 6AN "ELLE ' #IGARETTE SMOKING ALCOHOL USE AND 3!( 3TROKE -IZOI + 9OSHIMOTO 4 .AGAMINE 9 (OW TO TREAT INCIDENTAL CEREBRAL ANEURYSMS A REVIEW OF CONSECUTIVE CASES 3URG .EUROL -OYES 0 3URGICAL TREATMENT OF MULTIPLE ANEURYSMS AND OF INCIDENTALLY DISCOVERED UNRUPTERED ANEURYSMS * .EU ROSURG .AKAGAWA 4 (ASHI + 4HE INCIDENAE AND TREATMENT OF ASYMPTOMATIC UNRUPTURED CEREBRAL ANEURYSMS * .EURO SURG /JEMANN 2' -ANAGEMENT OF THE RUPTURED INTRACRA NIAL ANEURYSM . %NGL * -ED /KAWARA 3 7ARNING SIGNS PRIOR TO RUPTURE OF AN INTRA CRANIAL ANEURYSM * .EUROSURG 2AAYMAKERS 47 2INKEL ' ,IMBURG - -ORTA LITY AND MORBIDITY OF SURGERY FOR UNRUPTURED INTRACRANIAL ANEU RYSMS ! META ANALYSIS 3TROKE 2INKEL ' $JIBUTI - 6AN 'IJN * 0REVALENCE AND RISK OF UNRUPTURED INTRACRANIAL ANEURYSMS 3TROKE 2ONKAINEN ! -IETTINEN ( +ARKOLA + 2ISK OF HAR BORING AN UNRUPTURED INTRACRANIAL ANEURYSM 3TROKE 2OSENORN * %SKESEN 6 3CHMIDT + 5NRUPTURED INTRACRANIAL ANEURYSMS AN ASSESSMENT OF THE ANNUAL RISK OF RUPTURE BASED ON EPIDEMIOLOGICAL AND CLINICAL DATA "R * .EU ROSURG 3ALAZAR *, 3URGICAL TREATMENT OF ASYMPTOMATIC AND INCIDENTAL INTRACRANIAL ANEURYSMS * .EUROSURG 3AMSON $ (ODOSH 2 #LARK + 3URGICAL MANAGE MENT OF UNRUPTURED ASYMPTOMATIC ANEURYSMS * .EUROSURG
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3OLOMON 2 #ORRELL * 2UPTURED OF A PREVIOUSLY DOCUMENTED ASYMPTOMATIC ANEURYSM ENHANCES THE ARGUMENT FOR PROPHYLACTIC SURGICAL INTERVENTION 3URG .EUROL 3OLOMON 2 &INK - 0ILE 3PELLMAN * 3URGICAL MANAGEMENT OF UNRUPTURED INTRACRANIAL ANEURYSMS * .EURO SURG 4SUTSUMI + 5EKI + 5SUI - 2ISK OF SUBARACH NOID HEMORRHAGE AFTER SURGICAL TREATMENT OF UNRUPTURED CERE BRAL ANEURYSMS 3TROKE 5JIIE ( 4AMANO 9 3ASAKI + (ORI 4 )S THE ASPECT RATIO A RELIABLE INDEX FOR PREDICTING THE RUPTURE OF A SACCULAR ANEURYSM .EUROSURGERY 7IEBERS $ 4ORNER * -EISSNER ) )MPACT OF 5NUP TURED INTRACRANIAL ANEURYSMS ON PUBLIC HEALTH IN THE 5NITED 3TATES 3TROKE 7IEBERS $ 5NRUPTURED INTRACRANIAL ANEURYSMS RISK OF RUPTURE AND RISKS O F SURGICAL INTERVENTION )NTERNATIONAL STUDY OF UNRUPTURED INTRACRANIAL ANEURYSMS INVESTIGATORS . %NG * -ED 7IRTH & ,AWS % 0IEPGRAS $ 3COTT - 3URGICAL TREATMENT OF INCIDENTAL INTRACRANIAL ANEURYSMS .EUROSURGERY 9ASUI . -AGARISAWA 3 3USUKI ! 3UBARACHNOID HEMORRHAGE CAUSED BY PREVIOUSLY DIAGNOSED PREVIOUSLY UNRUP TURED INTRACRANIAL ANEURYSMS A RETROSPECTIVE ANALYSIS OF CASES .EUROSURGERY 9ASUI . 3USUKI ! .ISHIMURA ( ,ONG TERM FOLLOW UP STUDY OF UNRUPTURED INTRACRANIAL ANEURYSMS .EUROSURGERY
3PAGNUOLO $ONDERO % #ALVO 2UBAL ! 0EREDA #ASAS 0 4ARIGO -ORADOR ! ,A CIRUG¤A DE LOS ANEURISMAS GRADO !NÖLISIS DE CASOS .EUROCIRUG¤A #ORRESPONDENCIA POSTAL $R %DGARDO 3PAGNUOLO $ONDERO 3ERVI CIO DE .EUROLOG¤A Y .EUROCIRUG¤A (OSPITAL -ACIEL -INISTERIO DE 3ALUD 0¢BLICA -ONTEVIDEO 5RUGUAY
#OMENTARIO AL TRABAJO ,A CIRUG¤A DE LOS ANEURISMAS GRADO !NÖLISIS DE CASOS DE % 3PAGNOULO $ONDERO Y COLS %L TRABAJO DE LOS $RS 3PAGNUOLO #ALVO 0EREDA Y 4ARIGO PRESENTA SU EXPERIENCIA EN ANEURISMAS INCIDENTALES NO ROTOS EN PACIENTES TODOS LOS CUALES FUERON INTERVENIDOS CON EXCELENTES RESULTADOS .O OBSTANTE LAS CONCLUSIONES QUE LOS AUTORES EXPONEN NO DEBEN CONSIDERARSE COMO EXTRA¤DAS DEL TRABAJO SINO COMO OPINIONES DE LOS MISMOS .O ESTÖ PROBADO QUE SEA MEJOR EL TRATAMIENTO QUE LA ABSTENCIN EN TODOS LOS
ANEURISMAS NO ROTOS 4AMPOCO QUE DEBAN TRATARSE MEJOR CON CIRUG¤A LOS DE TOPOGRAF¤A HABITUAL Y CON OCLUSIN ENDOVASCULAR LOS DE TOPOGRAF¤A POCO HABITUAL %L TRATAMIENTO DE LOS ANEURISMAS NO ROTOS ES CONTROVER TIDO SOBRE TODO DESPU£S DE LA PUBLICACIN EN EN EL .EW %NGLAND *OURNAL OF -EDICINE DEL RESULTADO DEL %STU DIO )NTERNACIONAL AL QUE HAN REPLICADO ENTRE OTROS *UVELA Y
3PAGNUOLO Y COL
COL Y 4SUTSUMI Y COL #OMO RESUMEN DE TODA ESTA CONTRO VERSIA LOS TRABAJOS QUE OCUPAN LAS PRIMERAS PÖGINAS DEL PRIMER N¢MERO DE DEL *OURNAL OF .EUROSURGERY ESTÖN DEDICADOS A ESTE TEMA Y LA ¢NICA CONCLUSIN QUE PROBABLEMENTE COMPARTEN ES LA FALTA DE EVIDENCIA PARA SENTAR NINGUNA RECOMENDACIN Y LA NECESIDAD DE CONTINUAR EL %STUDIO )NTERNACIONAL 3IN EMBARGO A PESAR DE ESTAS CR¤TICAS DEBO FELICITAR A LOS AUTORES POR SUS RESULTADOS Y CREO QUE ES INTERESANTE Y ESTIMULANTE PARA LA COMUNIDAD NEUROQUIR¢RGICA CONOCER SU EXPERIENCIA "IBLIOGRAF¤A $UMONT !3 ,ANZINO ' Y +ASSEL) & 5NRUPTURED ANEURYSMS * .EUROSURG 4HE )NTERNACIONAL 3TUDY OF 5NRUPTURED )NTRACRANIAL !NEURYSMS )NVESTIGATORS 5NRUPTURED INTRACRANIAL ANEURYSMS RISK OF RUPTURE AND RISKS OF SURGICAL INTERVENTION . %NGL * -ED *UVELA 3 5NRUPTURED ANEURYSMS * .EUROSURG *UVELA 3 0ORRAS - Y 0OUSSA + .ATURAL HISTORY OF UNRUPTURED INTRACRANIAL ANEURYSMS PROBABILITY AND THE RISK FACTORS FOR ANEURYSMS RUPTURE * .EUROSURG
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*UVELA 3 0ORRAS - Y 0OUSSA + .ATURAL HISTORY OF UNRUPTURED INTRACRANIAL ANEURYSMS PROBABILITY AND THE RISK FACTORS FOR ANEURYSMS RUPTURE * .EUROSURG 0IEPGRAS $' 5NRUPTURED ANEURYSMS * .EUROSURG 2IINA ( Y 3PETZLER 2& 5NRUPTURED ANEURYSMS * .EUROSURG 4SUTSUMI + 5EKI + -ORITA ! Y COL 2ISK OF RUP TURE FROM INCIDENTAL CEREBRAL ANEURYSMS * .EURORURG 7EIR " 5NRUPTURED INTRACRANIA ANEURYSMS A REVIEW * .EUROSURG 7EIR " $ISNEY , Y +ARRISON 4 3IZES OF RUPTURED AND UNRUPTURED ANEURYSMS IN RELATION TO THEIR SITES AND AGES OF PATIENTS * .EUROSURG 7IEBERS $/ 0IEPGRAS $' "ROWN 2$ -EISSNER ) 4ORNER * +ASSELL & Y COL 5NRUPTURED ANEURYSMS * .EU ROSURG 7INN (2 3ECTION OVERVIEW UNRUPTURED ANEURYSMS * .EURORURG 7INN (2 *ANE *! 4AYLOR * +AISER $ Y "RITZ '7 0REVALENCE OF ASYMPTOMATIC INCIDENTAL ANEURYSMS REVIEW OF ARTERIOGRAMS * .EUROSURG
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#URRENT MANAGEMENT OF CEREBRAL ANEURYSMS %D ) !WAD !!.3 CHAP PP ,ONGSTRETH 74 .ELSON , - +OEPSELL 4 $ 6AN "ELLE ' #IGARETTE SMOKING ALCOHOL USE AND 3!( 3TROKE -IZOI + 9OSHIMOTO 4 .AGAMINE 9 (OW TO TREAT INCIDENTAL CEREBRAL ANEURYSMS A REVIEW OF CONSECUTIVE CASES 3URG .EUROL -OYES 0 3URGICAL TREATMENT OF MULTIPLE ANEURYSMS AND OF INCIDENTALLY DISCOVERED UNRUPTERED ANEURYSMS * .EU ROSURG .AKAGAWA 4 (ASHI + 4HE INCIDENAE AND TREATMENT OF ASYMPTOMATIC UNRUPTURED CEREBRAL ANEURYSMS * .EURO SURG /JEMANN 2' -ANAGEMENT OF THE RUPTURED INTRACRA NIAL ANEURYSM . %NGL * -ED /KAWARA 3 7ARNING SIGNS PRIOR TO RUPTURE OF AN INTRA CRANIAL ANEURYSM * .EUROSURG 2AAYMAKERS 47 2INKEL ' ,IMBURG - -ORTA LITY AND MORBIDITY OF SURGERY FOR UNRUPTURED INTRACRANIAL ANEU RYSMS ! META ANALYSIS 3TROKE 2INKEL ' $JIBUTI - 6AN 'IJN * 0REVALENCE AND RISK OF UNRUPTURED INTRACRANIAL ANEURYSMS 3TROKE 2ONKAINEN ! -IETTINEN ( +ARKOLA + 2ISK OF HAR BORING AN UNRUPTURED INTRACRANIAL ANEURYSM 3TROKE 2OSENORN * %SKESEN 6 3CHMIDT + 5NRUPTURED INTRACRANIAL ANEURYSMS AN ASSESSMENT OF THE ANNUAL RISK OF RUPTURE BASED ON EPIDEMIOLOGICAL AND CLINICAL DATA "R * .EU ROSURG 3ALAZAR *, 3URGICAL TREATMENT OF ASYMPTOMATIC AND INCIDENTAL INTRACRANIAL ANEURYSMS * .EUROSURG 3AMSON $ (ODOSH 2 #LARK + 3URGICAL MANAGE MENT OF UNRUPTURED ASYMPTOMATIC ANEURYSMS * .EUROSURG
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3OLOMON 2 #ORRELL * 2UPTURED OF A PREVIOUSLY DOCUMENTED ASYMPTOMATIC ANEURYSM ENHANCES THE ARGUMENT FOR PROPHYLACTIC SURGICAL INTERVENTION 3URG .EUROL 3OLOMON 2 &INK - 0ILE 3PELLMAN * 3URGICAL MANAGEMENT OF UNRUPTURED INTRACRANIAL ANEURYSMS * .EURO SURG 4SUTSUMI + 5EKI + 5SUI - 2ISK OF SUBARACH NOID HEMORRHAGE AFTER SURGICAL TREATMENT OF UNRUPTURED CERE BRAL ANEURYSMS 3TROKE 5JIIE ( 4AMANO 9 3ASAKI + (ORI 4 )S THE ASPECT RATIO A RELIABLE INDEX FOR PREDICTING THE RUPTURE OF A SACCULAR ANEURYSM .EUROSURGERY 7IEBERS $ 4ORNER * -EISSNER ) )MPACT OF 5NUP TURED INTRACRANIAL ANEURYSMS ON PUBLIC HEALTH IN THE 5NITED 3TATES 3TROKE 7IEBERS $ 5NRUPTURED INTRACRANIAL ANEURYSMS RISK OF RUPTURE AND RISKS O F SURGICAL INTERVENTION )NTERNATIONAL STUDY OF UNRUPTURED INTRACRANIAL ANEURYSMS INVESTIGATORS . %NG * -ED 7IRTH & ,AWS % 0IEPGRAS $ 3COTT - 3URGICAL TREATMENT OF INCIDENTAL INTRACRANIAL ANEURYSMS .EUROSURGERY 9ASUI . -AGARISAWA 3 3USUKI ! 3UBARACHNOID HEMORRHAGE CAUSED BY PREVIOUSLY DIAGNOSED PREVIOUSLY UNRUP TURED INTRACRANIAL ANEURYSMS A RETROSPECTIVE ANALYSIS OF CASES .EUROSURGERY 9ASUI . 3USUKI ! .ISHIMURA ( ,ONG TERM FOLLOW UP STUDY OF UNRUPTURED INTRACRANIAL ANEURYSMS .EUROSURGERY
3PAGNUOLO $ONDERO % #ALVO 2UBAL ! 0EREDA #ASAS 0 4ARIGO -ORADOR ! ,A CIRUG¤A DE LOS ANEURISMAS GRADO !NÖLISIS DE CASOS .EUROCIRUG¤A #ORRESPONDENCIA POSTAL $R %DGARDO 3PAGNUOLO $ONDERO 3ERVI CIO DE .EUROLOG¤A Y .EUROCIRUG¤A (OSPITAL -ACIEL -INISTERIO DE 3ALUD 0¢BLICA -ONTEVIDEO 5RUGUAY
#OMENTARIO AL TRABAJO ,A CIRUG¤A DE LOS ANEURISMAS GRADO !NÖLISIS DE CASOS DE % 3PAGNOULO $ONDERO Y COLS %L TRABAJO DE LOS $RS 3PAGNUOLO #ALVO 0EREDA Y 4ARIGO PRESENTA SU EXPERIENCIA EN ANEURISMAS INCIDENTALES NO ROTOS EN PACIENTES TODOS LOS CUALES FUERON INTERVENIDOS CON EXCELENTES RESULTADOS .O OBSTANTE LAS CONCLUSIONES QUE LOS AUTORES EXPONEN NO DEBEN CONSIDERARSE COMO EXTRA¤DAS DEL TRABAJO SINO COMO OPINIONES DE LOS MISMOS .O ESTÖ PROBADO QUE SEA MEJOR EL TRATAMIENTO QUE LA ABSTENCIN EN TODOS LOS
ANEURISMAS NO ROTOS 4AMPOCO QUE DEBAN TRATARSE MEJOR CON CIRUG¤A LOS DE TOPOGRAF¤A HABITUAL Y CON OCLUSIN ENDOVASCULAR LOS DE TOPOGRAF¤A POCO HABITUAL %L TRATAMIENTO DE LOS ANEURISMAS NO ROTOS ES CONTROVER TIDO SOBRE TODO DESPU£S DE LA PUBLICACIN EN EN EL .EW %NGLAND *OURNAL OF -EDICINE DEL RESULTADO DEL %STU DIO )NTERNACIONAL AL QUE HAN REPLICADO ENTRE OTROS *UVELA Y
3PAGNUOLO Y COL
COL Y 4SUTSUMI Y COL #OMO RESUMEN DE TODA ESTA CONTRO VERSIA LOS TRABAJOS QUE OCUPAN LAS PRIMERAS PÖGINAS DEL PRIMER N¢MERO DE DEL *OURNAL OF .EUROSURGERY ESTÖN DEDICADOS A ESTE TEMA Y LA ¢NICA CONCLUSIN QUE PROBABLEMENTE COMPARTEN ES LA FALTA DE EVIDENCIA PARA SENTAR NINGUNA RECOMENDACIN Y LA NECESIDAD DE CONTINUAR EL %STUDIO )NTERNACIONAL 3IN EMBARGO A PESAR DE ESTAS CR¤TICAS DEBO FELICITAR A LOS AUTORES POR SUS RESULTADOS Y CREO QUE ES INTERESANTE Y ESTIMULANTE PARA LA COMUNIDAD NEUROQUIR¢RGICA CONOCER SU EXPERIENCIA "IBLIOGRAF¤A $UMONT !3 ,ANZINO ' Y +ASSEL) & 5NRUPTURED ANEURYSMS * .EUROSURG 4HE )NTERNACIONAL 3TUDY OF 5NRUPTURED )NTRACRANIAL !NEURYSMS )NVESTIGATORS 5NRUPTURED INTRACRANIAL ANEURYSMS RISK OF RUPTURE AND RISKS OF SURGICAL INTERVENTION . %NGL * -ED *UVELA 3 5NRUPTURED ANEURYSMS * .EUROSURG *UVELA 3 0ORRAS - Y 0OUSSA + .ATURAL HISTORY OF UNRUPTURED INTRACRANIAL ANEURYSMS PROBABILITY AND THE RISK FACTORS FOR ANEURYSMS RUPTURE * .EUROSURG
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*UVELA 3 0ORRAS - Y 0OUSSA + .ATURAL HISTORY OF UNRUPTURED INTRACRANIAL ANEURYSMS PROBABILITY AND THE RISK FACTORS FOR ANEURYSMS RUPTURE * .EUROSURG 0IEPGRAS $' 5NRUPTURED ANEURYSMS * .EUROSURG 2IINA ( Y 3PETZLER 2& 5NRUPTURED ANEURYSMS * .EUROSURG 4SUTSUMI + 5EKI + -ORITA ! Y COL 2ISK OF RUP TURE FROM INCIDENTAL CEREBRAL ANEURYSMS * .EURORURG 7EIR " 5NRUPTURED INTRACRANIA ANEURYSMS A REVIEW * .EUROSURG 7EIR " $ISNEY , Y +ARRISON 4 3IZES OF RUPTURED AND UNRUPTURED ANEURYSMS IN RELATION TO THEIR SITES AND AGES OF PATIENTS * .EUROSURG 7IEBERS $/ 0IEPGRAS $' "ROWN 2$ -EISSNER ) 4ORNER * +ASSELL & Y COL 5NRUPTURED ANEURYSMS * .EU ROSURG 7INN (2 3ECTION OVERVIEW UNRUPTURED ANEURYSMS * .EURORURG 7INN (2 *ANE *! 4AYLOR * +AISER $ Y "RITZ '7 0REVALENCE OF ASYMPTOMATIC INCIDENTAL ANEURYSMS REVIEW OF ARTERIOGRAMS * .EUROSURG
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