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        "titulo" => "Resumen"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Durante 6 a&#241;os &#40;1983&#8211;1989&#41;&#44; se operaron 166 aneurismas intracraneales en la Ciudad Sanitaria de Vall d&#8217;Hebr&#243;n&#44; de los que 117 se abordaron directamente &#40;CD&#41; y en 49 se clip&#243; el saco aneurism&#225;tico despu&#233;s de mantener clipadas trasitoriamente&#44; durante la disecci&#243;n&#44; las arterias aferentes y a veces tambi&#233;n las eferentes al aneurisma &#40;CT&#41;&#46; Las edades&#44; sexo y clinica de ambos grupos fueron similares&#46; La tomograf&#237;a computarizada &#40;TC&#41;&#44; fue normal o exist&#237;a sangre en las cisternas de la base&#44; en la mayor&#237;a de los casos&#46; Los aneurismas CD se localizaban de preferencia en las regiones de las arterias&#58; comunicante anterior 41&#37;&#44; posterior 16&#44;2&#37; y cerebral media 13&#44;7&#37;&#46; En los CT los aneurismas se situaban preferentemente en la regi&#243;n de la arteria comunicante anterior 40&#44;8&#37; y cerebral media 38&#44;8&#37;&#46; Durante el CT el enfermo fue mantenido con hipertensi&#243;n arterial&#44; hiperventilaci&#243;n con O<span class="elsevierStyleInf">2</span> al 100&#37; y barbit&#250;ricos a altas dosis&#46; Los resultados inmediatos&#44; a los 7 d&#237;as de operados&#44; fueron muy similares&#46; Tuvieron una buena recuperaci&#243;n el 56&#44;4&#37; de los CD y el 40&#44;8&#37; de los CT&#44; persisti&#243; el d&#233;ficit previo en 11&#44;1&#37; de los CD y en el 10&#44;2&#37; de los CT&#46; Aument&#243; el d&#233;ficit en el 0&#44;9&#37; de los CD y en el 4&#44;1&#37; de los CT&#46; Apareci&#243; alg&#250;n d&#233;ficit neurol&#243;gico en el 21&#44;4&#37; del CD y en el 32&#44;7&#37; en el CT&#46; Hubo deterioro grave en el 4&#44;3&#37; del CD yen el 8&#44;2&#37; del CT&#46; La mortalidad fue del 6&#37; en el CD y 4&#44;1&#37; en el CT&#46; Los tiempos del CT oscilaron entre menos de 5 minutos y 110 minutos&#46; Siendo el promedio de 16&#44;7 minutos en el primer tiempo&#44; 3&#44;51 minutos en el segundo tiempo y de 0&#44;10 el tercer tiempo&#46; Los intervalos medios de descanso en el CT fueron de 0&#44;45 minutos entre el primero y segundo CT y 0&#44;20 minutos entre el segundo y tercer CT&#46; Los resultados a los 6 meses de la intervenci&#243;n&#44; no son diferentes en ambos grupos y no pueden ser relacionados con las t&#233;cnicas empleadas&#46; En los CD&#44; el 8&#37; no pudo ser clipado y se hizo &#171;wrapping&#187;&#44; mientras que todos los CT fueron clipados&#46; Se explican las causas de muerte&#46; En conclusi&#243;n&#44; el CT no modifica sustancialmente los resultados en la cirug&#237;a de los aneurismas y permite una mejor disecci&#243;n del saco aneurism&#225;tico y facilita el acto operatorio&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">During 6 years &#40;1983&#8211;1989&#41; we have operated on 166 cases of cerebral aneurysms in the Ciudad Sanitaria Vall d&#8217;Hebron&#44; 117 cases have been aproached directly &#40;CD&#41; and 49 cases have been operated through a transitory clipping of the aferent and sometimes too the eferent artery of the aneurysmal sac&#44; in the dissection &#40;CT&#41;&#46; The age&#44; sex and clinical pictures were similar in both groups&#46; The CT were normal in both groups or show blood in cerebral cisterns of the cranial base in the majority of the patients&#46; The aneurysm CD were localized preferently&#44; in the anterior communicating artery 41&#37;&#44; posterior communicating artery 16&#44;2&#37; and middle cerebral artery 13&#44;7&#37;&#46; In the CT the aneurysms were situated preferently&#44; in the anterior communicating artery 40&#44;8&#37; and in the middle cerebral artery 38&#44;8&#37;&#46; During the intervention of the CT aneurysms&#44; the patients have been supported with arterial hypertension&#44; hyperventilation with 0<span class="elsevierStyleInf">2</span> to 100&#37; and barbiturics to high dosis&#46; The immediate results&#44; 7th day of surgery&#44; were similar&#46; They have a good recuperation on 56&#44;4&#37; of the CD&#44; and 40&#44;8&#37; of the CT&#44; the previous deficit persisted on 11&#44;1&#37; of the CD&#44; and 10&#44;2&#37; of the CT&#44; the deficit increased on 0&#44;9&#37; of the CD&#44; and 4&#44;1&#37; of the CT&#46; A neurology deficit appear on 21&#44;4&#37; of the CD and 32&#44;7&#37; of the CT&#46; A serious deterioration on 4&#44;3&#37; of the CD and 8&#44;2&#37; of CT&#46; The mortality was 6&#37; on CD and 4&#44;1&#37; on CT&#46; The CT time oscillated between less 5 minutes to 110 minutes&#46; The averaged time of CT was 16&#44;7<span class="elsevierStyleHsp" style=""></span>min in the first time&#44; 3&#44;51<span class="elsevierStyleHsp" style=""></span>min in the second time and 0&#44;10<span class="elsevierStyleHsp" style=""></span>min in the third time&#46; The average of intervals clipping time was 0&#44;45<span class="elsevierStyleHsp" style=""></span>min between the first and second time&#44; 0&#44;20<span class="elsevierStyleHsp" style=""></span>min between the second and third time&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results&#44; 6 months after surgery&#44; weren&#8217;t different in each group and can&#8217;t be related to the tecnics used&#46; In the CD the 8&#37; could&#8217;t be clipped and we had to wrapping them&#44; while all of the CD were clipped&#46; We explain the causes of death&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In conclusion&#44; the CT don&#8217;t modify sustantially the results of aneurysms surgery&#44; and permit a best dissection of the aneurismal sac and facilitate the surgery&#46;</p>"
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                        "paginaFinal" => "211"
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                            0 => "J&#46;L&#46; Fox"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1983"
                        "editorial" => "Springer-Verlag"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
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            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular clips for the microsurgical treatrnent of stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;L&#46; Fox"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "1976"
                        "volumen" => "7"
                        "paginaInicial" => "489"
                        "paginaFinal" => "500"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/960173"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Endothelial cell damage by temporary arterial occlusion with surgical clips&#46; Study of the clips side by scaning and trasrnission electron microscopy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;D&#46; Gertz"
                            1 => "M&#46;L&#46; Rennels"
                            2 => "M&#46;S&#46; Forbes"
                            3 => "J&#46; Kawamura"
                            4 => "T&#46; Sunaga"
                            5 => "E&#46; Nelson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1976.45.5.0514"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1976"
                        "volumen" => "45"
                        "paginaInicial" => "514"
                        "paginaFinal" => "519"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/972335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral aneurysms rupture during neurosurgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46;M&#46; Greenberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1984"
                        "volumen" => "15"
                        "paginaInicial" => "243"
                        "paginaFinal" => "245"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6483142"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous subarachnoid hemorrhage of aneuysmal origin"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;B&#46; Hamby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J&#46; A&#46; M&#46; A&#46;"
                        "fecha" => "1948"
                        "volumen" => "136"
                        "paginaInicial" => "522"
                        "paginaFinal" => "528"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary vascular occlusion during aneurisms surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Jabre"
                            1 => "L&#46; Symon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg&#46; Neurol&#46;"
                        "fecha" => "1987"
                        "volumen" => "27"
                        "paginaInicial" => "47"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3787442"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monitoring of the somatosensory evoked potentials during aneurysms surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Kidooka"
                            1 => "Y&#46;D&#46; Nakasu"
                            2 => "K&#46; Watanabe"
                            3 => "M&#46; Matsuda"
                            4 => "J&#46; Hauda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg&#46; Neurol"
                        "fecha" => "1987"
                        "volumen" => "27"
                        "paginaInicial" => "69"
                        "paginaFinal" => "76"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3787445"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary clipping during early operation for rupture aneurysms&#46; Preliminary report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Ljunggren"
                            1 => "H&#46; Saveland"
                            2 => "L&#46; Brandt"
                            3 => "E&#46; Castron"
                            4 => "S&#46; Rehncrona"
                            5 => "P&#46;E&#46; Nilsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1983"
                        "volumen" => "12"
                        "paginaInicial" => "525"
                        "paginaFinal" => "530"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6866234"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The pathology of vascular &#40;&#171;arteriovenous&#187;&#41; malforrnations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;F&#46; McCormick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1966.24.4.0807"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1966"
                        "volumen" => "24"
                        "paginaInicial" => "807"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5934138"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of temporary arterial occlusion on somatosensory evoked responses in aneruysm surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Monma"
                            1 => "A&#46;D&#46; Wang"
                            2 => "L&#46; Symon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg&#46; Neurol"
                        "fecha" => "1987"
                        "volumen" => "27"
                        "paginaInicial" => "343"
                        "paginaFinal" => "352"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3824140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral complications following induced hypotension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46; Pasch"
                            1 => "W&#46; Huk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur&#46; J&#46; Anesthesiol"
                        "fecha" => "1986"
                        "volumen" => "3"
                        "paginaInicial" => "299"
                        "paginaFinal" => "312"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aneurysms of the anterior cornmunicating artery Bifrontal craniotomy and routine use of temporary clips"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;L&#46; Pool"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1961.18.1.0098"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1961"
                        "volumen" => "18"
                        "paginaInicial" => "98"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13737059"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Occlusion of the middle cerebral artery under normotension and anemically induced and chernically induced hypotension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Ralston"
                            1 => "T&#46; Rasmussen"
                            2 => "T&#46; Kennedy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1955.12.1.0026"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1955"
                        "volumen" => "12"
                        "paginaInicial" => "26"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13233980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative Neurosurgical Techniques &#40;lndications Methods and Results&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;H&#46; Schmidek"
                            1 => "W&#46;H&#46; Sweet"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1982"
                        "editorial" => "Grune &#38; Stratton"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A technique of clipping giant intracranial aneurysms with the preservations of the parent artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;N&#46; Sekhar"
                            1 => "P&#46;B&#46; Nelson"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg&#46; Neurol&#46;"
                        "fecha" => "1983"
                        "volumen" => "20"
                        "paginaInicial" => "361"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6635924"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology and clinical evaluation of subarachnoid hemorrhage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;R&#46; Smith"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
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                        "titulo" => "Neurological Surgery"
                        "paginaInicial" => "1&#46;627"
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                        "edicion" => "Second edition"
                        "serieFecha" => "1982"
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                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focal trasient cerebral ischemia in the squirrel monkey&#58; Effect on brain adenosine triphosphate and lactate level with electrocorticographic an pathologic correlation"
                      "autores" => array:1 [
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                          "autores" => array:2 [
                            0 => "T&#46;M&#46; Sundt J&#46;R&#46;"
                            1 => "J&#46;D&#46; Mrchenfelder"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Res"
                        "fecha" => "1972"
                        "volumen" => "30"
                        "paginaInicial" => "703"
                        "paginaFinal" => "712"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4623629"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The safety time limit of temporary clamping of cerebral arteries in the direct surgical treatrnent of intracranial aneurysms under moderate hypotherrnia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Suzuki"
                            1 => "R&#46; Kwak"
                            2 => "Y&#46; Okudairo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Tohoku J&#46; Exp&#46; Med&#46;"
                        "fecha" => "1979"
                        "volumen" => "127"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/760246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical tratament of middle cerebral artery aneurysm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Suzuki"
                            1 => "T&#46; Yoshimoto"
                            2 => "T&#46; Kayama"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1984.61.1.0017"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1984"
                        "volumen" => "61"
                        "paginaInicial" => "17"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6726392"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disordered cerebrovascular physiology in aneurysmal subarachnoid haemorrhage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Symon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "1978"
                        "volumen" => "41"
                        "paginaInicial" => "7"
                        "paginaFinal" => "22"
                      ]
                    ]
                  ]
                ]
              ]
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            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical experiences with intracranial aneurysms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Symon"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1984.61.6.1107"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Neurosurg&#46;"
                        "fecha" => "1984"
                        "volumen" => "61"
                        "paginaInicial" => "1&#46;009"
                        "paginaFinal" => "1&#46;020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6542131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perioperative use of somatosensory evoked responses in aneurysms suruerv"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Symon"
                            1 => "A&#46;D&#46; Wang"
                            2 => "E&#46; Costa"
                            3 => "I&#46;E&#46; Silva"
                            4 => "F&#46; Gentili"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                        "fecha" => "1978"
                        "paginaInicial" => "571"
                        "paginaFinal" => "572"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The microvasculature and microcirculation of the cerebral cortex after arterial occlusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;G&#46; Waltz"
                            1 => "T&#46;M&#46; Sundt Jr&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain"
                        "fecha" => "1967"
                        "volumen" => "90"
                        "paginaInicial" => "681"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4964526"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                  "contribucion" => array:1 [
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                      "Libro" => array:3 [
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                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of aneurysms of anterior circulation by intracranial procedures"
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                  ]
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                        "serieFecha" => "1982"
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                    ]
                  ]
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              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The principies of microsurgery applied to aneurysm surgery"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;G&#46; Yasargil"
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                            2 => "J&#46;L&#46; Firth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Operative Surgery &#40;Neurosurgery&#41;"
                        "paginaInicial" => "146"
                        "paginaFinal" => "153"
                        "serieFecha" => "1989"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
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Vol. 1. Núm. 6.
Páginas 375-383 (enero 1990)
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Vol. 1. Núm. 6.
Páginas 375-383 (enero 1990)
Clipaje transitorio de la arteria aferente al saco aneurismático en la cirugía de aneurismas intracraneales
Visitas
2309
E. Rubio, C.H. Castaño, J. Vilalta, J. García Díez, J. Sahuquillo
Servicio de Neurocirugía. Ciudad Sanitaria Vall d’Hebrón. Barcelona
Este artículo ha recibido
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Resumen

Durante 6 años (1983–1989), se operaron 166 aneurismas intracraneales en la Ciudad Sanitaria de Vall d’Hebrón, de los que 117 se abordaron directamente (CD) y en 49 se clipó el saco aneurismático después de mantener clipadas trasitoriamente, durante la disección, las arterias aferentes y a veces también las eferentes al aneurisma (CT). Las edades, sexo y clinica de ambos grupos fueron similares. La tomografía computarizada (TC), fue normal o existía sangre en las cisternas de la base, en la mayoría de los casos. Los aneurismas CD se localizaban de preferencia en las regiones de las arterias: comunicante anterior 41%, posterior 16,2% y cerebral media 13,7%. En los CT los aneurismas se situaban preferentemente en la región de la arteria comunicante anterior 40,8% y cerebral media 38,8%. Durante el CT el enfermo fue mantenido con hipertensión arterial, hiperventilación con O2 al 100% y barbitúricos a altas dosis. Los resultados inmediatos, a los 7 días de operados, fueron muy similares. Tuvieron una buena recuperación el 56,4% de los CD y el 40,8% de los CT, persistió el déficit previo en 11,1% de los CD y en el 10,2% de los CT. Aumentó el déficit en el 0,9% de los CD y en el 4,1% de los CT. Apareció algún déficit neurológico en el 21,4% del CD y en el 32,7% en el CT. Hubo deterioro grave en el 4,3% del CD yen el 8,2% del CT. La mortalidad fue del 6% en el CD y 4,1% en el CT. Los tiempos del CT oscilaron entre menos de 5 minutos y 110 minutos. Siendo el promedio de 16,7 minutos en el primer tiempo, 3,51 minutos en el segundo tiempo y de 0,10 el tercer tiempo. Los intervalos medios de descanso en el CT fueron de 0,45 minutos entre el primero y segundo CT y 0,20 minutos entre el segundo y tercer CT. Los resultados a los 6 meses de la intervención, no son diferentes en ambos grupos y no pueden ser relacionados con las técnicas empleadas. En los CD, el 8% no pudo ser clipado y se hizo «wrapping», mientras que todos los CT fueron clipados. Se explican las causas de muerte. En conclusión, el CT no modifica sustancialmente los resultados en la cirugía de los aneurismas y permite una mejor disección del saco aneurismático y facilita el acto operatorio.

Palabras clave:
Hemorragia subaracnoidea
aneurismas intracraneales
clipaje transitorio
Summary

During 6 years (1983–1989) we have operated on 166 cases of cerebral aneurysms in the Ciudad Sanitaria Vall d’Hebron, 117 cases have been aproached directly (CD) and 49 cases have been operated through a transitory clipping of the aferent and sometimes too the eferent artery of the aneurysmal sac, in the dissection (CT). The age, sex and clinical pictures were similar in both groups. The CT were normal in both groups or show blood in cerebral cisterns of the cranial base in the majority of the patients. The aneurysm CD were localized preferently, in the anterior communicating artery 41%, posterior communicating artery 16,2% and middle cerebral artery 13,7%. In the CT the aneurysms were situated preferently, in the anterior communicating artery 40,8% and in the middle cerebral artery 38,8%. During the intervention of the CT aneurysms, the patients have been supported with arterial hypertension, hyperventilation with 02 to 100% and barbiturics to high dosis. The immediate results, 7th day of surgery, were similar. They have a good recuperation on 56,4% of the CD, and 40,8% of the CT, the previous deficit persisted on 11,1% of the CD, and 10,2% of the CT, the deficit increased on 0,9% of the CD, and 4,1% of the CT. A neurology deficit appear on 21,4% of the CD and 32,7% of the CT. A serious deterioration on 4,3% of the CD and 8,2% of CT. The mortality was 6% on CD and 4,1% on CT. The CT time oscillated between less 5 minutes to 110 minutes. The averaged time of CT was 16,7min in the first time, 3,51min in the second time and 0,10min in the third time. The average of intervals clipping time was 0,45min between the first and second time, 0,20min between the second and third time.

The results, 6 months after surgery, weren’t different in each group and can’t be related to the tecnics used. In the CD the 8% could’t be clipped and we had to wrapping them, while all of the CD were clipped. We explain the causes of death.

In conclusion, the CT don’t modify sustantially the results of aneurysms surgery, and permit a best dissection of the aneurismal sac and facilitate the surgery.

Artículo

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