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y el riesgo acumulado en 5 a&#241;os del 3&#44;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#46; Estos porcentajes generales ascienden si el paciente presenta factores de riesgo como hipertensi&#243;n arterial &#40;HTA&#41;&#44; tabaquismo&#44; multiplicidad de aneurismas o presencia de hemorragia subaracnoidea &#40;HSA&#41; previa<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;5</span></a>&#46; Por otro lado el tratamiento de AINR conlleva una morbimortalidad baja&#44; pero no despreciable<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46; Existe controversia respecto al manejo de AINR&#44; ya que el tratamiento de los mismos podr&#237;a suponer un riesgo que superar&#237;a el beneficio de evitar una HSA&#44; en ocasiones devastadora pero poco probable&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En nuestro centro los AINR son valorados en comit&#233; y la indicaci&#243;n de tratamiento se fundamenta en criterios cl&#237;nicos &#40;edad&#44; factores de riesgo de sangrado&#41; y radiol&#243;gicos &#40;localizaci&#243;n&#44; tama&#241;o&#44; morfolog&#237;a&#44; crecimiento&#41;&#46; Si se decide ofrecer tratamiento&#44; se opta por t&#233;cnicas endovasculares o microquir&#250;rgicas en dependencia de las caracter&#237;sticas del paciente&#44; la probabilidad de cierre completo y de complicaciones&#46; Si se indica de manera juiciosa una u otra t&#233;cnica de cierre&#44; la tasa de complicaciones disminuye y la seguridad para el paciente mejora&#46; La microcirug&#237;a aporta una elevada tasa de cierre con resultados duraderos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Consideramos la presencia de aneurismas m&#250;ltiples un factor de riesgo relevante&#44; especialmente en pacientes que presentaron previamente una HSA&#46; Si uno de los AINR se considera quir&#250;rgico&#44; ofrecemos el clipaje de todos ellos mediante una minicraneotom&#237;a&#46; Para conocer si este manejo supone un mayor riesgo para el paciente pretendemos evaluar los resultados quir&#250;rgicos del clipaje de AINR&#44; comparando los resultados de los subgrupos de las cirug&#237;as en las que se clipa un &#250;nico aneurisma o m&#225;s de uno&#44; as&#237; como los factores de riesgo para el desarrollo de complicaciones posquir&#250;rgicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se trata de un estudio retrospectivo en el que se incluyeron pacientes intervenidos mediante microcirug&#237;a de AINR en nuestro centro en el per&#237;odo 2020-2023&#46; Los criterios de exclusi&#243;n fueron&#58; 1&#41; aneurismas traum&#225;ticos&#44; mic&#243;ticos o asociados a malformaciones vasculares&#44; 2&#41; pacientes intervenidos de AINR durante la cirug&#237;a de un aneurisma roto&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tras aprobaci&#243;n por parte del comit&#233; de &#233;tica de nuestro hospital&#44; se llev&#243; a cabo la revisi&#243;n de la historia cl&#237;nica electr&#243;nica de los pacientes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se dividi&#243; la muestra en pacientes en los que se clip&#243; un &#250;nico aneurisma o m&#225;s de uno en la misma cirug&#237;a&#46; Se incluyeron las siguientes variables&#58; edad&#44; sexo&#44; tabaquismo&#44; HTA&#44; HSA previa&#44; localizaci&#243;n del aneurisma&#44; tama&#241;o del aneurisma&#44; t&#233;cnica quir&#250;rgica&#44; abordaje&#44; control radiol&#243;gico posquir&#250;rgico y necesidad de retratamiento&#46; Consideramos abordaje <span class="elsevierStyleItalic">miniopen</span> al minipterional&#44; <span class="elsevierStyleItalic">lateral supraorbital approach</span>&#44; al <span class="elsevierStyleItalic">keyhole</span> supraorbitario transciliar o al abordaje interhemisf&#233;rico unilateral&#46; Fuera de este grupo se consider&#243; la craneotom&#237;a pterional cl&#225;sica y el abordaje interhemisf&#233;rico bifrontal&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se divideron las complicaciones en isqu&#233;micas&#44; hemorr&#225;gicas &#40;subaracnoidea y no subaracnoidea&#41;&#44; infecciosas y totales&#46; Se consider&#243; isquemia a toda hipodensidad posquir&#250;rgica en la tomograf&#237;a computarizada &#40;TC&#41; de control congruente con un territorio vascular&#44; sintom&#225;tica o no&#46; Describimos como complicaci&#243;n hemorr&#225;gica cualquier sangrado en TC de control sintom&#225;tico o no&#44; a excepci&#243;n de peque&#241;os vol&#250;menes asintom&#225;ticos en el lecho quir&#250;rgico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se emplea la escala de Rankin modificada &#40;mRS&#41; para definir el estado funcional pre y posquir&#250;rgico de los pacientes durante el seguimiento&#46; Se considera pron&#243;stico desfavorable la aparici&#243;n de cualquier s&#237;ntoma posquir&#250;rgico mantenido &#62;<span class="elsevierStyleHsp" style=""></span>3 meses tras la intervenci&#243;n&#44; lo que se valora como un empeoramiento de la escala mRS en al menos un punto&#46; Esto incluye la afectaci&#243;n cognitiva referida por paciente o familiares&#44; la cefalea o s&#237;ntomas inespec&#237;ficos&#44; como mareos o v&#233;rtigos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n del an&#225;lisis estad&#237;stico se utiliza el Microsoft Excel y el programa IBM SPSS Statistics versi&#243;n 25&#46;0&#46; Para calcular la normalidad se utiliza la prueba Kolmog&#243;rov-Smirnov&#46; Se considera p-valor &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 estad&#237;sticamente significativo&#46; Para el an&#225;lisis univariante se usa para variables cualitativas chi-cuadrado y variables cuantitativas param&#233;tricas t de Student&#44; y no par&#225;metricas U-de Mann-Whitney&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se intervinieron 82 pacientes de AINR mediante microcirug&#237;a durante el per&#237;odo de 2020-2023&#44; con un total de 114 aneurismas tratados&#46; En 60 pacientes se clip&#243; un &#250;nico aneurisma durante la intervenci&#243;n y en 22 pacientes se cliparon dos o m&#225;s&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Estos 82 pacientes presentaron un total de 173 aneurismas diagnosticados&#46; De estos&#44; 145 recibieron tratamiento endovascular &#40;31&#41; o microquir&#250;rgico &#40;114&#41;&#46; Se trataron el 91&#44;8&#37; de los aneurismas en pacientes que hab&#237;an sufrido una HSA previa&#46; Recibieron un tratamiento mixto 24 pacientes&#44; siendo m&#225;s frecuente entre pacientes que hab&#237;an presentado una HSA &#40;17&#47;24&#58; 70&#44;8&#37;&#41; que entre los que se diagnosticaron de AINR m&#250;ltiples asintom&#225;ticos &#40;7&#47;24&#58; 29&#44;2&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se aprecia una mayor tendencia a tratar aneurismas m&#250;ltiples en casos de HSA previa de otro aneurisma&#44; as&#237; como mayor probabilidad de que estos pacientes reciban un tratamiento mixto&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> la localizaci&#243;n de los 114 AINR intervenidos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra un an&#225;lisis descriptivo comparativo de cada uno de los dos grupos de pacientes a estudio&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factores de riesgo</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se aprecian dos grupos homog&#233;neos en cuanto a sexo y factores de riesgo&#44; con mayor n&#250;mero de pacientes j&#243;venes &#40;18&#44;3&#37; &#60;<span class="elsevierStyleHsp" style=""></span>46 a&#241;os&#41; en el grupo 1&#46; Un total de 22 pacientes &#40;26&#44;8&#37;&#41; presentaron previamente una HSA&#46; Cinco aneurismas del total de 114 eran de circulaci&#243;n posterior&#44; todos ellos en el grupo 2 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41;&#46; Se aprecia m&#225;s tendencia a clipar aneurismas peque&#241;os en el grupo de aneurismas m&#250;ltiples&#46; El tama&#241;o medio entre los intervenidos fue de 7&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">T&#233;cnica quir&#250;rgica</span><p id="par0085" class="elsevierStylePara elsevierViewall">En el grupo 1 hubo 3 casos en los que no se consider&#243; seguro el clipaje y se llev&#243; a cabo un <span class="elsevierStyleItalic">wrapping</span>&#44; lo que supone un 2&#44;6&#37; del total&#46; Se realizaron cinco abordajes interhemisf&#233;ricos &#40;4 aneurismas de ACA distal y uno de AcoA&#41;&#44; uno de ellos doble abordaje interhemisf&#233;rico&#47;minipterional con una misma incisi&#243;n para clipar aneurismas m&#250;ltiples&#46; El resto fueron abordajes laterales&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ambos grupos muestran un porcentaje similar de abordaje <span class="elsevierStyleItalic">miniopen</span> &#40;86&#44;6&#37; vs&#46; 86&#44;4&#41;&#46; La mayor&#237;a de los abordajes convencionales se realizaron en los primeros a&#241;os del estudio&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se ejemplifica la t&#233;cnica quir&#250;rgica&#46; Se aprecia m&#225;s tendencia a emplear clinoidectom&#237;a en los casos de clipaje m&#250;ltiple&#44; probablemente por&#58; 1&#41; los 5 aneurismas de circulaci&#243;n posterior se encuentran en el grupo 2 y se cliparon mediante minipterional o pterional con abordaje temporal anterior&#44; que suele requerir clinoidectom&#237;a anterior y en ocasiones tambi&#233;n posterior&#44; 2&#41; generalmente ante casos de aneurismas simples oft&#225;lmicos o paraclinoideos se ofrece tratamiento mediante <span class="elsevierStyleItalic">stent flow diverter</span> &#40;FD&#41;&#44; sin embargo ante la presencia de varios aneurismas es m&#225;s probable que llevemos a cabo el clipaje de todos ellos&#44; incluidos los paraclinoideos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Oclusi&#243;n del aneurisma</span><p id="par0095" class="elsevierStylePara elsevierViewall">El 87&#44;3&#37; de los pacientes clipados tienen una prueba de imagen de control del cierre&#44; el 41&#44;8&#37; mediante angio-TC y el 58&#44;2&#37; mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#46; El tiempo medio desde la cirug&#237;a al &#250;ltimo control fue de 10 meses &#40;1-37&#41;&#46; Se perdi&#243; el seguimiento en 2 pacientes y 8 tienen pendiente la realizaci&#243;n de la prueba&#46; Los 3 aneurismas tratados con <span class="elsevierStyleItalic">wrapping</span> han seguido controles mediante angio-RM&#44; sin crecimiento de los aneurismas&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Se apreci&#243; el cierre completo del 100&#37; de los aneurismas controlados mediante angio-TC y del 74&#44;3&#37; de los aneurismas seguidos mediante arteriograf&#237;a&#46; El 90&#44;3&#37; de los pacientes clipados seguidos por arteriograf&#237;a presentan un cuello &#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La tasa de cierre completo entre ambos grupos es similar&#44; aunque ligeramente mayor en el grupo 1 &#40;83&#44;7 vs&#46; 77&#44;6&#37;&#41;&#44; debido a que la mayor parte de los pacientes controlados mediante angio-TC pertenecen al grupo 1&#46; Dos pacientes del grupo 1 y 5 del grupo 2 presentaron un cuello &#8805;2<span class="elsevierStyleHsp" style=""></span>mm &#40;2-5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; sea por presencia de calcificaciones&#44; por salida de perforantes o riesgo de afectaci&#243;n de las mismas o por una t&#233;cnica de clipaje inadecuada&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cuatro aneurismas intervenidos requirieron retratamiento &#40;3&#44;5&#37;&#41;&#44; ya que no se consider&#243; haber conseguido una prevenci&#243;n &#243;ptima de crecimiento o sangrado&#58; 1&#41; aneurisma fusosacular de A2 que recreci&#243; entre clips y fue tratado mediante <span class="elsevierStyleItalic">FD</span>&#44; 2&#41; aneurisma de arteria cerebral media &#40;ACM&#41; contralateral cerrado parcialmente por el clip&#44; tratado con coils&#44; 3&#41; aneurisma trilobulado de AcoA en el que se apreci&#243; persistencia del tet&#243;n posterosuperior&#44; tratado con <span class="elsevierStyleItalic">FD</span> y 4&#41; aneurisma de AcoA clipado por minipterional con resto de 2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#44; que requiri&#243; abordaje interhemisf&#233;rico&#46; Todos presentaron cierre completo tras el tratamiento&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Complicaciones y situaci&#243;n funcional &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Se aprecia una tasa de sangrado&#47;resangrado y de mortalidad del 0&#37;&#44; con una morbilidad posquir&#250;rgica significativa &#40;empeoramiento de &#8805;2 puntos de mRS&#41; del 1&#44;2&#37;&#46; Por lo tanto&#44; durante el seguimiento el 98&#44;8&#37; de los pacientes presentaron una buena o muy buena situaci&#243;n funcional&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Seis pacientes &#40;7&#44;3&#37;&#41; presentaron un empeoramiento de un punto en la escala mRS&#58; d&#233;ficit neurol&#243;gico leve &#40;2&#41;&#44; mareos &#40;1&#41;&#44; empeoramiento cognitivo &#40;2&#41; y empeoramiento de cefalea previa &#40;1&#41;&#46; Tres pacientes &#40;3&#44;7&#37;&#41; mejoraron un punto debido a la disminuci&#243;n del efecto de masa&#46; Una paciente present&#243; mRS<span class="elsevierStyleHsp" style=""></span>&#62;2 despu&#233;s de la cirug&#237;a&#44; pasando de mRS 2 a mRS 5 tras presentar un infarto de ACM tras clipaje de aneurisma de ACI-oft&#225;lmica de 22<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se visualiza la situaci&#243;n funcional de los pacientes intervenidos&#46; Seis de los 8 pacientes que presentaban un mRS 2 prequir&#250;rgico hab&#237;an sufrido una HSA por otro aneurisma&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Se diagnosticaron adem&#225;s tres isquemias silentes &#40;3&#44;7&#37;&#41;&#44; todas ellas en circulaci&#243;n anterior &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Ninguno de los pacientes refiere afectaci&#243;n cognitiva pero solo un caso fue confirmado mediante test neuropsicol&#243;gicos&#46; Tres pacientes presentaron complicaciones hemorr&#225;gicas &#40;3&#44;7&#37;&#41;&#46; Ninguno requiri&#243; intervenci&#243;n quir&#250;rgica&#44; pero un paciente empeor&#243; su situaci&#243;n basal y requiri&#243; un ingreso prolongado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Dos pacientes &#40;2&#44;4&#37;&#41; presentaron una infecci&#243;n posquir&#250;rgica&#44; una de ellas superficial y otra intracraneal &#40;empiema&#41;&#59; ambos precisaron reintervenci&#243;n&#46; Otra paciente fue reintervenida con anestesia local para retirar un tapatr&#233;panos que le molestaba&#44; por lo que la tasa de reintervenci&#243;n por complicaciones fue del 3&#44;7&#37;&#46; Tres pacientes &#40;3&#44;7&#37;&#41; presentaron un d&#233;ficit neurol&#243;gico &#40;cuadro cl&#237;nico completo de isquemia de ACM izquierda&#44; afectaci&#243;n parcial del III pc y cuadrantanopsia&#41; tras la intervenci&#243;n&#44; mientras que otros tres presentaron mejor&#237;a neurol&#243;gica al disminuir el efecto de masa &#40;resoluci&#243;n de la afectaci&#243;n del III pc y hemiparesia&#41; tras trombectom&#237;a intraaneurism&#225;tica&#46; El an&#225;lisis univariante de las complicaciones se puede observar en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0140" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> no se aprecia mayor morbimortalidad en aquellas cirug&#237;as en las que se clipa m&#225;s de un aneurisma&#44; tampoco en las realizadas por t&#233;cnica <span class="elsevierStyleItalic">miniopen</span>&#44; ni en las que se realizan a pacientes que han sufrido previamente una HSA&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se aprecian diferencias estad&#237;sticamente significativas en la probabilidad de isquemia posquir&#250;rgica en cirug&#237;as en las que se lleva a cabo el clipaje de un aneurisma de circulaci&#243;n posterior&#46; Esto no implica una mayor probabilidad de empeoramiento de la situaci&#243;n funcional&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">El 30&#37; de los AINR se rompen a lo largo de la vida de un paciente<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46; En los estudios ISUIA<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> y UCAS<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> se describieron seis factores de riesgo independientes de rotura&#58; tama&#241;o&#44; localizaci&#243;n&#44; rotura de otro aneurisma previo&#44; edad&#44; HTA y origen geogr&#225;fico&#46; Se han identificado otros factores que favorecen el sangrado<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;7&#44;10</span></a>&#58; tabaquismo&#44; multiplicidad de aneurismas&#44; HSA &#8805;2 familiares de primer grado y caracter&#237;sticas asociadas al propio aneurisma como irregularidad&#44; crecimiento&#44; mayor <span class="elsevierStyleItalic">aspect ratio&#44;</span> localizaci&#243;n en ACoP e inflamaci&#243;n de la pared&#46; El 9&#37; de los AINR presentan crecimiento en el seguimiento en 2&#44;8 a&#241;os y el 45&#37; en 19<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#44; lo que incrementa la probabilidad de rotura en un 0&#44;2-2&#44;4&#37;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">No existe un consenso sobre la actitud a tomar en pacientes con aneurismas m&#250;ltiples tras HSA&#44; aunque es conocido que ambos criterios de manera individual aumentan el riesgo de sangrado<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;12&#44;13</span></a>&#46; La tasa de rotura en pacientes con aneurismas m&#250;ltiples y HSA previa es el doble que en pacientes con aneurismas simples &#40;3 vs&#46; 1&#44;5&#37;&#41;&#44; especialmente en aneurismas irregulares&#44; grandes y localizados en ACM<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&#46; Por otro lado&#44; el tratamiento de aneurismas m&#250;ltiples en una misma intervenci&#243;n no parece aumentar el riesgo de complicaciones&#44; incluso con el uso de varias craneotom&#237;as<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Ni las gu&#237;as de manejo cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> ni las escalas de decisi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;16&#44;17</span></a> aportan evidencia suficiente para apoyar la toma de decisiones<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;18&#44;19</span></a>&#46; Por dicho motivo&#44; es imprescindible individualizar el tratamiento de estos pacientes teniendo en cuenta los resultados obtenidos por cada unidad o centro&#46; Por un lado debe valorarse la capacidad de evitar el sangrado y por otro ha de tenerse en cuenta la morbilidad generada por el propio tratamiento&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En nuestro estudio se establece una tasa de cierre completo del 81&#44;63&#37;&#44; que disminuye a 74&#44;32&#37; cuando se eval&#250;an solamente los casos controlados mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los art&#237;culos previos no consideran la arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D como prueba de control posquir&#250;rgico&#44; reportando tasas de cierre del 94&#44;7&#37;&#44; valoradas con angio-TC o arteriograf&#237;a 2<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Un estudio reciente<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> eval&#250;a las tasa de cierre mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#44; consiguiendo un cierre completo en el 76&#44;9&#37; de los casos&#46; Describen que el 59&#37; de los cuellos remanentes no hab&#237;an sido visualizados en angiograf&#237;a 2<span class="elsevierStyleHsp" style=""></span>D&#46; Mientras que ning&#250;n aneurisma con cierre completo recreci&#243; o sangr&#243;&#44; el 11&#44;8&#37; de los aneurismas con cierre incompleto presentaron crecimiento durante el seguimiento&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La heterogeneidad de los estudios no permite establecer qu&#233; se considera un cierre adecuado de un AINR<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> e incluso en series modernas se emplea la angio-TC para definir el cierre completo<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46; Sin embargo&#44; parece apropiada la realizaci&#243;n de un primer control posquir&#250;rgico mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D para definir qu&#233; pacientes necesitar&#225;n seguimiento &#40;en torno a un 20&#37; de los mismos&#44; especialmente j&#243;venes y con aneurismas de mayor tama&#241;o&#41;&#46; En nuestra serie se observ&#243; un cierre completo mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D del 74&#44;3&#37;&#44; mientras que mediante angio-TC del 100&#37;&#46; No obstante si consideramos un cierre adecuado persistencia de un cuello &#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#44; el porcentaje de aneurismas con cierre completo o adecuado asciende al 90&#44;3&#37; de los pacientes clipados seguidos por arteriograf&#237;a y al 92&#44;9&#37; de los seguidos mediante ambas pruebas&#46; Por lo tanto&#44; seg&#250;n estos resultados se observa una mayor sensibilidad de la arteriograf&#237;a como t&#233;cnica para diagnosticar remanentes no ocluidos del aneurisma&#46; Este dato podr&#237;a ser analizado con mayor profundidad en pr&#243;ximos estudios&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el 3&#44;5&#37; de los AINR clipados requirieron retratamiento&#44; ninguno por crecimiento o sangrado&#46; El empleo de t&#233;cnicas endovasculares &#40;3&#47;4 casos&#41; no hace sino reforzar nuestro manejo multidisciplinar&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Por otro lado&#44; el objetivo de tratar AINR es evitar la rotura de los mismos&#46; La tasa de sangrado de pacientes clipados fue del 0&#37; en nuestra serie&#44; aunque se trata de un periodo corto de seguimiento&#46; Por ello&#44; se han revisado las 274 HSA aneurism&#225;ticas tratadas en nuestro hospital en el periodo 2017-2023&#44; observando que ninguna de ellas se produjo en pacientes previamente intervenidos por microcirug&#237;a&#44; ni tampoco en pacientes que hubieran presentado HSA previamente por otro aneurisma&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Las complicaciones secundarias al tratamiento microquir&#250;rgico de AINR han disminuido de manera considerable en las &#250;ltimas d&#233;cadas&#44; con tasas de mortalidad en torno al 0-1&#44;7&#37; y morbilidad del 4&#37;-10&#44;9&#37;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; En un estudio multic&#233;ntrico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> basado en 2245 casos tratados de una cohorte internacional se describe la tasa de resultados adecuados tras clipaje de AINR&#58; mRS &#8804;2 &#8805;95&#44;9&#37;&#44; complicaciones posquir&#250;rgicas &#8804;20&#44;7&#37;&#44; estancia hospitalaria &#8804;7&#44;7 d&#237;as&#44; infarto asintom&#225;tico &#8804;3&#44;6&#37;&#44; infecci&#243;n quir&#250;rgica &#8804;2&#44;7&#37;&#44; vasoespasmo &#8804;2&#44;5&#37; y focalidad neurol&#243;gica &#8804;5&#44;9&#37;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En nuestro trabajo observamos una probabilidad de mRS &#8804;2 del 98&#44;9&#37;&#44; con una mortalidad del 0&#37;&#46; Sin embargo&#44; dado que los pacientes intervenidos de AINR se encuentran en su mayor&#237;a asintom&#225;ticos o paucisintom&#225;ticos antes de la cirug&#237;a&#44; consideramos m&#225;s apropiado medir cualquier empeoramiento en la situaci&#243;n funcional del paciente&#44; aunque sea leve&#46; Un 7&#44;3&#37; de nuestros pacientes presentaron un empeoramiento leve que no les impide las actividades habituales&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Los factores asociados a complicaciones m&#225;s com&#250;nmente descritos en la literatura<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> son&#58; edad<span class="elsevierStyleHsp" style=""></span>&#62;50 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a>&#44; sexo femenino&#44; coagulopat&#237;a&#44; anticoagulaci&#243;n&#44; tabaquismo&#44; HTA<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#44; DM <a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#44; fallo card&#237;aco congestivo&#44; circulaci&#243;n posterior<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;26&#44;27&#44;30</span></a>&#44; calcificaciones y tama&#241;o del aneurisma<span class="elsevierStyleHsp" style=""></span>&#62;12mm<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;28</span></a>&#46; En la presente serie la tasa de complicaciones fue del 12&#44;2&#37;&#44; incluyendo las asintom&#225;ticas&#44; con necesidad de reintervenci&#243;n por las mismas del 3&#44;7&#37;&#46; Se aprecia una mayor probabilidad de complicaciones isqu&#233;micas en los casos intervenidos de aneurismas de circulaci&#243;n posterior&#44; aunque se trata en nuestro trabajo de 3 isquemias asintom&#225;ticas y de territorio ACM o ACA en el contexto del clipaje de otros aneurismas presentes&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Ni la cirug&#237;a en pacientes que previamente presentaron HSA&#44; ni el clipaje de varios aneurismas en la misma intervenci&#243;n&#44; ni el empleo de abordajes <span class="elsevierStyleItalic">miniopen</span> han supuesto una mayor probabilidad de complicaciones o empeoramiento funcional&#46; Los abordajes MIS ofrecen tasas de oclusi&#243;n aneurism&#225;tica similares a las craneotom&#237;as convencionales&#44; un menor tiempo quir&#250;rgico&#44; menor probabilidad de par&#225;lisis facial y atrofia temporal &#40;12&#37; vs&#46; 35&#37;&#41; y mayor satisfacci&#243;n del paciente&#44; calidad de vida y resultado est&#233;tico<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Es dif&#237;cil generalizar si los riesgos de la cirug&#237;a suponen un beneficio frente a la probabilidad de sangrado de AINR&#46; Cada caso debe ser evaluado de manera individual&#44; ya que riesgos no asumibles para un paciente con baja probabilidad de sangrado pueden ser adecuados en otro con un aneurisma m&#225;s inestable&#46; La toma de decisiones debe llevarse a cabo por un equipo multidisciplinar capaz de valorar las ventajas e inconvenientes de cada t&#233;cnica&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitaciones</span><p id="par0215" class="elsevierStylePara elsevierViewall">El presente estudio est&#225; sujeto a limitaciones&#46; En primer lugar&#44; el car&#225;cter retrospectivo del mismo que ha podido generar datos perdidos&#46; En segundo lugar&#44; se trata de un estudio unic&#233;ntrico por lo que est&#225; basado solo en la serie de nuestro centro&#46; Finalmente&#44; no todos los pacientes de la serie ten&#237;an un control arteriogr&#225;fico posquir&#250;rgico y no se ha valorado la complejidad de los aneurismas&#46; Por ello podr&#237;a plantearse en un futuro la realizaci&#243;n de un estudio multic&#233;ntrico prospectivo en el que todos los pacientes fueran sometidos para evaluar la tasa de cierre a una arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D y se recogiera el grado de complejidad de los anuerismas&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0220" class="elsevierStylePara elsevierViewall">La selecci&#243;n de la t&#233;cnica de cierre en el tratamiento de AINR tiene que ser individualizada y para ello debemos conocer los resultados obtenidos por cada grupo&#46; Con una correcta selecci&#243;n de pacientes&#44; la microcirug&#237;a supone una opci&#243;n eficiente con una mortalidad y una probabilidad de sangrado aneurism&#225;tico del 0&#37; en nuestra serie y una probabilidad de morbilidad severa del 1&#44;2&#37;&#46; El clipaje de aneurismas m&#250;ltiples mediante minicraneotom&#237;a en pacientes que han sufrido previamente una HSA no supone un riesgo a&#241;adido&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0230" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no&#160;ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
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              "titulo" => "Background and objectives"
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          "titulo" => "Introducci&#243;n"
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              "identificador" => "sec0020"
              "titulo" => "Factores de riesgo"
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            1 => array:2 [
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              "titulo" => "T&#233;cnica quir&#250;rgica"
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            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Oclusi&#243;n del aneurisma"
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              "titulo" => "Complicaciones y situaci&#243;n funcional &#40;tabla 3&#41;"
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              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2024-02-29"
    "fechaAceptado" => "2024-06-23"
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            0 => "Clipaje"
            1 => "Aneurismas intracraneales no rotos"
            2 => "Aneurismas m&#250;ltiples"
            3 => "Pron&#243;stico"
            4 => "Complicaciones"
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            0 => "Clipping"
            1 => "Unruptured intracranial aneurysms"
            2 => "Multiple intracranial aneurysms"
            3 => "Outcomes"
            4 => "Complications&#46;"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de aneurismas intracraneales no rotos es de un 1-3&#37;&#46; La tasa de rotura anual aumenta en pacientes con aneurismas m&#250;ltiples que han sufrido una hemorragia de uno de ellos&#46; Los objetivos son evaluar los resultados quir&#250;rgicos del clipaje de aneurismas no rotos&#44; comparando pacientes en los que se clipa un &#250;nico o varios y describir las complicaciones de las intervenciones de aneurismas no rotos estableciendo los factores de riesgo de un pron&#243;stico desfavorable&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo que incluye pacientes intervenidos de aneurismas no rotos mediante microcirug&#237;a entre 2020-2023 en nuestro centro&#46; Se analiza la tasa de cierre&#44; las complicaciones y el resultado funcional de los pacientes&#46; Se identifican los factores de riesgo de mal pron&#243;stico con un modelo univariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se intervinieron 82 pacientes con 114 aneurismas&#46; En 22 pacientes se clip&#243; m&#225;s de un aneurisma durante la intervenci&#243;n&#46; El 86&#44;5&#37; de las intervenciones se realizaron mediante abordaje <span class="elsevierStyleItalic">miniopen&#46;</span> El 78&#44;6&#37; de los aneurismas seguidos por arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D presentan cierre completo&#46; La tasa de complicaciones fue del 12&#44;2&#37;&#44; incluyendo asintom&#225;ticas&#46; La mortalidad fue del 0&#37;&#46; La probabilidad de empeorar el mRS 1 punto fue del 7&#44;3&#37; y 2 o m&#225;s del 1&#44;2&#37;&#44; con buen resultado funcional en el 98&#44;9&#37;&#46; El clipaje de varios aneurismas en una misma intervenci&#243;n&#44; empleo de minicraneotom&#237;as o la cirug&#237;a en pacientes con hemorragia subaracnoidea previa no increment&#243; el riesgo de complicaciones&#46; La cirug&#237;a de aneurismas de circulaci&#243;n posterior aument&#243; el riesgo de isquemia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La indicaci&#243;n de cirug&#237;a de aneurismas intracraneales no rotos debe de ser consensuada multidisciplinarmente&#44; conociendo resultados cl&#237;nicos y radiol&#243;gicos&#46; La microcirug&#237;a es una t&#233;cnica v&#225;lida y segura&#44; con una mortalidad 0&#37; y una morbilidad severa del 1&#44;2&#37; en nuestra serie&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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          1 => array:2 [
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            "titulo" => "Materiales y m&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The prevalence of unruptured intracranial aneurysms is 1-3&#37;&#46; The annual rupture rate increases in patients with multiple aneurysms that presented a previous hemorrhage from another aneurysm&#46; Objectives were evaluate outcomes of clipping unruptured aneurysms&#44; comparing patients with single or multiple aneurysms clipped&#44; describe the complications related to surgery and to identify risk factors predicting an unfavorable outcome&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Materials and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective study including patients who underwent clipping of unruptured aneurysms between 2020-2023 at our center&#46; Occlusion rate&#44; complications&#44; and functional outcome were analyzed&#46; Risk factors for poor prognosis are identified using univariate model&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">82 patients with 114 aneurysms were treated wit microsurgery&#46; Multiple aneurysms were clipped in 22 patients&#46; A mini-open approach was used in 86&#44;5&#37; of cases&#46; Complete occlusion in angio3D was found in 78&#46;6&#37; of clipped aneurysms&#46; Complication rate was 12&#46;2&#37;&#44; including asymptomatic cases&#46; Mortality was 0&#37;&#46; The probability of 1 point mRS worsening was 7&#46;3&#37; and 2 or more points was 1&#46;2&#37;&#44; with a good functional outcome in 98&#46;9&#37;&#46; Clipping multiple aneurysms&#44; miniopen approaches&#44; or surgery in patients with previous subarachnoid hemorrhage did not increase the risk of complications&#46; Posterior circulation aneurysms surgery increased the risk of ischemia&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The management for unruptured intracranial aneurysms should be multimodal and based on clinical and radiological outcomes&#46; Microsurgery is a valid and safe technique&#44; with 0&#37; mortality and bleeding rates and 1&#44;2&#37; rate of severe morbidity in our serie&#46;</p></span>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A y B&#41; T&#233;cnica de abordaje minipterional con separaci&#243;n roma de las fibras del m&#250;sculo temporal&#46; C y D&#41; T&#233;cnicas m&#225;s empleadas de clipaje de aneurismas de ACM mediante minicraneotom&#237;a para evitar las &#171;orejas de perro&#187;&#44; siguiendo el concepto de <span class="elsevierStyleItalic">ideal closure line</span>&#46; E y F&#41; Ejemplos de clipaje de aneurismas m&#250;ltiples mediante minicraneotom&#237;a&#58; E&#41; clipaje de aneurisma de AcoA y ACM mediante abordaje lateral supraorbitario derecho&#44; F&#41; clipaje de aneurisma de AchoA derecha&#44; A1 izquierda y top de la basilar mediante abordaje minipterional derecho&#46;</p>"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Complicaciones isqu&#233;micas y hemorr&#225;gicas&#46; A&#41; Isquemia en cabeza de caudado&#46; B&#41; Isquemia en regi&#243;n cortical anterior de ACM&#46; C&#41; Isquemia en regi&#243;n cortical lateral de ACM&#46; D&#41; Isquemia sintom&#225;tica en territorio ACM izquierda&#46; E&#41; Hemorragia cerebelosa &#40;signo de la cebra&#41; sintom&#225;tica&#46; F&#41; L&#225;mina subdural aguda izquierda&#46; G&#41; Hematoma subdural cr&#243;nico derecho&#46;</p>"
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                  \t\t\t\t">19&#47;114 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AB-ACS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;114 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">ACI oft&#47;paraclinoideo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3&#47;114 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                0 => """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo 1&#46; Pacientes en los que se trata un solo aneurisma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;717&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#47;60 &#40;73&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;22 &#40;77&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;60 &#40;26&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;22 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tabaquismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#47;60 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;22 &#40;54&#44;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;922&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HTA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;60 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;22 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HSA previa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#47;60 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;22 &#40;36&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n del aneurisma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;022</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circulaci&#243;n anterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#47;60 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#47;54 &#40;90&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circulaci&#243;n posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;60 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;54 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o del aneurisma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;011</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peque&#241;o &#60;<span class="elsevierStyleHsp" style=""></span>7mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;60 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#47;54 &#40;85&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediano 7-12mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;60 &#40;28&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;54 &#40;14&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grande 13-24mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gigante<span class="elsevierStyleHsp" style=""></span>&#62;24<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;60 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">T&#233;cnica quir&#250;rgica &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ClippingClip sobre coil previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#47;60 &#40;95&#37;&#41;2&#47;60 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#47;54 &#40;100&#37;&#41;5&#47;54 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Wrapping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abordajes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Miniopen</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#47;60 &#40;86&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;22 &#40;86&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clinoidectom&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;22 &#40;18&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Control radiol&#243;gico general &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas controlados por imagen&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;602&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cierre completo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#47;49 &#40;83&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#47;49 &#40;77&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Control por arteriograf&#237;a &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>aneurismas controlados por arteriograf&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cierre completo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;27 &#40;70&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;47 &#40;76&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello &#60;<span class="elsevierStyleHsp" style=""></span>2mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;27 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;47 &#40;12&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello &#8805;2mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;27 &#40;7&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;47 &#40;10&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necesidad de retratamiento &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>aneurismas totales&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;60 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;54 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab3715518.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis descriptivo entre pacientes en los que se trat&#243; un aneurisma o m&#225;s de un aneurisma en la misma intervenci&#243;n</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaciones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sobre total de pacientes &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isqu&#233;micas &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;82 &#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorr&#225;gicas no HSA &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resangrado aneurism&#225;tico &#40;HSA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;82 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infecciosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;82 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cualquier tipo de complicaci&#243;n &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;82 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintervenci&#243;n por complicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mRS &#8804; 2 en el seguimiento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Nuevo d&#233;ficit neurol&#243;gico focal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mejor&#237;a neurol&#243;gica focal &#40;gigantes&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Mortalidad&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;65 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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Investigación clínica
Aneurismas intracraneales no rotos tratados con microcirugía: análisis de resultados clínicos y radiológicos
Microsurgical clipping of unruptured intracranial aneurysms: clinical and radiological outcomes
Silvia Vázquez Sufuentes
Autor para correspondencia
silviavazquezsufuentes@gmail.com

Autor para correspondencia.
, Loreto Esteban Estallo, Jesús Moles Herbera, Luis Manuel González Martínez, Jouke Sieds van Popta, Juan Casado Pellejero
Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A y B&#41; T&#233;cnica de abordaje minipterional con separaci&#243;n roma de las fibras del m&#250;sculo temporal&#46; C y D&#41; T&#233;cnicas m&#225;s empleadas de clipaje de aneurismas de ACM mediante minicraneotom&#237;a para evitar las &#171;orejas de perro&#187;&#44; siguiendo el concepto de <span class="elsevierStyleItalic">ideal closure line</span>&#46; E y F&#41; Ejemplos de clipaje de aneurismas m&#250;ltiples mediante minicraneotom&#237;a&#58; E&#41; clipaje de aneurisma de AcoA y ACM mediante abordaje lateral supraorbitario derecho&#44; F&#41; clipaje de aneurisma de AchoA derecha&#44; A1 izquierda y top de la basilar mediante abordaje minipterional derecho&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La prevalencia de aneurismas intracraneales no rotos &#40;AINR&#41; en la poblaci&#243;n es del 1-3&#37;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Aproximadamente el 30&#37; de los pacientes con AINR presentan aneurismas m&#250;ltiples<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Debido al aumento en la solicitud de pruebas de imagen y a la mejor calidad de las mismas&#44; cada vez es m&#225;s frecuente el diagn&#243;stico de AINR incidentales<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La tasa de rotura anual de AINR es del 0&#44;3&#37; y el riesgo acumulado en 5 a&#241;os del 3&#44;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a>&#46; Estos porcentajes generales ascienden si el paciente presenta factores de riesgo como hipertensi&#243;n arterial &#40;HTA&#41;&#44; tabaquismo&#44; multiplicidad de aneurismas o presencia de hemorragia subaracnoidea &#40;HSA&#41; previa<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;5</span></a>&#46; Por otro lado el tratamiento de AINR conlleva una morbimortalidad baja&#44; pero no despreciable<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46; Existe controversia respecto al manejo de AINR&#44; ya que el tratamiento de los mismos podr&#237;a suponer un riesgo que superar&#237;a el beneficio de evitar una HSA&#44; en ocasiones devastadora pero poco probable&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En nuestro centro los AINR son valorados en comit&#233; y la indicaci&#243;n de tratamiento se fundamenta en criterios cl&#237;nicos &#40;edad&#44; factores de riesgo de sangrado&#41; y radiol&#243;gicos &#40;localizaci&#243;n&#44; tama&#241;o&#44; morfolog&#237;a&#44; crecimiento&#41;&#46; Si se decide ofrecer tratamiento&#44; se opta por t&#233;cnicas endovasculares o microquir&#250;rgicas en dependencia de las caracter&#237;sticas del paciente&#44; la probabilidad de cierre completo y de complicaciones&#46; Si se indica de manera juiciosa una u otra t&#233;cnica de cierre&#44; la tasa de complicaciones disminuye y la seguridad para el paciente mejora&#46; La microcirug&#237;a aporta una elevada tasa de cierre con resultados duraderos<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Consideramos la presencia de aneurismas m&#250;ltiples un factor de riesgo relevante&#44; especialmente en pacientes que presentaron previamente una HSA&#46; Si uno de los AINR se considera quir&#250;rgico&#44; ofrecemos el clipaje de todos ellos mediante una minicraneotom&#237;a&#46; Para conocer si este manejo supone un mayor riesgo para el paciente pretendemos evaluar los resultados quir&#250;rgicos del clipaje de AINR&#44; comparando los resultados de los subgrupos de las cirug&#237;as en las que se clipa un &#250;nico aneurisma o m&#225;s de uno&#44; as&#237; como los factores de riesgo para el desarrollo de complicaciones posquir&#250;rgicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se trata de un estudio retrospectivo en el que se incluyeron pacientes intervenidos mediante microcirug&#237;a de AINR en nuestro centro en el per&#237;odo 2020-2023&#46; Los criterios de exclusi&#243;n fueron&#58; 1&#41; aneurismas traum&#225;ticos&#44; mic&#243;ticos o asociados a malformaciones vasculares&#44; 2&#41; pacientes intervenidos de AINR durante la cirug&#237;a de un aneurisma roto&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Tras aprobaci&#243;n por parte del comit&#233; de &#233;tica de nuestro hospital&#44; se llev&#243; a cabo la revisi&#243;n de la historia cl&#237;nica electr&#243;nica de los pacientes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se dividi&#243; la muestra en pacientes en los que se clip&#243; un &#250;nico aneurisma o m&#225;s de uno en la misma cirug&#237;a&#46; Se incluyeron las siguientes variables&#58; edad&#44; sexo&#44; tabaquismo&#44; HTA&#44; HSA previa&#44; localizaci&#243;n del aneurisma&#44; tama&#241;o del aneurisma&#44; t&#233;cnica quir&#250;rgica&#44; abordaje&#44; control radiol&#243;gico posquir&#250;rgico y necesidad de retratamiento&#46; Consideramos abordaje <span class="elsevierStyleItalic">miniopen</span> al minipterional&#44; <span class="elsevierStyleItalic">lateral supraorbital approach</span>&#44; al <span class="elsevierStyleItalic">keyhole</span> supraorbitario transciliar o al abordaje interhemisf&#233;rico unilateral&#46; Fuera de este grupo se consider&#243; la craneotom&#237;a pterional cl&#225;sica y el abordaje interhemisf&#233;rico bifrontal&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se divideron las complicaciones en isqu&#233;micas&#44; hemorr&#225;gicas &#40;subaracnoidea y no subaracnoidea&#41;&#44; infecciosas y totales&#46; Se consider&#243; isquemia a toda hipodensidad posquir&#250;rgica en la tomograf&#237;a computarizada &#40;TC&#41; de control congruente con un territorio vascular&#44; sintom&#225;tica o no&#46; Describimos como complicaci&#243;n hemorr&#225;gica cualquier sangrado en TC de control sintom&#225;tico o no&#44; a excepci&#243;n de peque&#241;os vol&#250;menes asintom&#225;ticos en el lecho quir&#250;rgico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se emplea la escala de Rankin modificada &#40;mRS&#41; para definir el estado funcional pre y posquir&#250;rgico de los pacientes durante el seguimiento&#46; Se considera pron&#243;stico desfavorable la aparici&#243;n de cualquier s&#237;ntoma posquir&#250;rgico mantenido &#62;<span class="elsevierStyleHsp" style=""></span>3 meses tras la intervenci&#243;n&#44; lo que se valora como un empeoramiento de la escala mRS en al menos un punto&#46; Esto incluye la afectaci&#243;n cognitiva referida por paciente o familiares&#44; la cefalea o s&#237;ntomas inespec&#237;ficos&#44; como mareos o v&#233;rtigos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para la realizaci&#243;n del an&#225;lisis estad&#237;stico se utiliza el Microsoft Excel y el programa IBM SPSS Statistics versi&#243;n 25&#46;0&#46; Para calcular la normalidad se utiliza la prueba Kolmog&#243;rov-Smirnov&#46; Se considera p-valor &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 estad&#237;sticamente significativo&#46; Para el an&#225;lisis univariante se usa para variables cualitativas chi-cuadrado y variables cuantitativas param&#233;tricas t de Student&#44; y no par&#225;metricas U-de Mann-Whitney&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se intervinieron 82 pacientes de AINR mediante microcirug&#237;a durante el per&#237;odo de 2020-2023&#44; con un total de 114 aneurismas tratados&#46; En 60 pacientes se clip&#243; un &#250;nico aneurisma durante la intervenci&#243;n y en 22 pacientes se cliparon dos o m&#225;s&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Estos 82 pacientes presentaron un total de 173 aneurismas diagnosticados&#46; De estos&#44; 145 recibieron tratamiento endovascular &#40;31&#41; o microquir&#250;rgico &#40;114&#41;&#46; Se trataron el 91&#44;8&#37; de los aneurismas en pacientes que hab&#237;an sufrido una HSA previa&#46; Recibieron un tratamiento mixto 24 pacientes&#44; siendo m&#225;s frecuente entre pacientes que hab&#237;an presentado una HSA &#40;17&#47;24&#58; 70&#44;8&#37;&#41; que entre los que se diagnosticaron de AINR m&#250;ltiples asintom&#225;ticos &#40;7&#47;24&#58; 29&#44;2&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se aprecia una mayor tendencia a tratar aneurismas m&#250;ltiples en casos de HSA previa de otro aneurisma&#44; as&#237; como mayor probabilidad de que estos pacientes reciban un tratamiento mixto&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> la localizaci&#243;n de los 114 AINR intervenidos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se muestra un an&#225;lisis descriptivo comparativo de cada uno de los dos grupos de pacientes a estudio&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Factores de riesgo</span><p id="par0080" class="elsevierStylePara elsevierViewall">Se aprecian dos grupos homog&#233;neos en cuanto a sexo y factores de riesgo&#44; con mayor n&#250;mero de pacientes j&#243;venes &#40;18&#44;3&#37; &#60;<span class="elsevierStyleHsp" style=""></span>46 a&#241;os&#41; en el grupo 1&#46; Un total de 22 pacientes &#40;26&#44;8&#37;&#41; presentaron previamente una HSA&#46; Cinco aneurismas del total de 114 eran de circulaci&#243;n posterior&#44; todos ellos en el grupo 2 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;022&#41;&#46; Se aprecia m&#225;s tendencia a clipar aneurismas peque&#241;os en el grupo de aneurismas m&#250;ltiples&#46; El tama&#241;o medio entre los intervenidos fue de 7&#44;7<span class="elsevierStyleHsp" style=""></span>mm&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">T&#233;cnica quir&#250;rgica</span><p id="par0085" class="elsevierStylePara elsevierViewall">En el grupo 1 hubo 3 casos en los que no se consider&#243; seguro el clipaje y se llev&#243; a cabo un <span class="elsevierStyleItalic">wrapping</span>&#44; lo que supone un 2&#44;6&#37; del total&#46; Se realizaron cinco abordajes interhemisf&#233;ricos &#40;4 aneurismas de ACA distal y uno de AcoA&#41;&#44; uno de ellos doble abordaje interhemisf&#233;rico&#47;minipterional con una misma incisi&#243;n para clipar aneurismas m&#250;ltiples&#46; El resto fueron abordajes laterales&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ambos grupos muestran un porcentaje similar de abordaje <span class="elsevierStyleItalic">miniopen</span> &#40;86&#44;6&#37; vs&#46; 86&#44;4&#41;&#46; La mayor&#237;a de los abordajes convencionales se realizaron en los primeros a&#241;os del estudio&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se ejemplifica la t&#233;cnica quir&#250;rgica&#46; Se aprecia m&#225;s tendencia a emplear clinoidectom&#237;a en los casos de clipaje m&#250;ltiple&#44; probablemente por&#58; 1&#41; los 5 aneurismas de circulaci&#243;n posterior se encuentran en el grupo 2 y se cliparon mediante minipterional o pterional con abordaje temporal anterior&#44; que suele requerir clinoidectom&#237;a anterior y en ocasiones tambi&#233;n posterior&#44; 2&#41; generalmente ante casos de aneurismas simples oft&#225;lmicos o paraclinoideos se ofrece tratamiento mediante <span class="elsevierStyleItalic">stent flow diverter</span> &#40;FD&#41;&#44; sin embargo ante la presencia de varios aneurismas es m&#225;s probable que llevemos a cabo el clipaje de todos ellos&#44; incluidos los paraclinoideos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Oclusi&#243;n del aneurisma</span><p id="par0095" class="elsevierStylePara elsevierViewall">El 87&#44;3&#37; de los pacientes clipados tienen una prueba de imagen de control del cierre&#44; el 41&#44;8&#37; mediante angio-TC y el 58&#44;2&#37; mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#46; El tiempo medio desde la cirug&#237;a al &#250;ltimo control fue de 10 meses &#40;1-37&#41;&#46; Se perdi&#243; el seguimiento en 2 pacientes y 8 tienen pendiente la realizaci&#243;n de la prueba&#46; Los 3 aneurismas tratados con <span class="elsevierStyleItalic">wrapping</span> han seguido controles mediante angio-RM&#44; sin crecimiento de los aneurismas&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Se apreci&#243; el cierre completo del 100&#37; de los aneurismas controlados mediante angio-TC y del 74&#44;3&#37; de los aneurismas seguidos mediante arteriograf&#237;a&#46; El 90&#44;3&#37; de los pacientes clipados seguidos por arteriograf&#237;a presentan un cuello &#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La tasa de cierre completo entre ambos grupos es similar&#44; aunque ligeramente mayor en el grupo 1 &#40;83&#44;7 vs&#46; 77&#44;6&#37;&#41;&#44; debido a que la mayor parte de los pacientes controlados mediante angio-TC pertenecen al grupo 1&#46; Dos pacientes del grupo 1 y 5 del grupo 2 presentaron un cuello &#8805;2<span class="elsevierStyleHsp" style=""></span>mm &#40;2-5<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; sea por presencia de calcificaciones&#44; por salida de perforantes o riesgo de afectaci&#243;n de las mismas o por una t&#233;cnica de clipaje inadecuada&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cuatro aneurismas intervenidos requirieron retratamiento &#40;3&#44;5&#37;&#41;&#44; ya que no se consider&#243; haber conseguido una prevenci&#243;n &#243;ptima de crecimiento o sangrado&#58; 1&#41; aneurisma fusosacular de A2 que recreci&#243; entre clips y fue tratado mediante <span class="elsevierStyleItalic">FD</span>&#44; 2&#41; aneurisma de arteria cerebral media &#40;ACM&#41; contralateral cerrado parcialmente por el clip&#44; tratado con coils&#44; 3&#41; aneurisma trilobulado de AcoA en el que se apreci&#243; persistencia del tet&#243;n posterosuperior&#44; tratado con <span class="elsevierStyleItalic">FD</span> y 4&#41; aneurisma de AcoA clipado por minipterional con resto de 2&#44;8<span class="elsevierStyleHsp" style=""></span>mm&#44; que requiri&#243; abordaje interhemisf&#233;rico&#46; Todos presentaron cierre completo tras el tratamiento&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Complicaciones y situaci&#243;n funcional &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Se aprecia una tasa de sangrado&#47;resangrado y de mortalidad del 0&#37;&#44; con una morbilidad posquir&#250;rgica significativa &#40;empeoramiento de &#8805;2 puntos de mRS&#41; del 1&#44;2&#37;&#46; Por lo tanto&#44; durante el seguimiento el 98&#44;8&#37; de los pacientes presentaron una buena o muy buena situaci&#243;n funcional&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Seis pacientes &#40;7&#44;3&#37;&#41; presentaron un empeoramiento de un punto en la escala mRS&#58; d&#233;ficit neurol&#243;gico leve &#40;2&#41;&#44; mareos &#40;1&#41;&#44; empeoramiento cognitivo &#40;2&#41; y empeoramiento de cefalea previa &#40;1&#41;&#46; Tres pacientes &#40;3&#44;7&#37;&#41; mejoraron un punto debido a la disminuci&#243;n del efecto de masa&#46; Una paciente present&#243; mRS<span class="elsevierStyleHsp" style=""></span>&#62;2 despu&#233;s de la cirug&#237;a&#44; pasando de mRS 2 a mRS 5 tras presentar un infarto de ACM tras clipaje de aneurisma de ACI-oft&#225;lmica de 22<span class="elsevierStyleHsp" style=""></span>mm&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se visualiza la situaci&#243;n funcional de los pacientes intervenidos&#46; Seis de los 8 pacientes que presentaban un mRS 2 prequir&#250;rgico hab&#237;an sufrido una HSA por otro aneurisma&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Se diagnosticaron adem&#225;s tres isquemias silentes &#40;3&#44;7&#37;&#41;&#44; todas ellas en circulaci&#243;n anterior &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Ninguno de los pacientes refiere afectaci&#243;n cognitiva pero solo un caso fue confirmado mediante test neuropsicol&#243;gicos&#46; Tres pacientes presentaron complicaciones hemorr&#225;gicas &#40;3&#44;7&#37;&#41;&#46; Ninguno requiri&#243; intervenci&#243;n quir&#250;rgica&#44; pero un paciente empeor&#243; su situaci&#243;n basal y requiri&#243; un ingreso prolongado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Dos pacientes &#40;2&#44;4&#37;&#41; presentaron una infecci&#243;n posquir&#250;rgica&#44; una de ellas superficial y otra intracraneal &#40;empiema&#41;&#59; ambos precisaron reintervenci&#243;n&#46; Otra paciente fue reintervenida con anestesia local para retirar un tapatr&#233;panos que le molestaba&#44; por lo que la tasa de reintervenci&#243;n por complicaciones fue del 3&#44;7&#37;&#46; Tres pacientes &#40;3&#44;7&#37;&#41; presentaron un d&#233;ficit neurol&#243;gico &#40;cuadro cl&#237;nico completo de isquemia de ACM izquierda&#44; afectaci&#243;n parcial del III pc y cuadrantanopsia&#41; tras la intervenci&#243;n&#44; mientras que otros tres presentaron mejor&#237;a neurol&#243;gica al disminuir el efecto de masa &#40;resoluci&#243;n de la afectaci&#243;n del III pc y hemiparesia&#41; tras trombectom&#237;a intraaneurism&#225;tica&#46; El an&#225;lisis univariante de las complicaciones se puede observar en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0140" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> no se aprecia mayor morbimortalidad en aquellas cirug&#237;as en las que se clipa m&#225;s de un aneurisma&#44; tampoco en las realizadas por t&#233;cnica <span class="elsevierStyleItalic">miniopen</span>&#44; ni en las que se realizan a pacientes que han sufrido previamente una HSA&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Se aprecian diferencias estad&#237;sticamente significativas en la probabilidad de isquemia posquir&#250;rgica en cirug&#237;as en las que se lleva a cabo el clipaje de un aneurisma de circulaci&#243;n posterior&#46; Esto no implica una mayor probabilidad de empeoramiento de la situaci&#243;n funcional&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">El 30&#37; de los AINR se rompen a lo largo de la vida de un paciente<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46; En los estudios ISUIA<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> y UCAS<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> se describieron seis factores de riesgo independientes de rotura&#58; tama&#241;o&#44; localizaci&#243;n&#44; rotura de otro aneurisma previo&#44; edad&#44; HTA y origen geogr&#225;fico&#46; Se han identificado otros factores que favorecen el sangrado<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2&#44;7&#44;10</span></a>&#58; tabaquismo&#44; multiplicidad de aneurismas&#44; HSA &#8805;2 familiares de primer grado y caracter&#237;sticas asociadas al propio aneurisma como irregularidad&#44; crecimiento&#44; mayor <span class="elsevierStyleItalic">aspect ratio&#44;</span> localizaci&#243;n en ACoP e inflamaci&#243;n de la pared&#46; El 9&#37; de los AINR presentan crecimiento en el seguimiento en 2&#44;8 a&#241;os y el 45&#37; en 19<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#44; lo que incrementa la probabilidad de rotura en un 0&#44;2-2&#44;4&#37;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">No existe un consenso sobre la actitud a tomar en pacientes con aneurismas m&#250;ltiples tras HSA&#44; aunque es conocido que ambos criterios de manera individual aumentan el riesgo de sangrado<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;12&#44;13</span></a>&#46; La tasa de rotura en pacientes con aneurismas m&#250;ltiples y HSA previa es el doble que en pacientes con aneurismas simples &#40;3 vs&#46; 1&#44;5&#37;&#41;&#44; especialmente en aneurismas irregulares&#44; grandes y localizados en ACM<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a>&#46; Por otro lado&#44; el tratamiento de aneurismas m&#250;ltiples en una misma intervenci&#243;n no parece aumentar el riesgo de complicaciones&#44; incluso con el uso de varias craneotom&#237;as<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Ni las gu&#237;as de manejo cl&#237;nico<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> ni las escalas de decisi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;16&#44;17</span></a> aportan evidencia suficiente para apoyar la toma de decisiones<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;18&#44;19</span></a>&#46; Por dicho motivo&#44; es imprescindible individualizar el tratamiento de estos pacientes teniendo en cuenta los resultados obtenidos por cada unidad o centro&#46; Por un lado debe valorarse la capacidad de evitar el sangrado y por otro ha de tenerse en cuenta la morbilidad generada por el propio tratamiento&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">En nuestro estudio se establece una tasa de cierre completo del 81&#44;63&#37;&#44; que disminuye a 74&#44;32&#37; cuando se eval&#250;an solamente los casos controlados mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los art&#237;culos previos no consideran la arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D como prueba de control posquir&#250;rgico&#44; reportando tasas de cierre del 94&#44;7&#37;&#44; valoradas con angio-TC o arteriograf&#237;a 2<span class="elsevierStyleHsp" style=""></span>D<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;21</span></a>&#46; Un estudio reciente<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> eval&#250;a las tasa de cierre mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D&#44; consiguiendo un cierre completo en el 76&#44;9&#37; de los casos&#46; Describen que el 59&#37; de los cuellos remanentes no hab&#237;an sido visualizados en angiograf&#237;a 2<span class="elsevierStyleHsp" style=""></span>D&#46; Mientras que ning&#250;n aneurisma con cierre completo recreci&#243; o sangr&#243;&#44; el 11&#44;8&#37; de los aneurismas con cierre incompleto presentaron crecimiento durante el seguimiento&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La heterogeneidad de los estudios no permite establecer qu&#233; se considera un cierre adecuado de un AINR<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> e incluso en series modernas se emplea la angio-TC para definir el cierre completo<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46; Sin embargo&#44; parece apropiada la realizaci&#243;n de un primer control posquir&#250;rgico mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D para definir qu&#233; pacientes necesitar&#225;n seguimiento &#40;en torno a un 20&#37; de los mismos&#44; especialmente j&#243;venes y con aneurismas de mayor tama&#241;o&#41;&#46; En nuestra serie se observ&#243; un cierre completo mediante arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D del 74&#44;3&#37;&#44; mientras que mediante angio-TC del 100&#37;&#46; No obstante si consideramos un cierre adecuado persistencia de un cuello &#60;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm&#44; el porcentaje de aneurismas con cierre completo o adecuado asciende al 90&#44;3&#37; de los pacientes clipados seguidos por arteriograf&#237;a y al 92&#44;9&#37; de los seguidos mediante ambas pruebas&#46; Por lo tanto&#44; seg&#250;n estos resultados se observa una mayor sensibilidad de la arteriograf&#237;a como t&#233;cnica para diagnosticar remanentes no ocluidos del aneurisma&#46; Este dato podr&#237;a ser analizado con mayor profundidad en pr&#243;ximos estudios&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; el 3&#44;5&#37; de los AINR clipados requirieron retratamiento&#44; ninguno por crecimiento o sangrado&#46; El empleo de t&#233;cnicas endovasculares &#40;3&#47;4 casos&#41; no hace sino reforzar nuestro manejo multidisciplinar&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Por otro lado&#44; el objetivo de tratar AINR es evitar la rotura de los mismos&#46; La tasa de sangrado de pacientes clipados fue del 0&#37; en nuestra serie&#44; aunque se trata de un periodo corto de seguimiento&#46; Por ello&#44; se han revisado las 274 HSA aneurism&#225;ticas tratadas en nuestro hospital en el periodo 2017-2023&#44; observando que ninguna de ellas se produjo en pacientes previamente intervenidos por microcirug&#237;a&#44; ni tampoco en pacientes que hubieran presentado HSA previamente por otro aneurisma&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Las complicaciones secundarias al tratamiento microquir&#250;rgico de AINR han disminuido de manera considerable en las &#250;ltimas d&#233;cadas&#44; con tasas de mortalidad en torno al 0-1&#44;7&#37; y morbilidad del 4&#37;-10&#44;9&#37;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#46; En un estudio multic&#233;ntrico<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> basado en 2245 casos tratados de una cohorte internacional se describe la tasa de resultados adecuados tras clipaje de AINR&#58; mRS &#8804;2 &#8805;95&#44;9&#37;&#44; complicaciones posquir&#250;rgicas &#8804;20&#44;7&#37;&#44; estancia hospitalaria &#8804;7&#44;7 d&#237;as&#44; infarto asintom&#225;tico &#8804;3&#44;6&#37;&#44; infecci&#243;n quir&#250;rgica &#8804;2&#44;7&#37;&#44; vasoespasmo &#8804;2&#44;5&#37; y focalidad neurol&#243;gica &#8804;5&#44;9&#37;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En nuestro trabajo observamos una probabilidad de mRS &#8804;2 del 98&#44;9&#37;&#44; con una mortalidad del 0&#37;&#46; Sin embargo&#44; dado que los pacientes intervenidos de AINR se encuentran en su mayor&#237;a asintom&#225;ticos o paucisintom&#225;ticos antes de la cirug&#237;a&#44; consideramos m&#225;s apropiado medir cualquier empeoramiento en la situaci&#243;n funcional del paciente&#44; aunque sea leve&#46; Un 7&#44;3&#37; de nuestros pacientes presentaron un empeoramiento leve que no les impide las actividades habituales&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Los factores asociados a complicaciones m&#225;s com&#250;nmente descritos en la literatura<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> son&#58; edad<span class="elsevierStyleHsp" style=""></span>&#62;50 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a>&#44; sexo femenino&#44; coagulopat&#237;a&#44; anticoagulaci&#243;n&#44; tabaquismo&#44; HTA<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a>&#44; DM <a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a>&#44; fallo card&#237;aco congestivo&#44; circulaci&#243;n posterior<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20&#44;26&#44;27&#44;30</span></a>&#44; calcificaciones y tama&#241;o del aneurisma<span class="elsevierStyleHsp" style=""></span>&#62;12mm<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;28</span></a>&#46; En la presente serie la tasa de complicaciones fue del 12&#44;2&#37;&#44; incluyendo las asintom&#225;ticas&#44; con necesidad de reintervenci&#243;n por las mismas del 3&#44;7&#37;&#46; Se aprecia una mayor probabilidad de complicaciones isqu&#233;micas en los casos intervenidos de aneurismas de circulaci&#243;n posterior&#44; aunque se trata en nuestro trabajo de 3 isquemias asintom&#225;ticas y de territorio ACM o ACA en el contexto del clipaje de otros aneurismas presentes&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Ni la cirug&#237;a en pacientes que previamente presentaron HSA&#44; ni el clipaje de varios aneurismas en la misma intervenci&#243;n&#44; ni el empleo de abordajes <span class="elsevierStyleItalic">miniopen</span> han supuesto una mayor probabilidad de complicaciones o empeoramiento funcional&#46; Los abordajes MIS ofrecen tasas de oclusi&#243;n aneurism&#225;tica similares a las craneotom&#237;as convencionales&#44; un menor tiempo quir&#250;rgico&#44; menor probabilidad de par&#225;lisis facial y atrofia temporal &#40;12&#37; vs&#46; 35&#37;&#41; y mayor satisfacci&#243;n del paciente&#44; calidad de vida y resultado est&#233;tico<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Es dif&#237;cil generalizar si los riesgos de la cirug&#237;a suponen un beneficio frente a la probabilidad de sangrado de AINR&#46; Cada caso debe ser evaluado de manera individual&#44; ya que riesgos no asumibles para un paciente con baja probabilidad de sangrado pueden ser adecuados en otro con un aneurisma m&#225;s inestable&#46; La toma de decisiones debe llevarse a cabo por un equipo multidisciplinar capaz de valorar las ventajas e inconvenientes de cada t&#233;cnica&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitaciones</span><p id="par0215" class="elsevierStylePara elsevierViewall">El presente estudio est&#225; sujeto a limitaciones&#46; En primer lugar&#44; el car&#225;cter retrospectivo del mismo que ha podido generar datos perdidos&#46; En segundo lugar&#44; se trata de un estudio unic&#233;ntrico por lo que est&#225; basado solo en la serie de nuestro centro&#46; Finalmente&#44; no todos los pacientes de la serie ten&#237;an un control arteriogr&#225;fico posquir&#250;rgico y no se ha valorado la complejidad de los aneurismas&#46; Por ello podr&#237;a plantearse en un futuro la realizaci&#243;n de un estudio multic&#233;ntrico prospectivo en el que todos los pacientes fueran sometidos para evaluar la tasa de cierre a una arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D y se recogiera el grado de complejidad de los anuerismas&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusiones</span><p id="par0220" class="elsevierStylePara elsevierViewall">La selecci&#243;n de la t&#233;cnica de cierre en el tratamiento de AINR tiene que ser individualizada y para ello debemos conocer los resultados obtenidos por cada grupo&#46; Con una correcta selecci&#243;n de pacientes&#44; la microcirug&#237;a supone una opci&#243;n eficiente con una mortalidad y una probabilidad de sangrado aneurism&#225;tico del 0&#37; en nuestra serie y una probabilidad de morbilidad severa del 1&#44;2&#37;&#46; El clipaje de aneurismas m&#250;ltiples mediante minicraneotom&#237;a en pacientes que han sufrido previamente una HSA no supone un riesgo a&#241;adido&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0230" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no&#160;ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Background and objectives"
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          "titulo" => "Introducci&#243;n"
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              "identificador" => "sec0020"
              "titulo" => "Factores de riesgo"
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            1 => array:2 [
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              "titulo" => "T&#233;cnica quir&#250;rgica"
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              "titulo" => "Oclusi&#243;n del aneurisma"
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              "titulo" => "Complicaciones y situaci&#243;n funcional &#40;tabla 3&#41;"
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              "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2024-02-29"
    "fechaAceptado" => "2024-06-23"
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            0 => "Clipaje"
            1 => "Aneurismas intracraneales no rotos"
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            3 => "Pron&#243;stico"
            4 => "Complicaciones"
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          "clase" => "keyword"
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            0 => "Clipping"
            1 => "Unruptured intracranial aneurysms"
            2 => "Multiple intracranial aneurysms"
            3 => "Outcomes"
            4 => "Complications&#46;"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de aneurismas intracraneales no rotos es de un 1-3&#37;&#46; La tasa de rotura anual aumenta en pacientes con aneurismas m&#250;ltiples que han sufrido una hemorragia de uno de ellos&#46; Los objetivos son evaluar los resultados quir&#250;rgicos del clipaje de aneurismas no rotos&#44; comparando pacientes en los que se clipa un &#250;nico o varios y describir las complicaciones de las intervenciones de aneurismas no rotos estableciendo los factores de riesgo de un pron&#243;stico desfavorable&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo que incluye pacientes intervenidos de aneurismas no rotos mediante microcirug&#237;a entre 2020-2023 en nuestro centro&#46; Se analiza la tasa de cierre&#44; las complicaciones y el resultado funcional de los pacientes&#46; Se identifican los factores de riesgo de mal pron&#243;stico con un modelo univariante&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se intervinieron 82 pacientes con 114 aneurismas&#46; En 22 pacientes se clip&#243; m&#225;s de un aneurisma durante la intervenci&#243;n&#46; El 86&#44;5&#37; de las intervenciones se realizaron mediante abordaje <span class="elsevierStyleItalic">miniopen&#46;</span> El 78&#44;6&#37; de los aneurismas seguidos por arteriograf&#237;a 3<span class="elsevierStyleHsp" style=""></span>D presentan cierre completo&#46; La tasa de complicaciones fue del 12&#44;2&#37;&#44; incluyendo asintom&#225;ticas&#46; La mortalidad fue del 0&#37;&#46; La probabilidad de empeorar el mRS 1 punto fue del 7&#44;3&#37; y 2 o m&#225;s del 1&#44;2&#37;&#44; con buen resultado funcional en el 98&#44;9&#37;&#46; El clipaje de varios aneurismas en una misma intervenci&#243;n&#44; empleo de minicraneotom&#237;as o la cirug&#237;a en pacientes con hemorragia subaracnoidea previa no increment&#243; el riesgo de complicaciones&#46; La cirug&#237;a de aneurismas de circulaci&#243;n posterior aument&#243; el riesgo de isquemia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La indicaci&#243;n de cirug&#237;a de aneurismas intracraneales no rotos debe de ser consensuada multidisciplinarmente&#44; conociendo resultados cl&#237;nicos y radiol&#243;gicos&#46; La microcirug&#237;a es una t&#233;cnica v&#225;lida y segura&#44; con una mortalidad 0&#37; y una morbilidad severa del 1&#44;2&#37; en nuestra serie&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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          1 => array:2 [
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            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The prevalence of unruptured intracranial aneurysms is 1-3&#37;&#46; The annual rupture rate increases in patients with multiple aneurysms that presented a previous hemorrhage from another aneurysm&#46; Objectives were evaluate outcomes of clipping unruptured aneurysms&#44; comparing patients with single or multiple aneurysms clipped&#44; describe the complications related to surgery and to identify risk factors predicting an unfavorable outcome&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Materials and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective study including patients who underwent clipping of unruptured aneurysms between 2020-2023 at our center&#46; Occlusion rate&#44; complications&#44; and functional outcome were analyzed&#46; Risk factors for poor prognosis are identified using univariate model&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">82 patients with 114 aneurysms were treated wit microsurgery&#46; Multiple aneurysms were clipped in 22 patients&#46; A mini-open approach was used in 86&#44;5&#37; of cases&#46; Complete occlusion in angio3D was found in 78&#46;6&#37; of clipped aneurysms&#46; Complication rate was 12&#46;2&#37;&#44; including asymptomatic cases&#46; Mortality was 0&#37;&#46; The probability of 1 point mRS worsening was 7&#46;3&#37; and 2 or more points was 1&#46;2&#37;&#44; with a good functional outcome in 98&#46;9&#37;&#46; Clipping multiple aneurysms&#44; miniopen approaches&#44; or surgery in patients with previous subarachnoid hemorrhage did not increase the risk of complications&#46; Posterior circulation aneurysms surgery increased the risk of ischemia&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The management for unruptured intracranial aneurysms should be multimodal and based on clinical and radiological outcomes&#46; Microsurgery is a valid and safe technique&#44; with 0&#37; mortality and bleeding rates and 1&#44;2&#37; rate of severe morbidity in our serie&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#47;114 &#40;16&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">AB-ACS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#47;22 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35&#47;60 &#40;58&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#47;22 &#40;72&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62;65 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">14&#47;60 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;22 &#40;27&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">0&#44;717&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#47;60 &#40;73&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#47;22 &#40;77&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#47;60 &#40;26&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#47;22 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tabaquismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32&#47;60 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#47;22 &#40;54&#44;54&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;922&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">HTA</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&#47;60 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#47;22 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;217&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HSA previa</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#47;60 &#40;23&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#47;22 &#40;36&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n del aneurisma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;022</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circulaci&#243;n anterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#47;60 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#47;54 &#40;90&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circulaci&#243;n posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;60 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;54 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tama&#241;o del aneurisma &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;011</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peque&#241;o &#60;<span class="elsevierStyleHsp" style=""></span>7mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;60 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#47;54 &#40;85&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mediano 7-12mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;60 &#40;28&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;54 &#40;14&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Grande 13-24mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gigante<span class="elsevierStyleHsp" style=""></span>&#62;24<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;60 &#40;6&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">T&#233;cnica quir&#250;rgica &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ClippingClip sobre coil previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#47;60 &#40;95&#37;&#41;2&#47;60 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#47;54 &#40;100&#37;&#41;5&#47;54 &#40;9&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Wrapping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;54 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abordajes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Miniopen</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#47;60 &#40;86&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;22 &#40;86&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clinoidectom&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;60 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;22 &#40;18&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Control radiol&#243;gico general &#40;N</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">aneurismas controlados por imagen&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;602&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cierre completo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#47;49 &#40;83&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#47;49 &#40;77&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Control por arteriograf&#237;a &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>aneurismas controlados por arteriograf&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cierre completo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#47;27 &#40;70&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;47 &#40;76&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello &#60;<span class="elsevierStyleHsp" style=""></span>2mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;27 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;47 &#40;12&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cuello &#8805;2mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;27 &#40;7&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;47 &#40;10&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Necesidad de retratamiento &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>aneurismas totales&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;60 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;54 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis descriptivo entre pacientes en los que se trat&#243; un aneurisma o m&#225;s de un aneurisma en la misma intervenci&#243;n</p>"
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sobre total de pacientes &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isqu&#233;micas &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;82 &#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemorr&#225;gicas no HSA &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resangrado aneurism&#225;tico &#40;HSA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;82 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infecciosas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;82 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cualquier tipo de complicaci&#243;n &#40;incluye asintom&#225;ticas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;82 &#40;12&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reintervenci&#243;n por complicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">mRS &#8804; 2 en el seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#47;82 &#40;98&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empeoramiento mRS en 1 punto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;82 &#40;7&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Empeoramiento mRS en 2 puntos o m&#225;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;82 &#40;1&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nuevo d&#233;ficit neurol&#243;gico focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mejor&#237;a neurol&#243;gica focal &#40;gigantes&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;82 &#40;3&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mortalidad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;82 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;65 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#47;62 &#40;6&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;568&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#47;62 &#40;16&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;62 &#40;9&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62; 65a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;61 &#40;4&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#47;61 &#40;8&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;144&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#47;61 &#40;9&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;671&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;21 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#47;21 &#40;23&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;21 &#40;4&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Posterior&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 11301473
Idioma original: Español
DOI:10.1016/j.neucir.2024.06.004
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Septiembre 2 2 4

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