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Serie de la arteria vertebral izquierda, proyecciones lateral B) y anteroposterior C). Aneurisma gigante fusiforme en los dos tercios inferiores de la arteria basilar. Se descartaron opciones terapéuticas como el sacrificio del vaso principal o la reconstrucción asistida con <span class="elsevierStyleItalic">stent</span> por la edad de la paciente y consideraciones anatómicas.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Secuencias T1 y recuperación de la inversión atenuada de fluido (FLAIR) de RM: postoperatorio inmediato (D y E) y seis meses de postoperatorio (F y G). Las imágenes muestran una reducción progresiva del saco aneurismático y resolución parcial del efecto masa y la hidrocefalia obstructiva.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana Gutiérrez-Vélez, Clara Ferrero García-Loygorri, Mariano Del Valle Diéguez, Juan Vicente Darriba Alles" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ana" "apellidos" => "Gutiérrez-Vélez" ] 1 => array:2 [ "nombre" => "Clara" "apellidos" => "Ferrero García-Loygorri" ] 2 => array:2 [ "nombre" => "Mariano" "apellidos" => "Del Valle Diéguez" ] 3 => array:2 [ "nombre" => "Juan Vicente" "apellidos" => "Darriba Alles" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287924001169" "doi" => "10.1016/j.anpede.2024.03.050" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924001169?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320305348?idApp=UINPBA00005H" "url" => "/16954033/0000009500000003/v1_202109030550/S1695403320305348/v1_202109030550/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2341287924000851" "issn" => "23412879" "doi" => "10.1016/j.anpede.2024.03.030" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "3074" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2024;100:e26-e27" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "Perineal mass at birth" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e26" "paginaFinal" => "e27" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Masa en el periné al nacimiento" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1531 "Ancho" => 2094 "Tamanyo" => 333719 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Perineal mass that had undergone exstrophy between the right outer fold of the vulva, which was hypertrophic, and the anus: (A) appearance on initial examination; (B) improved visualization of its relationship with adjacent perineal anatomic structures; (<span class="elsevierStyleSmallCaps">C</span>) surgical specimen.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ignacio Arroyo Carrera, Carlos Manuel Ojeda Espino, Rafael Ayuso Velasco, Yoana Franco Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Arroyo Carrera" ] 1 => array:2 [ "nombre" => "Carlos Manuel" "apellidos" => "Ojeda Espino" ] 2 => array:2 [ "nombre" => "Rafael" "apellidos" => "Ayuso Velasco" ] 3 => array:2 [ "nombre" => "Yoana" "apellidos" => "Franco Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320305415" "doi" => "10.1016/j.anpedi.2020.12.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320305415?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924000851?idApp=UINPBA00005H" "url" => "/23412879/0000010000000004/v1_202404250845/S2341287924000851/v1_202404250845/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S234128792400084X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2024.03.029" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "2973" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "An Pediatr (Barc). 2024;100:e21-e23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "Vitamin D deficiency as cause of rickets in a patient of African origin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e21" "paginaFinal" => "e23" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Raquitismo carencial en un paciente de raza negra" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1623 "Ancho" => 2092 "Tamanyo" => 214890 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imaging features suggestive of rickets, with significant osteopenia and diaphyseal fracture in both fibulas associated with periosteal reaction. General long bone metaphyseal widening, cupping and fraying. Marked longitudinal widening of the growth plates. Generalised bowing of long bone diaphyses.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patricia Rubio Sánchez, Marta Ferrer Lozano" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Patricia" "apellidos" => "Rubio Sánchez" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Ferrer Lozano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320304161" "doi" => "10.1016/j.anpedi.2020.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320304161?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128792400084X?idApp=UINPBA00005H" "url" => "/23412879/0000010000000004/v1_202404250845/S234128792400084X/v1_202404250845/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Paediatrics</span>" "titulo" => "Diffuse subarachnoid haemorrhage with obstructive hydrocephalus in a 4-year-old girl" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e24" "paginaFinal" => "e25" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Gutiérrez-Vélez, Clara Ferrero García-Loygorri, Mariano Del Valle Diéguez, Juan Vicente Darriba Alles" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ana" "apellidos" => "Gutiérrez-Vélez" "email" => array:1 [ 0 => "ana.gutierrez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Clara" "apellidos" => "Ferrero García-Loygorri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Mariano" "apellidos" => "Del Valle Diéguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Juan Vicente" "apellidos" => "Darriba Alles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Urgencias Pediátricas, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Radiología Vascular e Intervencionista, Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia subaracnoidea difusa con hidrocefalia obstructiva en niña de 4 años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3574 "Ancho" => 1352 "Tamanyo" => 379811 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The CT scan showed subarachnoid haemorrhage and obstructive hydrocephalus.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cerebral angiogram. Left vertebral artery series: (B) lateral view and (C) anteroposterior view. Giant fusiform aneurysm in the two lower thirds of the basilar artery. Treatment options like parent artery sacrifice or stent-assisted reconstruction were ruled out on account of the age of the patient and anatomical considerations.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">T1-weighted and FLAIR (fluid-attenuated inversion recovery) MRI images: (D) and (E) immediate postoperative period, and (F) and (G) 6 months after surgery. The images show a progressive reduction of the aneurysmal pouch and partial resolution of mass effect and obstructive hydrocephalus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A girl aged 4 years was brought to the emergency department for assessment intense headache and vomiting the onset of which was followed by an episode of loss of consciousness and hypotonia that lasted 5 min. The patient presented with pallor and a Glasgow Coma Scale of 14 points. The mother reported that the patient had suffered from chronic headache for one year. The findings of a CT scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) prompted placement of an external ventricular drain. The angiogram (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C) revealed the presence of an aneurysm in the basilar artery.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Parent artery sacrifice and stent-assisted reconstruction were ruled out as treatment options like were ruled out on account of the age of the patient and anatomical considerations. Flow reversal in the parent artery was considered the optimal approach, as the balloon occlusion test of the single left vertebral (with extreme hypoplasia of the right vertebral artery), was performed under neurophysiological monitoring and achieved an adequate deviation of basilar flow. Thus, the aneurysm was managed through endovascular occlusion of the left vertebral artery past the posterior cerebellar artery. An MRI scan was performed after the endovascular intervention (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D–G). The patient was discharged at 34 days free of neurologic sequelae.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cerebral aneurysms are infrequent in children, with an estimated incidence of 0.5%–4.6%. The most common clinical manifestation is headache, followed by syncope and seizures. Partially thrombosed giant aneurysms are a particular subset of aneurysms that should be considered a separate clinical and pathological entity. Due to its histological characteristics and the tendency to exert a mass effect, the optimal treatment is the sacrifice of the parent vessel with open or endovascular surgery. In this article, we present the second paediatric case managed with this approach in our hospital.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any external funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3574 "Ancho" => 1352 "Tamanyo" => 379811 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) The CT scan showed subarachnoid haemorrhage and obstructive hydrocephalus.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cerebral angiogram. Left vertebral artery series: (B) lateral view and (C) anteroposterior view. Giant fusiform aneurysm in the two lower thirds of the basilar artery. Treatment options like parent artery sacrifice or stent-assisted reconstruction were ruled out on account of the age of the patient and anatomical considerations.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">T1-weighted and FLAIR (fluid-attenuated inversion recovery) MRI images: (D) and (E) immediate postoperative period, and (F) and (G) 6 months after surgery. The images show a progressive reduction of the aneurysmal pouch and partial resolution of mass effect and obstructive hydrocephalus.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000004/v1_202404250845/S2341287924001169/v1_202404250845/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000004/v1_202404250845/S2341287924001169/v1_202404250845/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287924001169?idApp=UINPBA00005H" ]
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