[Endoscopic treatment of mine-explosive spine injuries: 3 clinical cases and literature review]. / Endoskopicheskoe lechenie minno-vzryvnykh ranenii pozvonochnika: 3 klinicheskikh nablyudeniya i obzor literatury.

Modern warfare is characterized by common mine-explosive injuries. The last ones are accompanied by multiple injuries, large area of damage and severe clinical status of victims. OBJECTIVE: To demonstrate treatment of mine-explosive spinal injuries using modern minimally invasive endoscopic techniques. MATERIAL AND METHODS: The authors present 3 victims with various mine-explosive injuries. Endoscopic removal of fragments from the lumbar and cervical spine was successful in all cases. DISCUSSION: Most of victims with injuries of the spine and spinal cord do not require urgent surgery and can underwent surgical treatment after clinical stabilization. At the same time, minimally invasive techniques provide surgical treatment with minimal risk and earlier rehabilitation, as well as reduce the risk of infectious complications associated with foreign bodies. CONCLUSION: Careful selection of patients for spinal video endoscopy will ensure positive outcomes. Minimization of iatrogenic postoperative injuries is especially important in patients with combined trauma. However, well-experienced surgeons should perform these procedures at the stage of specialized medical care.

[New surgical treatment for vertebral artery pseudoaneurysm at the boundary between the V2 and V3 segments].

The clinical case of a patient with a pseudoaneurysm of the left vertebral artery at the boundary between V(2) and V(3) segments after a stab wound to the neck is reported. The patient underwent a rare variant of surgical reconstruction of the vertebral artery, including resection of the vertebral artery pseudoaneurysm at the boundary between the V(2) and V(3) segments, the vertebrovertebral autovenous shunting (from the C(IV) vertebra to the C(I)-C(II) vertebrae with resection of the anterior wall of the vertebral artery canal). Postoperatively, SCT angiography revealed satisfactory blood flow in the shunt and improvement of the neurological status. The article provides a literature review on surgical procedures at the distal portion of the vertebral artery. The surgical technique was illustrated (intraoperative photos), demonstrating that the vertebral artery can be easily mobilized at any part of the V(2) segment with minimum damage to the adjacent tissues.

[Surgical treatment of the internal carotid artery atherosclerotic occlusion].

Internal carotid artery occlusion is the cause of carotid territory transient ischemic attacks or infarction approximately in 15% of patients. Extracranial-lntracranial (EC-IC) Bypass Study and Carotid Occlusion Surgery Study (COSS) failed to show a benefit of EC-IC bypass over medical therapy in patients with symptomatic carotid artery occlusion. Weak sides of COSS were investigators reliance on post hoc analysis, use of specific thresholds in the definition of impaired cerebral hemodynamics and high perioperative morbidity. In selected subset of patients with medically refractory ischemic symptoms, EC-IC bypass, can provide benefit from surgery performed with sufficiently low perioperative morbidity. The potential of functional and cognitive improvement after cerebral revascularization needs further investigation.

[Carotid endarterectomy or carotid stenting: optimal therapeutic decision-making for patients with carotid artery stenoses].

The work was aimed at comparatively studying the outcomes of carotid endarterectomy and carotid stenting for optimal therapeutic decision-making in patients presenting with carotid artery stenoses. We examined and treated a total of one hundred and sixty-seven patients. In the group of endarterectomy, we performed a total of 91 operations in 85 patients, and in the group of carotid stenting, a total of 87 stenting procedures were carried out on the internal carotid artery with cerebral protection in 82 patients. This was followed by analysing both short- and long-term outcomes with a follow-up period ranging from 1 year to 3 years. We examined the following postoperative parameters: «stroke + lethality¼, incidence of transitory ischaemic attacks, as well as the rate of craniocerebral neuropathy and acute myocardial infarction. In the remote period we evaluated the prevalence rate of the parameter «stroke + myocardial infarction + lethality¼, as well as restenosis recurrence. In the carotid-endarterectomy group, the predictors of unfavourable surgical outcomes were contralateral occlusion (p=0.048) and cardial pathology (p=0.0245). In the group of carotid stenting, these predictors turned out to be a heterogeneous atherosclerotic plaque with an uneven or ulcerated contour (p=0.004), and the degree of cerebrovascular insufficiency (p=0.005).

[Comparative analysis of carotid-subclavian transposition and stenting in case of stenotic damage of subclavian artery].

So carotid-subclavian transposition and stenting are effective and safe methods of correction of occlusive subclavian artery disease. Angioplasty and stenting of the subclavian artery is particularly indicated in patients with high surgical risk. Patients at low risk of surgery is preferred execution carotid-subclavian transposition.

[Topographic-anatomic grounding cervical-distalvertebral reconstruction of V3 segment vertebral artery vertebral artery].

Using 10 block-mounts "brain-base of skull- cervical spine" there were detected morphometric peculiarities of vertebral artery on the level C(I)-C(II) of spines of vertebra and of premastoidal part of cervical artery. Were effectuated 20 distalvertebral reconstructions. Were precised stages and technique of realization.

[Assessing efficacy and risk factors of carotid endarterectomy and carotid stenting in patients with symptomatic stenoses of internal carotid arteries in early postoperative period].

The present work was aimed at comparative assessment of efficacy and risk factors of carotid endarterectomy and carotid stenting in patients suffering from symptomatic stenoses of the internal carotid arteries, with due regard for the degree of the accompanying cardiac pathology, the presence of contralateral occlusion, and severity of chronic cerebrovascular insufficiency. We examined and treated a total of 142 patients diagnosed with stenoses of the internal carotid arteries and symptoms of chronic cerebrovascular insufficiency. In the cohort of those subjected to carotid endarterectomy we performed a total of 76 operations in 73 patients, and in the group of carotid stenting 71 operations of stenting of the internal carotid artery with cerebral protection in 69 patients. Postoperatively we assessed the following parameters: «stroke+lethality¼, incidence of transitory ischaemiс attacks, incidence rate of cerebrovascular neuropathy, and acute myocardial infarction. In the carotid endarterectomy group, we revealed increased risk for the development of neuropathy of the craniocerebral nerves (OR=0.0564, 95% CI 0.9953, P=0.049). In the group of stenting, we revealed increased risk for the development of transitory ischaemia.

[Surgical correction of cerebral blood flow steal syndrome by aortic branches stenosis].

Results of surgical treatment of 119 patients with cerebral/coronary blood flow steal syndrome were analyzed. Vertebro-subclavian steal syndrome was registered in 91.5%. 80 patients were treated with the use of endovascular methods, open procedure was performed in 62 cases. Physiological blood flow was successfully reconstructed in 95.8%. Postoperative lethality was 5,1% after open operations, there were no deaths among patients, treated endoscopically. Bypass thrombosis was registered in 3.4% of patients treated by traditional method; restenosis or occlusion occurred after 34.3% of endovascular operations. Endovascular operations should be a method of choice in treatment of patients with severe occlusion of branches of aorta and cerebro-vascular insufficiency. By impossibility of subclavian artery or brachiocephal trunk recanalization with the use of endovascular techniques, open procedure should be performed.

[Aneurysmal degeneration of the autovenous carotid-subclavian bypass: experience with the treatment, review of literature].

The authors describe an experience gained with successful surgical treatment of a 73-year-old patient with a genuine aneurysm of the autoveinous carotid-subclavian bypass, iwelve years ago the patient was operated on for stenosing atherosclerosis of the coronary and left subclavian arteries (SCA). Aneurysm emergence was consequent on the use of v.saphena magna as a bypass in the given <> and was not associated with appreciable circulatory disorders in the left upper limb. However, its further existence was conjugated with the risk of rupture and bleeding. Examination (duplex scanning, angiography) confirmed the diagnosis of aneurysm. Besides, critical stenosis of segment I of the left SCA and opening of the left internal carotid artery (ICA) were verified as well. The patient was operated on: the first stage involved angioplasty and stenting of segment I of the left SCA; the second stage involved carotid endarterectomy on the left, resection of bypass aneurysm together with its disengagement. On control angiography performed 11 months later the patency of the reconstructed arteries appeared satisfactory; stenosis was not recorded. The given case demonstrates a modern approach to the treatment of patients with coexistent vascular pathology (atherosclerotic stenosis plus aneurysm).

[Kimmerle's anomaly and stroke]. / Anomaliia Kimmerle i mozgovoi insul't.

The anomaly of cranio-vertebral area can frequently be the reason of acute cerebrovascular disorders in vertebro-basilar field. The frequent C1 pathology in the Kimmerle's anomaly. The anatomic studies has shown that 30% of people had this type of anomaly. This pathology can lead to severe vascular diseases of cerebrum because of the squeezing effect upon vertebral arteries in the zone of osteal ponticulus of the rear arch of atlas.