RESUMO
OBJECTIVE: To develop the principles for the treatment of traumatic intracranial aneurysms after combat damage to skull and brain. MATERIAL AND METHODS: There were 18 patients with traumatic intracranial aneurysms from February 2022 to the present. Of these, 15 ones had gunshot penetrating wounds of the skull and brain. In 3 cases, aneurysms developed after explosive injury. All patients underwent computed tomography (CT) of the brain, CT angiography of brain vessels and selective cerebral angiography. We analyzed nature of brain damage, trajectory of the wounding projectile and aneurysm location to determine predictors of traumatic intracranial aneurysms. Surgical treatment was performed in all cases. RESULTS: Hemorrhagic manifestations were observed in 11 patients. In 4 cases, traumatic intracranial aneurysms were diagnosed before rupture. Blunt head injury was followed by subarachnoid hemorrhage in 2 cases and ischemic stroke in 1 case. Endovascular or microsurgical intervention was performed depending on location of aneurysm, clinical manifestations and severity of brain damage. In case of distal aneurysms, endovascular and microsurgical destructive interventions prevailed. At the same time, proximal aneurysms (within or below the circle of Willis) required reconstructive endovascular treatment. CONCLUSION: Traumatic aneurysms should be suspected in all patients with penetrating craniocerebral injuries. Follow-up is contraindicated for traumatic intracranial aneurysms due to high risk of hemorrhage.
Assuntos
Lesões Encefálicas , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/cirurgia , Angiografia Cerebral/métodos , Hemorragia Subaracnóidea/cirurgia , Tomografia Computadorizada por Raios X/métodosRESUMO
The authors present dopplerographic predictors of cognitive status dynamics of patients undergoing carotid angioplasty with stenting. It was stated that the cognitive status dynamics depended on the initial condition of patients and reactivity coefficient on hypercapnia in target vascular pool.
Assuntos
Artérias Carótidas/cirurgia , Estenose das Carótidas , Circulação Cerebrovascular/fisiologia , Transtornos Cognitivos/diagnóstico , Cognição/fisiologia , Complicações Pós-Operatórias/diagnóstico , Idoso , Angioplastia/efeitos adversos , Angioplastia/métodos , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Stents , Ultrassonografia Doppler Dupla/métodosRESUMO
Modern angiographic complexes allow performing emulation of computed tomography (CT). Comparison of the resolving power of XperCT and CT indicated sufficient sensitivity of the new technology in detection of focal lesions of the brain, the possibility of its application in interventional neuroradiology. The application of XperGuide allows control the position of the instrument during operation directly without using additional equipment of moving the patient. The application of XperGuide decreases the risk of intra- and early postoperative complications.
