RESUMO
The article discusses results of surgical treatment of 82 patients with large and giant cerebral aneurysms operated in Burdenko Neurosurgical Institute (Moscow, Russia) during the recent 14 years. Special attention was given to benefits of intravascular blood aspiration (IBA) technique. This technique was proven to be very effective, allowing to clip the aneurysm in 87.8% of cases with good recovery in 41.5% and with moderate disability in 39%. Postoperative mortality was 4.9% (4 patients). The authors suggested original surgical classification of large and giant aneurysms. IBA was ineffective in cases of giant partially thrombosed aneurysms with sclerotic walls and giant aneurysms with very wide neck. These aneurysms require other surgical procedures such as embolization of ICA followed by extraintracranial bypass or high-flow bypass.
Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Microcirurgia/métodos , Adulto , Idoso , Aneurisma/complicações , Aneurisma/diagnóstico , Aneurisma/mortalidade , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/mortalidade , Feminino , Humanos , Masculino , Microcirurgia/tendências , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Sucção/métodos , Resultado do Tratamento , Adulto JovemRESUMO
A mechanical device for making arterial wide-section anastomoses was tested on a series of 15 laboratory rabbits. End-to-side anastomoses were made using a vein graft and they functioned in 93.1% of cases, as evidenced by intraoperative Doppler studies. When an anastomosis is made, the mean duration of temporary blood flow arrest in the rabbit aorta averaged 2 min. According to outcomes, the survived animals were divided into 3 groups: Group 1 comprised 2 (13.3%) rabbits that died within 10-12 hours after surgery and had significant symptoms of anastomotic dysfunction. Group 2 included 8 (53.3%) animals that died 2-3 days after surgery. They moved 5-6 hours following surgery without assistance, which was indicating of anastomotic functioning. Group 3 consisted of 3 (20%) rabbits that survived 2 weeks. Autoptic studies revealed no anastomic thrombosis in Group 2 animals. Group 3 animals were noted to have signs of allograft thrombosis and rejection. Thus, it is expedient to continue studies to make arterial wide-section anastomoses, by using the above device, in order to introduce this procedure into clinical practice.
