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1.
Artigo em Russo | MEDLINE | ID: mdl-29076471

RESUMO

The article describes a case of one-stage surgical treatment of a patient with progressive chronic cerebral ischemia caused by combined steno-occlusive lesions of the carotid and vertebral arteries. The disease was complicated by intolerance to temporary occlusion of the carotid artery due to an incomplete circle of Willis. We performed extra-anatomic carotid-vertebral artery bypass with subsequent ipsilateral carotid endarterectomy. A temporary intraluminal shunt was used at the main stage of reconstructive surgery. We use this clinical case to analyze the issues of surgical treatment for combined lesions of the carotid and vertebral arteries and the techniques for prevention of associated ischemic complications.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Artéria Vertebral , Insuficiência Vertebrobasilar , Idoso , Anastomose Cirúrgica , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/cirurgia , Doença Crônica , Humanos , Masculino , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/fisiopatologia , Artéria Vertebral/cirurgia , Insuficiência Vertebrobasilar/diagnóstico por imagem , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/cirurgia
2.
Artigo em Russo | MEDLINE | ID: mdl-28524130

RESUMO

The article describes a case of successful surgical treatment of an 81-year-old male patient with symptomatic occlusion of the internal carotid artery that led to severe impairment of cerebral hemodynamics and was accompanied by severe gait and equilibrium disorders. Given the patient's age and his positive medical history, he underwent surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia, with spontaneous breathing and a baseline level of consciousness being maintained. In the postoperative period, the patient achieved a marked clinical effect in the form of complete regression of syncopal conditions and gait disorders associated with recovery of cerebral perfusion in the right MCA territory. The article discusses the indications for surgical treatment and the technical details of surgery for the creation of an extracranial-intracranial microvascular anastomosis under regional anesthesia.


Assuntos
Anestesia por Condução/métodos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Revascularização Cerebral/métodos , Idoso de 80 Anos ou mais , Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Angiografia por Ressonância Magnética , Masculino , Resultado do Tratamento , Ultrassonografia Doppler Dupla
3.
Artigo em Russo | MEDLINE | ID: mdl-29393281

RESUMO

The main aim of the study was to investigate the effect of carotid endarterectomy on the prognosis of chronic cerebral ischemia in patients with symptomatic occlusions of the contralateral internal carotid artery, assess risks of surgical complications, and substantiate the staged surgical approach for treatment of patients with this pathology. The article analyzes the experience in surgical treatment of 83 patients with symptomatic ICA occlusions who underwent surgery for contralateral carotid artery stenosis. In 40 patients, only carotid endarterectomy (CEA) was performed on the side of hemodynamically significant stenosis (group 1). In 43 (52%) cases, apart from CEA, extracranial-intracranial (EC-IC) bypass was performed at the second stage (23 cases, group 2) or the first stage (19 cases, group 3). A surgical treatment approach was chosen based on clinical symptoms, severity of contralateral carotid artery stenosis, and the magnitude of perfusion deficiency in the territory of carotid occlusion. The conducted analysis revealed that patients with symptomatic occlusions and contralateral carotid artery stenoses represented a heterogeneous group with a different efficacy of carotid endarterectomy and with risks of perioperative complications. As cerebrovascular insufficiency in the territory of carotid occlusion and a related neurological deficit worsen, the risks of complications of contralateral carotid endarterectomy increase, and its clinical efficacy decreases. In these cases, cerebral revascularization on the ICA occlusion side should be performed at the first stage.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-27070258

RESUMO

PURPOSE: The article analyzes results of surgical revascularization in patients with symptoms of chronic cerebral ischemia caused by occlusion of the carotid arteries. MATERIAL AND METHODS: We analyzed 404 surgeries for placement of extra-intracranial microvascular anastomoses (EICMAs) performed in 376 patients between 2000 and 2015. All patients underwent detailed neurological and neuropsychological examinations before surgery and throughout the follow-up period using the neurological deficit scale (NIHSS). Additionally, the medical history data, technical features of surgery, and results of instrumental tests were recorded. For a more detailed study of the cerebral circulation, a SCT perfusion examination was conducted in 58 patients before and after placement of EICMA. RESULTS: All patients were divided into 3 groups, depending on the surgical treatment outcomes: improvement (53%), without significant changes (43%), and worsening of clinical symptoms (4%). A statistical analysis revealed that the efficacy of EICMA surgery ranged from 22 to 79% and was reliably confirmed by hemodynamic and anamnestic factors as well as by technical details of surgery. CONCLUSION: When determining the indications for surgical revascularization in patients with ischemic stroke consequences, the patient's age, occlusion duration, location and size of ischemic lesions should be considered. Also, the choice of the acceptor artery and blood flow through the created anastomosis are of great importance.


Assuntos
Isquemia Encefálica/cirurgia , Revascularização Cerebral , Acidente Vascular Cerebral/cirurgia , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-27070260

RESUMO

The article presents a case of successful surgical treatment of a patient with progressive chronic cerebral ischemia due to occlusions of both internal carotid arteries combined with occlusion of the vertebral artery in the first and second segments. We describe a surgical technique that includes an auto arterial carotid-subclavian bypass in the third segment of the vertebral artery, with an extracranial portion of the occluded internal carotid artery (after preliminary thromboendarterectomy) being used as a shunt. Previously, the patient had undergone surgery for creating bilateral EICMA. We analyzed the indications for each phase of the surgery with allowance for the peculiarities of compensatory collateral circulation and possible complications of the surgical treatment.


Assuntos
Anastomose Cirúrgica/métodos , Artéria Carótida Interna , Estenose das Carótidas , Revascularização Cerebral/métodos , Artéria Vertebral , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Vertebral/patologia , Artéria Vertebral/cirurgia
6.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-28139576

RESUMO

AIM: The study purpose was to present a clinical case of spinal stroke in a pregnant female, which was caused by an endodermal cyst of the cervical spinal cord, and to analyze treatment tactics. RESULTS: A 20 week pregnant female presented with acute transverse spinal cord injury at the of C3-C5 spinal segment level. CT revealed an extramedullary space-occupying lesion in the ventrolateral position, with compression of the spinal cord at this level. The patient in the state of progressive deterioration with respiratory failure was transferred to the Neurosurgical Institute on the 5th day after disease onset. The patient underwent surgery on the 7th day after disease onset. Doctors of various specialties participated in preparation for surgery. During surgery, total resection of the space-occupying lesion and spinal cord decompression were performed. An obstetrician-gynecologist conducted intraoperative fetal monitoring by ultrasound. The histological diagnosis was an endodermal cyst. There was no improvement of neurological symptoms in the early postoperative period. After stabilization of the condition, the patient was discharged for follow-up care at the place of residence. According to the follow-up report, the patient underwent the cesarean section because of exacerbation of lung infection and a significant delay in the fetal development. After a few days, the patient died due to multiple organ failure. The child was alive, in serious condition, under mechanical ventilation. CONCLUSION: In the case of spinal stroke, the decision on treatment tactics should be made no later than 12 hours after its onset; otherwise, the outcome is usually unfavorable, and a neurological deficit is irreversible. The decision about continuing pregnancy should be made individually in each case, and an approach to the choice of appropriate treatment tactics should be multi-disciplinary.


Assuntos
Cistos/diagnóstico , Complicações na Gravidez/diagnóstico , Isquemia do Cordão Espinal/diagnóstico , Medula Cervical/irrigação sanguínea , Medula Cervical/patologia , Cistos/complicações , Cistos/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Gravidez , Resultado da Gravidez , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/cirurgia , Adulto Jovem
7.
Anesteziol Reanimatol ; 60(4): 4-8, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26596023

RESUMO

Awake craniotomy is a "gold standard"for intraoperative brain language mapping. One of the main anesthetic challenge of awake craniotomy is providing of optimal sedation for initial stages of intervention. The goal of this study was comparison of different technics of anesthesia for awake craniotomy. Materials and methods: 162 operations were divided in 4 groups: 76 cases with propofol sedation (2-4mg/kg/h) without airway protection; 11 cases with propofol sedation (4-5 mg/kg/h) with MV via LMA; 36 cases of xenon anesthesia; and 39 cases with dexmedetomidine sedation without airway protection. Results and discussion: brain language mapping was successful in 90% of cases. There was no difference between groups in successfulness of brain mapping. However in the first group respiratory complications were more frequent. Three other technics were more safer Xenon anesthesia was associated with ultrafast awakening for mapping (5±1 min). Dexmedetomidine sedation provided high hemodynamic and respiratory stability during the procedure.


Assuntos
Sedação Consciente/métodos , Craniotomia/métodos , Dexmedetomidina , Propofol , Xenônio , Adulto , Sedação Consciente/efeitos adversos , Craniotomia/efeitos adversos , Humanos , Máscaras Laríngeas , Monitorização Intraoperatória , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial
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