Methods of endovascular surgery of an aneurysm of cerebral arteries
An increase in cases of vascular, cardiac, atherosclerosis, aortic disease requires a constant search for solutions this problem, so scientists and physicians are actively working on the invention of new diagnostic techniques and treatment. In addition to traditional medication and standard recommendations for monitoring progression diseases, are now widely introduced into everyday medical practice, endovascular surgical methods.
Their meaning consists in the non-invasive delivery of a medicinal product or a special device for the purpose of embolizing a vessel, restoration of its lumen, removal of thrombotic masses, as well as in oncology for targeted exposure to the tumor with the help of chemo- and radiotherapy.
- Endovascular surgery of cerebral artery aneurysms: methods
- Indications for endovascular surgery
- What is an aneurysm of the cerebral vessels?
- Preparation for endovascular intervention
- Methods of conducting endovascular surgical interventions
- Advantages of endovascular interventions
- Risks of endovascular treatment of cerebral aneurysms
- Consequences after an operation of an aneurysm of cerebral vessels
Endovascular surgery of cerebral artery aneurysms: methods
Among the types of endovascular surgical interventions on vessels, the following methods are distinguished.
- Install special tools and devices. A long catheter is carried to the site of the vascular problem through a large femoral vein. At its free end is attached balloon, stent or microspiral.
- Cylinders are installed to open the lumen of the vessels during angioplasty.
- Stents - mesh tubes that are placed inside the vessel to stabilize its walls, especially when it has atherosclerotic plaques, and restore its patency.
- Spirals are special devices that block the flow of blood through the vessels. The most commonly used for the treatment of cerebral aneurysms.
- Catheters are traps for the removal of thrombi and the removal of tissue debris in neurosurgical operations.
- Delivery of medicines for the purpose of dissolving thrombotic masses, conducting targeted chemotherapy malignant tumors, as well as drugs that have an antispasmodic effect on the muscular layer of the arteries, which improves the blood flow in them.
- The introduction of embolizing substances that stop the flow of blood throughout a specific area of the vessel. Most often used sclerosants based on alcohol, glue-like materials, for example, N-butylcyanacrylate, as well as special gels, foams, produced in the form of microspheres.
Indications for endovascular surgery
Non-invasive techniques are widely used in oncology, for example, to stop or reduce the blood supply of a large tumor, if it can not be removed at once. Or vice versa, the restoration of blood flow during stroke or the threat of its occurrence. And also for angioplasty with vascular malformations of the brain, such as an operation for an aneurysm of the brain. Vascular changes are the following:
- Aneurysms - protrusion of the walls of blood vessels in the weakest of its places.
- The pathological change in the shape of the vessel is a tortuosity and an expansion, as a result of which the rate of blood flow changes, which leads to increased tromobiogenesis.
- The communication between the vessels, for example between the veins and the arteries through the fistula, as a result of which the high-oxygenated arterial blood mixes with the venous, rich in carbon dioxide.
What is an aneurysm of the cerebral vessels?
The aneurysm of the vessel is the protrusion of the wall at the site of its most severe weakening and thinning. With increased blood pressure, there is a risk of stratification, rupture and bleeding in the brain tissue, into the ventricles or underneath its membranes.
There are several reasons for the formation of aneurysms. First, an inborn violation of the formation of muscle fibers of the vascular wall, as well as the structure of connective tissue. Of the acquired conditions - atherosclerosis, which causes inflammation and over the site of narrowing in the zone of the plaque forming the area of expansion of the vessel.
Aneurysms come in many forms:
- lateral - as a tumor of the vessel wall;
- saccate - protrusion, in which an anatomically distinguish the cervix, the body and the dome of the aneurysm;
- spindle-shaped - protrusion over the vessel, making it wide curved.
Dimensions of aneurysms:
- small (up to 3 mm);
- medium (from 4 to 15 mm);
- Large (from 16 to 25 mm);
- giant (more than 25 mm).
Preparation for endovascular intervention
Such a serious operation is preceded by a whole complex of preparatory measures. These include:
- conversation with the attending physician, during which he finds out all the necessary information for the exact establishment of the final diagnosis,
- time of occurrence and precise localization of an aneurysm.
It should be said about the previous surgical interventions, their results and the course of general anesthesia. About the presence of various devices implanted in the body: defibrillators, rhythm drivers, neurostimulants, inner ear prostheses, eyes, central vascular catheters.
At the same time, the doctor determines the drugs, the use of which must be canceled two to three days before the procedure. These include aspirin preparations that have a hemorrhage effect, as well as some drugs that are used for hypertension and heart failure. It is also necessary to inform the doctor about the available drug allergy, used for contrasting, especially iodine-containing, antibiotics and non-steroidal anti-inflammatory drugs.
For a qualitative full-fledged assessment of the patient's health, a number of tests are prescribed:
- clinical blood test,
- a blood test to determine the level of sugar,
- infectious diseases: viral hepatitis B, syphilis,
- as well as general analysis of urine,
- and analysis of feces for the detection of eggs of worms.
Instrumental examination before surgery includes:
- fluorography of the chest,
- Ultrasound of the abdominal cavity and retroperitoneal space.
Women of childbearing age should be given a pregnancy test, especially if an X-ray is planned, because it has a teratogenic and embryotoxic effect..
After that, the doctor gives exhaustive instructions for the preparation for the operation, as well as information about its course, stages and postoperative period.
Methods of conducting endovascular surgical interventions
If there is a narrowing of the area of the vessel that threatens the development of a stroke, it is shown that its patency is restored with the help of medical instruments. For this procedure, the patient is immersed in general anesthesia and intravenously injected with a contrast agent.
At this time he is on the operating table, the puncture site of the femoral vein is treated in a special way with antiseptic means and covered with sterile sheets. In the peripheral vein, most often in the area of the elbow fold, put a catheter for infusion, so that the possibility of introducing solutions and funds for anesthesia.
Life indicators are controlled with the help of special equipment, which connect and fix the heart rate, blood pressure, electrocardiogram, degree of oxygen saturation of blood.
In the operating room, there should be a radiographic unit, through which the catheter moves along the vessels to the established portion of the vessel. Then, through the free end of the boat, a special occlusal device is placed in the vessel, or it must be fixed in advance. It is ensured that it is installed reliably, one of the criteria is the complete restoration of blood flow.
Treatment of brain aneurysms is carried out using a spiral, the action of which is the opposite. Fibrin threads, blood cells settle on it and, thus, a thrombus is gradually formed blocking the course of the blood and further increasing the aneurysm.
The endovascular embolization of the brain aneurysm possesses a similar action, the preparations for which are delivered in the same way through the catheter. After it was possible to reach the site of protrusion or vascular malformation, a sclerosing substance is introduced, for example, on the basis of alcohol.
There is a burn of the inner surface of the vessel and the walls are glued together. The blood flow is stopped along the pathologically altered vessel, the progression of growth of the wall defect is suspended, the probability of rupture and the emergence of a massive intracerebral bleeding.
Another, no less effective, method of treating vascular aneurysms is stereotactic radiosurgery. The procedure of exposure to radiological radiation on pathologically altered vessels absolutely does not require any incisions or punctures. A beam of gamma radiation through the tissue falls exactly to the location of the aneurysm. This is possible thanks to special calculations, which are carried out by doctors of radiation therapy, the radiation is not actually dissipated, minimizing the effect on surrounding healthy tissues.
The patient's head is placed in a special fixing frame. It is fixed with special screws. Before installation, the scalp is obezbalivaetsya on the forehead and on the back of the head. Such a device ensures reliable immobilization of the patient's head and prevents from accidental involuntary jerking. This also increases the accuracy of the direction of the gamma rays. As a result, there is also a thickening of the vessel wall, and complete occlusion can be achieved in a few years, sometimes repeated X-ray endovascular procedures are required.
After the manipulation is completed, take a series of shots after a certain time to make sure the plugging of the vessel is reliable. The catheter is carefully removed, and the site of the puncture is treated and sealed with a patch, or a pressure bandage is applied. The duration of the operation, depending on the complexity, is about 30-40 minutes. After it, the patient is shown bed rest for eight hours.
Advantages of endovascular interventions
If there is a need to remove the aneurysm of the cerebral vessels, it is better to opt for endovascular techniques. Their most important and undeniable advantage is minimally invasive. To insert the catheter, no large access is required, a small incision or even a puncture is sufficient. At the end of the operation, no need to apply stitches, enough of a small bandage. Malostrauma of endovascular operations significantly reduces the time of hospitalization of patients. The extract can be planned for the next day after the intervention. The risk of such unpleasant consequences as scarring and serious complications in the form of recurrence of bleeding, joining of a secondary bacterial infection decreases.
For emergency operations, for example, with massive bleeding, embolization of cerebral aneurysms is more effective and requires less time.
The introduction of such methods of treatment allowed to help people whose illness was previously considered incurable.
In some cases, such an operation can be performed under local anesthesia using sedatives. This is especially true for patients whose concomitant diseases are a contraindication for general anesthesia.
Risks of endovascular treatment of cerebral aneurysms
- Possibility of repeated bleeding due to puncture of the vascular wall, poor installation of spirals, due to structural features and the size of the aneurysms. There are large protrusions with wide necks, in which a spiral is difficult to install without additional microclimbing or embolization with sclerosants.
- Risk of infection of the puncture site, development of phlebitis.
- Migration of stents and spirals, as well as embolizing materials from the place of their introduction. But, the development of cerebral stroke is unlikely, the devices are equipped with special grids that do not interfere with blood flow. It is very rare when repeated surgery is necessary.
- Development of an allergic reaction to a contrast agent that is life-threatening.
- Recurrent thrombosis and stroke. Difficulties in speech, visual and memory impairments, problems with coordination and movements, convulsive attacks.
- Complication, in the form of cerebral edema.
Consequences after an operation of an aneurysm of cerebral vessels
Rehabilitation after the operation of an aneurysm of the brain does not take a long time, the patients actually return to everyday life and work immediately. Until the end of the restoration takes about two months. Patients can complain about such symptoms:
- non-intensive headaches,
- Discomfort and swelling at the puncture site,
- as well as general weakness.
In general, the consequences after removal of the brain aneurysm are rare.
To such people, the attending physician gives recommendations concerning the lifestyle, work and rest regime, as well as a list of medications that must be taken in the postoperative period. It is necessary to remember the need to monitor the results of treatment six months and a year after the operation with the help of computed tomography.
In detecting an asymptomatic course of the disease, it makes sense to carry out preventive endovascular treatment of cerebral aneurysms to prevent severe consequences... .