Common Challenges in Different Invasive Operation methods Used in Treatment and Closure of Cerebral Aneurysms
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Cerebālo artēriju aneirismas parasti ir maisveidīgi cerebrālo asinvadu paplašinājumi, kuri lokalizējas lielo artēriju bifurkācijas vietās un to sieniņas ir plānākas salīdzinot ar normālu asinsvada sienu. Aneirismu izveidošanās dažādās smadzeņu daļās var būtiski atšķirties, kas var apgrūtināt identificēt atbilstošas cerebrālo asinsvadu lokālas problēmas. Pie riska faktoriem pieder augsts asinsspiediens, smēķēšana un alkohola pārmērīga lietošana. Somijā un Japānā aneirismu plīsumi ir trīs reizes biežāk kā citur pasaulē, kā rezultātā no tiem ir lielāka mirstībā salīdzinot pat ar negadījumiem.
Aneirismas plīsums ir dzīvībai bīstama asiņošana smadzeņu subarahnoidālajā telpā un letalitātes procents ir samērā augsts. Pacienti parasti ir vidēja vecuma darba spējīgi cilvēki.
Plīsušu un intaktu aneirismu ārstēšanā izmanto modernas ķirurģiskas metodes, kā piemēram, kraniotomija, kuras laikā aneirismas maiss tiek direkti slēgts ar metāla klipu vai arī invazīvās radioloģijas metode, kad intraarteriāli nokļūst līdz aneirismai un veic tās koilēšanu ar platīna spirālēm vai arī asinsvada sieniņas protezēšanu ar asins plūsmas modulatoru. Labākais veids kā salīdzināt dažādas aneirismu invazīvās ārstēšanas tehnikas un metodes ir novērtēt kā pacientu blakussaslimšanas ir ietekmējušas veiksmīga rezultātu sasniegšanu. Dažādu ārstēšanas metožu, pēc- operācijas klīnisko rezultātu, un aneirismu rekanalizācijas statistikas salīdzināšana ir svarīga pareizā lēmuma pieņemšanā. Tehniski veiksmīgas ārstēšanas rezultātu palīdz izvērtēt pēcoperācijas angiogrāfijas dati.
Izpratne par aneirismu attīstību palīdzēs identificēt iespējamās problēmas jau agrīni, kā arī veicinās ārstus un citu medicīnas personālu izmantot piemērotākās ārstēšanas metodes.
Šajā darbā es apskatīšu literatūru un pētījumus par smadzeņu aneirismu attīstību un to ārstēšanu. Es aprakstīšu aneirismu tipus un to atšķirības atkarībā no izmēra un lokācijas, kā arī īsu apskatu par to agrīno attīstību un blakus slimībām, kas tās varētu ietekmēt. Tiks apskatīts arī laika logs un iespējamās ārstēšanas metodes, kuras var tikt izmantotas, lai glābtu pacienta dzīvību un izvairītos no aneirismas ruptūras, kā arī vairāku blakus slimību esamības ietekme uz ārstēšanu. Darbā tiks analizētas dažādas aneirismas, kas bieži vien tiek konstatētas kā nejaušs atradums, ja vien tās nav plīsušas. Pētījumā salīdzināšu dažādas ārstēšanas metodes balstoties uz pacientu un ķirurgu individuālo pieeju, atkarībā no operācijas veida un tās gaitas. Literatūras apskatā izvērtēšu dažādas ārstēšanas metodes, ko izmanto neiroķirurgi un ko novēroju arī pati piedaloties LinncParis2018 un LinncSingapore2018 neiroķirurgu konferencēs. Klīniskie gadījumi, dažādi neiroķirurgi, dažādas pieejas, metodes un materiāli.Jautājums vēl joprojām pastāv – ārstēt aneirismu ar atvērtās ķirurģijas metodi vai endovaskulāri? Šajā darbā tiks aprakstīti pētījuma rezultāti, kas atbalsta manus pieņēmumus.
Aneurysms of different cerebral arteries are typically a sac-like projection and the wall of which is markedly more fragile than that of a normal blood vessel and most often they are found in the major branching points of large cerebral arteries. The nature of the development of aneurysms in different parts of the brain vary widely, which is likely to make it difficult to identify exact disturbances on different cerebral vessels. Risk factors include high blood pressure, smoking and alcohol abuse. It is almost three times more common in Finland and Japan than anywhere else in the world, causing more casualties than accidents. Sudden bursting of an aneurysm causes life-threatening hemorrhage in the subarachnoid space surrounding the brain. Patients are usually of working age and mortality is high. Modern methods of sealing a leaking and also unruptured aneurysms include either surgery performed through craniotomy and direct occlusion of the bulge with a metal clip or endovascular surgery done with intraarterial occlusion with thin platinum wires (so-called coiling) and flow-diverters on a x-ray table. The best way to evaluate the different techniques used in invasive treatment methods when treating aneurysms, is to evaluate successful rates and comorbidities influencing to the results. When analyzing and evaluating the outcomes of operations, clinical and technical success combined with non-occlusion percentages are corner stones. Understanding the development of aneurysms and the implications of it will help to identify possible problems in aneurysm development earlier as well as support doctors and medical field generally to incorporate appropriate measures. In this article, I review the literature and studies that have been made about the development and treatment of brain aneurysms. I describe the nature of aneurysms and their differences depending on size and location. I give a short review of early development of aneurysms and comorbidities affecting them including the time and possible methods needed to take actions in order to save a patient and avoid the rupture of the aneurysm. I describe the simultaneous comorbidities affecting the patient ́s treatment and their characteristics. I will be analyzing the nature of aneurysm, which is actually silent, often found as an accidental finding, unless rupturing occurs. I will compare different methods selected based on patients and surgeon ́s individual aspects affecting to the course and the nature of the operation. In my literature review I will be evaluating different methods used by neurosurgeons andobserved myself while participating in LinncParis2018 and LinncSingapore2018 neurosurgeon conferences. Live cases, different neurosurgeons, different approaches and different new treatment materials. The big question remains: To treat the aneurysm with open surgery or with endovascular approach? In this review I will describe research findings supporting my conclusions.
Aneurysms of different cerebral arteries are typically a sac-like projection and the wall of which is markedly more fragile than that of a normal blood vessel and most often they are found in the major branching points of large cerebral arteries. The nature of the development of aneurysms in different parts of the brain vary widely, which is likely to make it difficult to identify exact disturbances on different cerebral vessels. Risk factors include high blood pressure, smoking and alcohol abuse. It is almost three times more common in Finland and Japan than anywhere else in the world, causing more casualties than accidents. Sudden bursting of an aneurysm causes life-threatening hemorrhage in the subarachnoid space surrounding the brain. Patients are usually of working age and mortality is high. Modern methods of sealing a leaking and also unruptured aneurysms include either surgery performed through craniotomy and direct occlusion of the bulge with a metal clip or endovascular surgery done with intraarterial occlusion with thin platinum wires (so-called coiling) and flow-diverters on a x-ray table. The best way to evaluate the different techniques used in invasive treatment methods when treating aneurysms, is to evaluate successful rates and comorbidities influencing to the results. When analyzing and evaluating the outcomes of operations, clinical and technical success combined with non-occlusion percentages are corner stones. Understanding the development of aneurysms and the implications of it will help to identify possible problems in aneurysm development earlier as well as support doctors and medical field generally to incorporate appropriate measures. In this article, I review the literature and studies that have been made about the development and treatment of brain aneurysms. I describe the nature of aneurysms and their differences depending on size and location. I give a short review of early development of aneurysms and comorbidities affecting them including the time and possible methods needed to take actions in order to save a patient and avoid the rupture of the aneurysm. I describe the simultaneous comorbidities affecting the patient ́s treatment and their characteristics. I will be analyzing the nature of aneurysm, which is actually silent, often found as an accidental finding, unless rupturing occurs. I will compare different methods selected based on patients and surgeon ́s individual aspects affecting to the course and the nature of the operation. In my literature review I will be evaluating different methods used by neurosurgeons andobserved myself while participating in LinncParis2018 and LinncSingapore2018 neurosurgeon conferences. Live cases, different neurosurgeons, different approaches and different new treatment materials. The big question remains: To treat the aneurysm with open surgery or with endovascular approach? In this review I will describe research findings supporting my conclusions.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Arteriovenozās anomālijas priekšpusē artēriju artērija Bioresorbējams magnija sakausējuma stents Cerebrospinālais šķidrums Datortomogrāfija, Ehlera Danlosa sindroms, Pietiekama sānu pieeja (ELA), Endovaskulāra ārstēšana Plūsmas novirzīšanas endoluminālā ierīce Intrakraniālas aneirismas, Anterior communicating artery, Arteriovenous malformations, Bioresorbable magnesium-alloy stent, Cerebrospinal fluid, Computed tomography, Ehlers Danlos Syndrome, Enough lateral approach (ELA), Endovascular treatment, Flow-Redirection, Endoluminal Device, Intracranial aneurysms