Pub Date : 2023-02-16DOI: 10.26683/2786-4855-2022-3(41)-38-45
O.L. Nikishyn, I. Altman, I.I. Al-Qashgish, A. I. Gavretskiy, S. I. Savoluk, M. Muz
Objective ‒ to analyze the results of endovascular revascularization of the femoropopliteal segment with drug-eluting stents. Materials and methods. Endovascular intervention was performed in 23 patients with stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 10 men (43.5 %), 13 women (56.5 %). The mean age of the patients was (66.0 ± 3.5) years. There were 16 (69.6 %) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (23.4 %) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (56.5 %) cases, intermittent claudication ‒ in 5 (21.7 %). Isolated lesions of the femoral-popliteal segment were noted in 3 (13.4 %) patients, lesions of the iliac and femoral-popliteal segments ‒ in 4 (17.4 %), lesions of the femoral-popliteal and ankle segments ‒ in 16 (69.6 %). Results. Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. Among postoperative complications, 3 (13.04 %) patients had puncture site hematomas that did not require surgical evacuation. In 6 (26.1 %) patients, signs of reperfusion syndrome were observed, which were treated with conservative treatment. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. In 1 (5.0 %) case, a hemodynamically significant stenosis of the SFA was observed outside the implanted stent. The patient successfully underwent angioplasty of SFA stenosis. There were no «major» amputations during follow-up period. «Small» ankle amputations were performed in 7 (35.0 %) patients with diabetic gangrene, where endovascular revascularization of the femoro-popliteal and ankle segments was the stage of surgical treatment. Conclusions. Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.
{"title":"Use of stents with medication coating for the treatment of occlusive-stenotic lesions of the superficial femoral artery","authors":"O.L. Nikishyn, I. Altman, I.I. Al-Qashgish, A. I. Gavretskiy, S. I. Savoluk, M. Muz","doi":"10.26683/2786-4855-2022-3(41)-38-45","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-3(41)-38-45","url":null,"abstract":"Objective ‒ to analyze the results of endovascular revascularization of the femoropopliteal segment with drug-eluting stents. Materials and methods. Endovascular intervention was performed in 23 patients with stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 10 men (43.5 %), 13 women (56.5 %). The mean age of the patients was (66.0 ± 3.5) years. There were 16 (69.6 %) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (23.4 %) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (56.5 %) cases, intermittent claudication ‒ in 5 (21.7 %). Isolated lesions of the femoral-popliteal segment were noted in 3 (13.4 %) patients, lesions of the iliac and femoral-popliteal segments ‒ in 4 (17.4 %), lesions of the femoral-popliteal and ankle segments ‒ in 16 (69.6 %). Results. Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. Among postoperative complications, 3 (13.04 %) patients had puncture site hematomas that did not require surgical evacuation. In 6 (26.1 %) patients, signs of reperfusion syndrome were observed, which were treated with conservative treatment. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. In 1 (5.0 %) case, a hemodynamically significant stenosis of the SFA was observed outside the implanted stent. The patient successfully underwent angioplasty of SFA stenosis. There were no «major» amputations during follow-up period. «Small» ankle amputations were performed in 7 (35.0 %) patients with diabetic gangrene, where endovascular revascularization of the femoro-popliteal and ankle segments was the stage of surgical treatment. Conclusions. Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133156771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.26683/2786-4855-2022-3(41)-20-28
N. Aleieva
Objective – to study the affectiveness of contact correction of hypermetropia in school-age children in the long of observetion.Materials and methods. The study included 56 children (112 eyes) aged 6 to 16 years with hyperopic refraction and astigmatism, who used soft silicone hydrogel contact lenses to correct ametropia. In these patients, a study of visual acuity, objective and subjective clinical refraction, axial length of the eye, corneal thickness and diameter, keratometry, as well as phorometric data (accommodation, vergence, dispar areas of the oculomotor system and their interaction) in early and late observation periods. Results. When using contact correction in school-age children with hyperopia and hyperopic astigmatism, statistically significant after 3 years of observation there was an increase in uncorrected visual acuity by 85 % (t = 7.9; p <0.01), corrected visual acuity by 7 % (t = 7.4; p <0.01), keratometry in the weak meridian by 1 % (t = 6.1; p <0.01), by 1 % (t = 8.9; p <0.01) in the strong meridian, the thickness of the cornea in the central zone by 4 % (t = 4.6; p <0.01), as well as a decrease in the sphere equivalent by 38 % (t = 3,1; p <0,01), the amplitude of accommodation by 20 % (t = 5.8; p <0.01), the negative part of the relative accommodation by 20 % (t = 3.0; p <0.01), the positive part of the relative accommodation by 18 % (t = 3.5; p <0.01), excess accommodation response by 64 % (t = 7.2; p <0.01), foria by 33 % (t = 4.4; p <0.01), foria by close by 22 % (t = 2.8; p <0.01), the ratio of accommodation convergence to accommodation by 18 % (t = 3.1; p <0.01).Conclusions. As a result of 3-year observation of school-age children with hypermetropia in which correction was used by various optical methods, it was established that correction with soft silicone-hydrogel aspheric contact lenses is the most effective way to control this ametropia, which is confirmed by an increase in visual acuity, spheroequivalent indicators, as well as changes in the front surface of the cornea: an increase in thickness in the central zone, and an improvement in keratometry, as well as a positive effect on accommodation ability, muscle balance and stereoscopic vision.
{"title":"Effeciency contact correction of hypermetropia in children of school-age in the distant term of caution","authors":"N. Aleieva","doi":"10.26683/2786-4855-2022-3(41)-20-28","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-3(41)-20-28","url":null,"abstract":"Objective – to study the affectiveness of contact correction of hypermetropia in school-age children in the long of observetion.Materials and methods. The study included 56 children (112 eyes) aged 6 to 16 years with hyperopic refraction and astigmatism, who used soft silicone hydrogel contact lenses to correct ametropia. In these patients, a study of visual acuity, objective and subjective clinical refraction, axial length of the eye, corneal thickness and diameter, keratometry, as well as phorometric data (accommodation, vergence, dispar areas of the oculomotor system and their interaction) in early and late observation periods. Results. When using contact correction in school-age children with hyperopia and hyperopic astigmatism, statistically significant after 3 years of observation there was an increase in uncorrected visual acuity by 85 % (t = 7.9; p <0.01), corrected visual acuity by 7 % (t = 7.4; p <0.01), keratometry in the weak meridian by 1 % (t = 6.1; p <0.01), by 1 % (t = 8.9; p <0.01) in the strong meridian, the thickness of the cornea in the central zone by 4 % (t = 4.6; p <0.01), as well as a decrease in the sphere equivalent by 38 % (t = 3,1; p <0,01), the amplitude of accommodation by 20 % (t = 5.8; p <0.01), the negative part of the relative accommodation by 20 % (t = 3.0; p <0.01), the positive part of the relative accommodation by 18 % (t = 3.5; p <0.01), excess accommodation response by 64 % (t = 7.2; p <0.01), foria by 33 % (t = 4.4; p <0.01), foria by close by 22 % (t = 2.8; p <0.01), the ratio of accommodation convergence to accommodation by 18 % (t = 3.1; p <0.01).Conclusions. As a result of 3-year observation of school-age children with hypermetropia in which correction was used by various optical methods, it was established that correction with soft silicone-hydrogel aspheric contact lenses is the most effective way to control this ametropia, which is confirmed by an increase in visual acuity, spheroequivalent indicators, as well as changes in the front surface of the cornea: an increase in thickness in the central zone, and an improvement in keratometry, as well as a positive effect on accommodation ability, muscle balance and stereoscopic vision.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124979643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.26683/2786-4855-2022-3(41)-29-37
Y. Flomin
Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU).Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed.Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.
{"title":"Determining ischemic stroke subtype: an improved algorithm and its use in a comprehensive stroke unit","authors":"Y. Flomin","doi":"10.26683/2786-4855-2022-3(41)-29-37","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-3(41)-29-37","url":null,"abstract":"Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU).Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed.Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"265 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129876185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.26683/2786-4855-2022-3(41)-46-58
A. Netliukh, O. Kobyletskyi, V. M. Salo, N. Prokopenko, A. Sukhanov
Four therapeutic approaches have been developed for the treatment of arteriovenous malformations (AVMs): microsurgery, radiosurgery, embolization, and conservative treatment. The lack of consensus regarding the choice of treatment method and the different specializations of the doctor who are onvolved to the patient with AVM often determine the wrong treatment strategy. We performed a prospective analysis of the results of AVM of the IV degree according to Spetzler‒Martin scale, 4–5 points on the Buffalo scale complex treatment, based on clinical and tomographic data after the use of partial endovascular embolization and radical microsurgical removal of the AVM node assisted by cell saving technology. According to cerebral angiography 4 months follow-up there is no visible AVM vessels, the malformation was completely resected.Treatment of large and giant AVMs (IV and V degrees according to the Spetzler‒Martin scale) requires tailored surgical treatment approache using endovascular, microsurgical and radiosurgical techniques, but in many cases without achieving a radical result. The use of cell saver technology is necessary to reduce the risks of intraoperative complications associated with blood loss during microsurgical intervention, and enables radical removal of the AVM and recovery of the patient. The role of cell saver technology is crucial in vascular microsurgical interventions, which are often accompanied by a significant volume of blood loss, ensuring rapid autologous hemotransfusion and restoration of circulating blood volume. Endovascular embolization is a necessary step to reduce the risks of intraoperative complications during microsurgical intervention, which, together with the use of cell saver technology, makes it possible to achieve radical AVM removal and patient recovery.
{"title":"A complex approach to the treatment of arteriovenous IV-V degree malformations according to Spetzler‒Martin scale. Clinical case","authors":"A. Netliukh, O. Kobyletskyi, V. M. Salo, N. Prokopenko, A. Sukhanov","doi":"10.26683/2786-4855-2022-3(41)-46-58","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-3(41)-46-58","url":null,"abstract":"Four therapeutic approaches have been developed for the treatment of arteriovenous malformations (AVMs): microsurgery, radiosurgery, embolization, and conservative treatment. The lack of consensus regarding the choice of treatment method and the different specializations of the doctor who are onvolved to the patient with AVM often determine the wrong treatment strategy. We performed a prospective analysis of the results of AVM of the IV degree according to Spetzler‒Martin scale, 4–5 points on the Buffalo scale complex treatment, based on clinical and tomographic data after the use of partial endovascular embolization and radical microsurgical removal of the AVM node assisted by cell saving technology. According to cerebral angiography 4 months follow-up there is no visible AVM vessels, the malformation was completely resected.Treatment of large and giant AVMs (IV and V degrees according to the Spetzler‒Martin scale) requires tailored surgical treatment approache using endovascular, microsurgical and radiosurgical techniques, but in many cases without achieving a radical result. The use of cell saver technology is necessary to reduce the risks of intraoperative complications associated with blood loss during microsurgical intervention, and enables radical removal of the AVM and recovery of the patient. The role of cell saver technology is crucial in vascular microsurgical interventions, which are often accompanied by a significant volume of blood loss, ensuring rapid autologous hemotransfusion and restoration of circulating blood volume. Endovascular embolization is a necessary step to reduce the risks of intraoperative complications during microsurgical intervention, which, together with the use of cell saver technology, makes it possible to achieve radical AVM removal and patient recovery.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128940943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.26683/2786-4855-2022-3(41)-14-19
D. Shchehlov, O. Svyrydiuk, O.F. Sydorenko, M. Vyval
20 years have past since the publication of the results of the International Subarachnoid Aneurysm Trial (ISAT), which changed the worldwide clinical practice of the treating of ruptured cerebral aneurysms. ISAT lasted almost 8 years until May 30, 2002, in many centers all around the world and included 2143 patients. This first prospective randomized multi-center study confirmed the superiority of endovascular treatment for ruptured cerebral aneurysms. Further, long term follow-up study of ISAT groups confirmed these results. Development of the endovascular method was possible due to pioneers in this field, including professor V.I. Shchehlov, founder of the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», who made his first endovascular procedure using detachable latex balloons for the treatment of aneurysm on November 27, 1974 at the Kiev Institute of Neurosurgery. His contribution in development of endovascular neurosurgery was highly appreciated by the author of the ISAT study, Andrew Molyneux, during his lecture at the world congress of the European Society of Minimally Invasive Neurological Therapy.
{"title":"20 Years of the isat (international subarachnoid aneurysm trial) study. End of argument","authors":"D. Shchehlov, O. Svyrydiuk, O.F. Sydorenko, M. Vyval","doi":"10.26683/2786-4855-2022-3(41)-14-19","DOIUrl":"https://doi.org/10.26683/2786-4855-2022-3(41)-14-19","url":null,"abstract":"20 years have past since the publication of the results of the International Subarachnoid Aneurysm Trial (ISAT), which changed the worldwide clinical practice of the treating of ruptured cerebral aneurysms. ISAT lasted almost 8 years until May 30, 2002, in many centers all around the world and included 2143 patients. This first prospective randomized multi-center study confirmed the superiority of endovascular treatment for ruptured cerebral aneurysms. Further, long term follow-up study of ISAT groups confirmed these results. Development of the endovascular method was possible due to pioneers in this field, including professor V.I. Shchehlov, founder of the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», who made his first endovascular procedure using detachable latex balloons for the treatment of aneurysm on November 27, 1974 at the Kiev Institute of Neurosurgery. His contribution in development of endovascular neurosurgery was highly appreciated by the author of the ISAT study, Andrew Molyneux, during his lecture at the world congress of the European Society of Minimally Invasive Neurological Therapy.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128756350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-09DOI: 10.26683/2786-4855-2023-1(43)-28-35
D. Shcheglov, O. Svyrydiuk, M. Vyval, I. Altman, M. S. Gudym, S.V. Chebanyuk, M. Mamonova
Carotid-cavernous fistulas (CCF) is a pathological connection between the arteries and the cavernous sinus, which can be direct or indirect (dural). Direct CCS are characterized by the presence of a direct fistula between the internal carotid artery and the cavernous sinus, while indirect (low-flow) CCS are the result of a pathological connection between the branches of the carotid artery and the cavernous sinus. For more than a century (from the end of the 19th century to the beginning of the 20th century), clinical manifestations and surgical methods of treatment of CCF were discussed. The treatment of patients with indirect shunts and minimal clinical manifestations is not well defined, especially in case where endovascular embolization is associated with technical difficulties considering device selection and difficulties in access to the fistulas, both transarterial and transvenous. Few articles has been studied the tendency of spontaneous occlusion of the CCF ‒ a natural process of recovery. The study of the tendency of the CCS to spontaneous occlusion is promising for optimizing the treatment of this specific group of patients and improving the results of their treatment.Objective ‒ to analyze the cases of spontaneous occlusion of the CCF and data from the literature for optimizing the management of patients with this pathology.Materials and methods. A retrospective analysis of the database of 63 patients with a diagnosis of CCF confirmed by angiography who were treated at the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» during the period from 2014 to 2022, was conducted. There were 67 (in 4 patients they were bilateral) patients with CCF. In 7 (11.1 %) cases, their spontaneous occlusion was detected, which was confirmed with follow-up examinations.Results. Among 7 patients with documented spontaneous CCS occlusion, 2 were male and 5 were female. The average age of patients was (56.31 ± 10.39) years. In all cases, CCF were unilateral, dural, low-flow, and occlusion occurred within 3 – 4 months after the manifestation (appearance of clinical symptoms). In 2 (28.6 %) cases, CCF occurred as a result of trauma, in 5 (71.4 %) ‒ they were spontaneous. In 3 (42.8 %) patients, the occlusion occurred before the planned endovascular embolization. In 1 (14.3 %) case, the endovascular treatment was technically unsuccessful, but the CCF regressed after 4 months, which was confirmed by control cerebral angiography. Three (42.8 %) patients refused the procedure and received conservative treatment. Ocular manifestations of the CCF prevailed in all patients (conjunctival injection ‒ in 7 (100 %), diplopia ‒ in 5 (71.4 %), proptosis ‒ in 4 (57.1 %), retro-orbital pain ‒ in 3 (42.8 %), visual impairment in 1 (14.3%). Five (71.4 %) patients complained of headache, 1 (14.3 %) ‒ tinnitus. In 2 (28.6 %) patients spontaneous occlusion was accompanied by an increase in clinical symptoms and their subsequent regression, in 5 (71.4
{"title":"SPONTANEOUS OCCLUSION OF THE CAROTID-CAVERNOUS FISTULAS. CASE SERIES AND LITERATURE REVIEW","authors":"D. Shcheglov, O. Svyrydiuk, M. Vyval, I. Altman, M. S. Gudym, S.V. Chebanyuk, M. Mamonova","doi":"10.26683/2786-4855-2023-1(43)-28-35","DOIUrl":"https://doi.org/10.26683/2786-4855-2023-1(43)-28-35","url":null,"abstract":"Carotid-cavernous fistulas (CCF) is a pathological connection between the arteries and the cavernous sinus, which can be direct or indirect (dural). Direct CCS are characterized by the presence of a direct fistula between the internal carotid artery and the cavernous sinus, while indirect (low-flow) CCS are the result of a pathological connection between the branches of the carotid artery and the cavernous sinus. For more than a century (from the end of the 19th century to the beginning of the 20th century), clinical manifestations and surgical methods of treatment of CCF were discussed. The treatment of patients with indirect shunts and minimal clinical manifestations is not well defined, especially in case where endovascular embolization is associated with technical difficulties considering device selection and difficulties in access to the fistulas, both transarterial and transvenous. Few articles has been studied the tendency of spontaneous occlusion of the CCF ‒ a natural process of recovery. The study of the tendency of the CCS to spontaneous occlusion is promising for optimizing the treatment of this specific group of patients and improving the results of their treatment.Objective ‒ to analyze the cases of spontaneous occlusion of the CCF and data from the literature for optimizing the management of patients with this pathology.Materials and methods. A retrospective analysis of the database of 63 patients with a diagnosis of CCF confirmed by angiography who were treated at the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» during the period from 2014 to 2022, was conducted. There were 67 (in 4 patients they were bilateral) patients with CCF. In 7 (11.1 %) cases, their spontaneous occlusion was detected, which was confirmed with follow-up examinations.Results. Among 7 patients with documented spontaneous CCS occlusion, 2 were male and 5 were female. The average age of patients was (56.31 ± 10.39) years. In all cases, CCF were unilateral, dural, low-flow, and occlusion occurred within 3 – 4 months after the manifestation (appearance of clinical symptoms). In 2 (28.6 %) cases, CCF occurred as a result of trauma, in 5 (71.4 %) ‒ they were spontaneous. In 3 (42.8 %) patients, the occlusion occurred before the planned endovascular embolization. In 1 (14.3 %) case, the endovascular treatment was technically unsuccessful, but the CCF regressed after 4 months, which was confirmed by control cerebral angiography. Three (42.8 %) patients refused the procedure and received conservative treatment. Ocular manifestations of the CCF prevailed in all patients (conjunctival injection ‒ in 7 (100 %), diplopia ‒ in 5 (71.4 %), proptosis ‒ in 4 (57.1 %), retro-orbital pain ‒ in 3 (42.8 %), visual impairment in 1 (14.3%). Five (71.4 %) patients complained of headache, 1 (14.3 %) ‒ tinnitus. In 2 (28.6 %) patients spontaneous occlusion was accompanied by an increase in clinical symptoms and their subsequent regression, in 5 (71.4","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131386159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-09DOI: 10.26683/2786-4855-2023-1(43)-36-41
V. Smolanka
Among the pain syndromes caused by damage to cranial nerves, trigeminal nerve pathology occupies the main place. Trigeminal neuralgia is an exhausting condition characterized by acute shooting recurrent pain in the face. However, according to modern classification of facial pain types, there is also a distinction made for the second type of neuralgia, in which the mentioned pain alternates with dull, burning pain in the area of trigeminal nerve innervation. Numerous clinical and diagnostic criteria which can influence the results of surgical treatment of trigeminal neuralgia are being actively studied. However, the data varies both in terms of the number of criteria considered and the nature of the study, as well as the research outcomes.Objective ‒ to determine the demographic, clinical, and anatomical characteristics of patients with classical trigeminal neuralgia upon their admission in the neurosurgical ward for microvascular decompression of the trigeminal nerve.Materials and мethods. A retrospective analysis of medical data from 92 patients with trigeminal neuralgia, who were admitted to the Regional Clinical Center of Neurosurgery and Neurology from 2011 to 2023 was performed. The data included: patient's gender and age, type of neuralgia according to K. Burchiel and colleagues' classification (2009), involvement of trigeminal nerve branches, duration of pain prior to hospitalization, medication for conservative therapy and its dosage. Results. Trigeminal neuralgia most commonly affects elderly patients. This may be associated with systemic atherosclerotic vessel damage, leading to increased irritation by a denser vessel wall. Another cause of late disease manifestation may be gradual demyelination in the vicinity of the neurovascular conflict. Women are more likely to be affected than men. Right-sided trigeminal nerve involvement and the involvement of lower and upper jaw branches are more characteristic, with pain more frequently being paroxysmal in nature. In seven out of ten patients, the cause of neurovascular conflict is an artery, with the upper cerebellar artery being the most typical conflict.Conclusions. Demographic and clinical-diagnostic indicators vary among patients with trigeminal neuralgia. There are numerous variables that can influence the long-term effects of conservative and surgical treatment in patients with trigeminal neuralgia. A comprehensive assessment of these factors can identify a group of patients who are likely to have the most successful long-term treatment outcomes for trigeminal neuralgia.
{"title":"Clinical characteristics of pain in patients with trigeminal neuralgia: data from a neurosurgical clinic","authors":"V. Smolanka","doi":"10.26683/2786-4855-2023-1(43)-36-41","DOIUrl":"https://doi.org/10.26683/2786-4855-2023-1(43)-36-41","url":null,"abstract":"Among the pain syndromes caused by damage to cranial nerves, trigeminal nerve pathology occupies the main place. Trigeminal neuralgia is an exhausting condition characterized by acute shooting recurrent pain in the face. However, according to modern classification of facial pain types, there is also a distinction made for the second type of neuralgia, in which the mentioned pain alternates with dull, burning pain in the area of trigeminal nerve innervation. Numerous clinical and diagnostic criteria which can influence the results of surgical treatment of trigeminal neuralgia are being actively studied. However, the data varies both in terms of the number of criteria considered and the nature of the study, as well as the research outcomes.Objective ‒ to determine the demographic, clinical, and anatomical characteristics of patients with classical trigeminal neuralgia upon their admission in the neurosurgical ward for microvascular decompression of the trigeminal nerve.Materials and мethods. A retrospective analysis of medical data from 92 patients with trigeminal neuralgia, who were admitted to the Regional Clinical Center of Neurosurgery and Neurology from 2011 to 2023 was performed. The data included: patient's gender and age, type of neuralgia according to K. Burchiel and colleagues' classification (2009), involvement of trigeminal nerve branches, duration of pain prior to hospitalization, medication for conservative therapy and its dosage. Results. Trigeminal neuralgia most commonly affects elderly patients. This may be associated with systemic atherosclerotic vessel damage, leading to increased irritation by a denser vessel wall. Another cause of late disease manifestation may be gradual demyelination in the vicinity of the neurovascular conflict. Women are more likely to be affected than men. Right-sided trigeminal nerve involvement and the involvement of lower and upper jaw branches are more characteristic, with pain more frequently being paroxysmal in nature. In seven out of ten patients, the cause of neurovascular conflict is an artery, with the upper cerebellar artery being the most typical conflict.Conclusions. Demographic and clinical-diagnostic indicators vary among patients with trigeminal neuralgia. There are numerous variables that can influence the long-term effects of conservative and surgical treatment in patients with trigeminal neuralgia. A comprehensive assessment of these factors can identify a group of patients who are likely to have the most successful long-term treatment outcomes for trigeminal neuralgia.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133693629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-09DOI: 10.26683/2786-4855-2023-1(43)-42-50
O.L. Nikishyn, I. Altman, I.I. Al-Qashgish, A. I. Gavretskiy, S. I. Savoluk, M.I. Mus
With the development of advanced technologies, minimally invasive methods are becoming increasingly widespread in surgery, offering several advantages compared to traditional open surgery. In vascular surgery, endovascular revascularization methods are gaining increasing importance in the management of lower limb occlusive diseases. However, there are certain challenges that limit the effectiveness of endovascular revascularization and increase the likelihood of technical failure. One of the major challenges in endovascular revascularization of lower limb arteries is achieving re-entry into the vessel lumen during subintimal angioplasty.In certain cases, especially when there is severe atherosclerotic involvement of the vessel wall or calcification, the use of standard wire loop techniques may not always allow for re-entry into the true lumen of the vessel, and performing other surgical interventions may be limited or even impossible. Increasing the success rate of subintimal angioplasty will enhance the competitiveness of endovascular revascularization compared to open and hybrid reconstructive surgeries.Several techniques have been proposed to optimize the outcomes of endovascular revascularization, including the SAFARI technique, which combines antegrade and retrograde access for traversing complex occlusions. Re-entry devices equipped with specially curved needles at the catheter tip are used to direct the 0.014 inch wire into the true lumen of the vessel. Atherectomy devices with high-speed rotating blades driven by a motor are also employed to disrupt calcified plaques, creating a passage through heavily calcified occlusions that cannot be traversed by other means. These methods of optimizing the outcomes of endovascular revascularization can be used individually or in combination.We have analyzed the technical aspects of performing the mentioned procedures and their clinical outcomes based on literature sources. According to published data, the application of methods to optimize the outcomes of endovascular revascularization of infrainguinal arteries increases the success rate of these procedures to ≥90%. The widespread use of these methods is hindered by the high cost of re-entry and atherectomy devices. Accumulating our own experience will help improve the effectiveness of angioplasty in patients with chronic infrainguinal artery occlusions.
{"title":"Methods of optimizing the results of endovascular revascularization of infrainguinal arteries (literature review)","authors":"O.L. Nikishyn, I. Altman, I.I. Al-Qashgish, A. I. Gavretskiy, S. I. Savoluk, M.I. Mus","doi":"10.26683/2786-4855-2023-1(43)-42-50","DOIUrl":"https://doi.org/10.26683/2786-4855-2023-1(43)-42-50","url":null,"abstract":"With the development of advanced technologies, minimally invasive methods are becoming increasingly widespread in surgery, offering several advantages compared to traditional open surgery. In vascular surgery, endovascular revascularization methods are gaining increasing importance in the management of lower limb occlusive diseases. However, there are certain challenges that limit the effectiveness of endovascular revascularization and increase the likelihood of technical failure. One of the major challenges in endovascular revascularization of lower limb arteries is achieving re-entry into the vessel lumen during subintimal angioplasty.In certain cases, especially when there is severe atherosclerotic involvement of the vessel wall or calcification, the use of standard wire loop techniques may not always allow for re-entry into the true lumen of the vessel, and performing other surgical interventions may be limited or even impossible. Increasing the success rate of subintimal angioplasty will enhance the competitiveness of endovascular revascularization compared to open and hybrid reconstructive surgeries.Several techniques have been proposed to optimize the outcomes of endovascular revascularization, including the SAFARI technique, which combines antegrade and retrograde access for traversing complex occlusions. Re-entry devices equipped with specially curved needles at the catheter tip are used to direct the 0.014 inch wire into the true lumen of the vessel. Atherectomy devices with high-speed rotating blades driven by a motor are also employed to disrupt calcified plaques, creating a passage through heavily calcified occlusions that cannot be traversed by other means. These methods of optimizing the outcomes of endovascular revascularization can be used individually or in combination.We have analyzed the technical aspects of performing the mentioned procedures and their clinical outcomes based on literature sources. According to published data, the application of methods to optimize the outcomes of endovascular revascularization of infrainguinal arteries increases the success rate of these procedures to ≥90%. The widespread use of these methods is hindered by the high cost of re-entry and atherectomy devices. Accumulating our own experience will help improve the effectiveness of angioplasty in patients with chronic infrainguinal artery occlusions.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"EC-1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126549515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-09DOI: 10.26683/2786-4855-2023-1(43)-51-56
M. S. Gudym, I. Bortnik, M. Vyval
Cavernous hemangiomas (CH) are benign vascular lesions of the central nervous system, which are thin-walled vascular sinusoids without smooth muscle with hemosiderin deposits. CH is the second (after aneurysms) most frequent incidental vascular finding on magnetic resonance imaging of the brain, with a prevalence of 1 case per 625. CHs can be asymptomatic, cause seizures, intracranial hemorrhage due to rupture, or be the cause of focal neurological deficits without signs of previous hemorrhage. Intracranial hemorrhages of varying degrees of severity can occur both in supratentorial and infratentorial CH. The annual frequency of bleeding in CH is 0.3‒2.4 %, but they are rarely fatal, especially with supratentorial localization. Indications and timing of surgical intervention in CH are the question of debate.The presented case demonstrates the possibility of intracerebral hematoma formation as a result of the rupture of one of the multiple supratentorial CHs, which led to clinical deterioration and required urgent neurosurgical treatment. Although such clinical course is rare, it should be taken into account when planning treatment and informing patients with CH. A 62-year-old woman fell ill suddenly. The disease manifested with the onset of headache and left-sided hemiplegia At the local hospital, magnetic resonance imaging of the brain was performed and an intracranial hemorrhage in the right subcortical area due to rupture of the CH, and another asymptomatic CH in the triangle of the left lateral ventricle, ware founded. The patient initially received conservative therapy, but 48 hours after the onset of the disease, the patient's consciousness declined to 10 GCS points, and she was urgently transferred to the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», and an emergency operation was performed for removal of intracerebral hematoma and CH. Histological examination confirmed the diagnosis «cavernous hemangioma». The postoperative course was uneventful, and the neurological deficit regressed to mild left-sided hemiparesis. Indications and timing of surgical intervention in CH remain uncertain.
{"title":"A case of urgent neurosurgical treatment of intracerebral hemorrhage due to rupture of a cavernous hemangioma because of the progressive clinical deterioration","authors":"M. S. Gudym, I. Bortnik, M. Vyval","doi":"10.26683/2786-4855-2023-1(43)-51-56","DOIUrl":"https://doi.org/10.26683/2786-4855-2023-1(43)-51-56","url":null,"abstract":"Cavernous hemangiomas (CH) are benign vascular lesions of the central nervous system, which are thin-walled vascular sinusoids without smooth muscle with hemosiderin deposits. CH is the second (after aneurysms) most frequent incidental vascular finding on magnetic resonance imaging of the brain, with a prevalence of 1 case per 625. CHs can be asymptomatic, cause seizures, intracranial hemorrhage due to rupture, or be the cause of focal neurological deficits without signs of previous hemorrhage. Intracranial hemorrhages of varying degrees of severity can occur both in supratentorial and infratentorial CH. The annual frequency of bleeding in CH is 0.3‒2.4 %, but they are rarely fatal, especially with supratentorial localization. Indications and timing of surgical intervention in CH are the question of debate.The presented case demonstrates the possibility of intracerebral hematoma formation as a result of the rupture of one of the multiple supratentorial CHs, which led to clinical deterioration and required urgent neurosurgical treatment. Although such clinical course is rare, it should be taken into account when planning treatment and informing patients with CH. A 62-year-old woman fell ill suddenly. The disease manifested with the onset of headache and left-sided hemiplegia At the local hospital, magnetic resonance imaging of the brain was performed and an intracranial hemorrhage in the right subcortical area due to rupture of the CH, and another asymptomatic CH in the triangle of the left lateral ventricle, ware founded. The patient initially received conservative therapy, but 48 hours after the onset of the disease, the patient's consciousness declined to 10 GCS points, and she was urgently transferred to the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», and an emergency operation was performed for removal of intracerebral hematoma and CH. Histological examination confirmed the diagnosis «cavernous hemangioma». The postoperative course was uneventful, and the neurological deficit regressed to mild left-sided hemiparesis. Indications and timing of surgical intervention in CH remain uncertain.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127065344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-09DOI: 10.26683/2786-4855-2023-1(43)-17-27
T. Morozov, M. Kvasha
Objective ‒ to improve reconstructive and plastic methods of treatment of patients with malignant tumors that spread beyond the brain skull to ensure a decent quality of life.Materials and methods. The results of a comprehensive clinical examination and surgical treatment (with a reconstructive component) of 21 patients with scalp and skull tissue defects operated on in the extracerebral tumor clinic of Romodanov Institute of Neurosurgery of NAMS of Ukraine in the period from 2018 to 2021. There were 9 women and 12 men among the patients. The age of the patients is from 36 to 80 years old. All patients underwent clinical, neurological and instrumental examinations. The diagnosis was verified by the results of histopathomorphological examination. Statistical methods (discriminant analysis (MANOVA)) were used for data processing. Statistical significance was tested using the Pearson test (χ²).Results. The patients were divided into two groups. The main group (n=16) – operated on using adapted patented plastic techniques that take into account the optimal angle of direction of stress vectors in the tissue of skin-aponeurotic flaps in the postoperative period during stress relaxation. The comparison group was made up of 5 people operated on using traditional methods of mobilization and fixation of skin-aponeurotic flaps. Using the patient’s own tissues is the most reliable and effective method of cosmetic restoration of the head after radical treatment for locally advanced tumors. Active tactics (postoperative monitoring of the flap) make it possible to detect blood circulation disorders in the transplanted tissues at an early stage and to carry out a timely revision of the anastomoses. Performing simultaneous reconstructive operations is an integral part of complex treatment of patients with malignant tumors, expands the indications for performing gentle operations, allows to obtain «excellent» and «good» functional and aesthetic results in 85 % of cases. Simultaneous microsurgical reconstructive operations are possible in patients after complex treatment, although the frequency of thrombotic complications in this group was higher (12.5 %) than in the comparison group (7.5 %).Conclusions. The perspective of plastic-reconstructive replacement of defects for clinical application has been proven and the method has been improved using the latest technologies.Key words: malignant tumors; intracranial/extracranial spread; surgical treatment; reconstruction; quality of life.
{"title":"Improvement of reconstructive surgical operations with closure of skull tissue defects in primary malignant tumors with intra-extracranial and extra-intracranial localization","authors":"T. Morozov, M. Kvasha","doi":"10.26683/2786-4855-2023-1(43)-17-27","DOIUrl":"https://doi.org/10.26683/2786-4855-2023-1(43)-17-27","url":null,"abstract":"Objective ‒ to improve reconstructive and plastic methods of treatment of patients with malignant tumors that spread beyond the brain skull to ensure a decent quality of life.Materials and methods. The results of a comprehensive clinical examination and surgical treatment (with a reconstructive component) of 21 patients with scalp and skull tissue defects operated on in the extracerebral tumor clinic of Romodanov Institute of Neurosurgery of NAMS of Ukraine in the period from 2018 to 2021. There were 9 women and 12 men among the patients. The age of the patients is from 36 to 80 years old. All patients underwent clinical, neurological and instrumental examinations. The diagnosis was verified by the results of histopathomorphological examination. Statistical methods (discriminant analysis (MANOVA)) were used for data processing. Statistical significance was tested using the Pearson test (χ²).Results. The patients were divided into two groups. The main group (n=16) – operated on using adapted patented plastic techniques that take into account the optimal angle of direction of stress vectors in the tissue of skin-aponeurotic flaps in the postoperative period during stress relaxation. The comparison group was made up of 5 people operated on using traditional methods of mobilization and fixation of skin-aponeurotic flaps. Using the patient’s own tissues is the most reliable and effective method of cosmetic restoration of the head after radical treatment for locally advanced tumors. Active tactics (postoperative monitoring of the flap) make it possible to detect blood circulation disorders in the transplanted tissues at an early stage and to carry out a timely revision of the anastomoses. Performing simultaneous reconstructive operations is an integral part of complex treatment of patients with malignant tumors, expands the indications for performing gentle operations, allows to obtain «excellent» and «good» functional and aesthetic results in 85 % of cases. Simultaneous microsurgical reconstructive operations are possible in patients after complex treatment, although the frequency of thrombotic complications in this group was higher (12.5 %) than in the comparison group (7.5 %).Conclusions. The perspective of plastic-reconstructive replacement of defects for clinical application has been proven and the method has been improved using the latest technologies.Key words: malignant tumors; intracranial/extracranial spread; surgical treatment; reconstruction; quality of life.","PeriodicalId":325397,"journal":{"name":"Ukrainian Interventional Neuroradiology and Surgery","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123825786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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