RU2260449C1 - Method for draining subarachnoid space - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making skin incision beginning from focal projection and continuing it to zygomatic arch. Silicone muff is brought in blunt way through temporal muscle. The muff and thin draining tubes introduced into it are fixed on periosteum. Proximal ends of the draining tubes are placed in pathological focus and the distal ends are brought under zygomatic arch and through micro-incisions in chewer fascia into depth of the chewer. Several pathological focuses being available, the proximal ends of the draining tubes are introduced into each of them and the distal ends are distributed in superficial and deep layers of the chewer.

EFFECT: wide range of functional applications.

2 cl, 1 dwg

Description

The invention relates to medicine, namely to neurosurgery, and can be used to treat chronic subdural hematomas and cerebrospinal fluid.

Known methods of treating chronic subdural hematomas and cerebrospinal fluid by craniotomy and osteoplastic craniotomy. However, these interventions are traumatic and cause the need for a significant amount (up to 37%) of postoperative repeated operations [1, 2].

There are also methods of treating chronic subdural hematomas and cerebrospinal fluid by removing them through the milling hole, followed by subcutaneous, external or closed external drainage [3, 4]. However, external drainage is fraught with the development of infection [5].

The closest in technical solution to the proposed one is subdural-peritoneal drainage [6]. However, its implementation requires special, expensive technical equipment, and the manipulation itself is a complex surgical intervention. It consists in the fact that a drainage tube is inserted into the subdural space of the brain through a hole in the brain, to which a shunt with a valve is connected. The entire system is located subcutaneously, and the end of the tube is in the abdominal cavity. Often, clogging of the valve occurs in this system, which leads to the cessation of drainage function and requires repeated surgical intervention. In addition, there are many contraindications for using this system.

The essence of the invention lies in the combination of essential features sufficient to achieve the desired technical result, namely: improving treatment outcomes, expressed in simplifying the technique and reducing the invasiveness of the operation, earlier restoration of brain function, in preventing relapses and eliminating the need for expensive equipment.

This essence is that:

1) A skin incision is made, starting from the projection of the focus, continuing it to the zygomatic arch, using a blunt way through the temporal muscle, a silicone sleeve is inserted with thin drainage tubes inserted into it, the proximal ends of which are directed to the pathological focus, and their distal ends are carried out under the zygomatic arch and through microinvasion of the fascia of the chewing muscle in its thickness.

2) If there are several pathological foci, the proximal ends of the drainage tubes are inserted into each of them, and the distal ones are distributed in the superficial and deep layers of the masticatory muscle.

The layout of the drainage system is shown in the attached illustration, where:

1 - pathological cavity;

2 - proximal ends of the drainage tubes;

3 - silicone coupling;

4 - the surface layer of the masticatory muscle with the immersed distal ends of the drainage tubes;

5 - a deep layer of chewing muscle with a submerged distal end of the drainage tube.

The method is as follows.

Starting from the projection of the localization of the pathological focus under local anesthesia or general anesthesia, a linear skin incision is made to the zygomatic arch. A hole is drilled in the bone above the focus with a milling cutter, at the same time the dura mater and the underlying capsule are opened. Penetrate into the subshell space, into which, depending on the number of liquid chambers, two or more elastic bioinert drainage tubes, for example, substernal catheters, are introduced. The middle part of the tubes is placed in a silicone sleeve, which is fixed with seams to the periosteum in the area of the milling hole and the zygomatic arch. The distal sections of the tubes through microinvasion of the fascia of the masticatory muscle (m.masseter) are inserted into the thickness of the indicated muscle with micro forceps. Depending on the number of peripheral tubes, they are distributed both in the superficial and in the deep layers of the muscle. A blind suture is applied to the skin wound.

Constant contractions of the masticatory muscle provide an improvement in the functioning of the drainage system, creating a vacuum effect, they provide an active outflow of fluid from pathological cavities of the brain and its further resorption. Removal of the drainage system is carried out after non-invasive methods of brain imaging (CT, MRI), eliminating the need for its further use.

Clinical example.

B-naya G-va, 68 years old, was admitted to the neurosurgical department with a diagnosis of Post-traumatic chronic subdural hematoma in the left hemisphere. Prescription of mild head injury 4 weeks. During hospitalization: soporous state, motor excitement, right-sided pyramidal insufficiency, elements of motor aphasia. On the CT scan - signs of chronic subdural hematoma.

Operation: General anesthesia. A linear skin incision from the projection of the localization of the pathological focus to the zygomatic arch. A milling hole was made above the focus, the dura mater and the underlying wall of the capsule were opened. Two drainage tubes were introduced into the hematoma area, the middle part of which is placed in a silicone sleeve. The clutch with seams is fixed to the periosteum in the area of the milling hole and zygomatic arch. The distal sections of the tubes through the microinvasion of the fascia of the chewing muscle are inserted into its thickness. Stitches on the wound.

On a CT scan 5 days after surgery, there is no data for a recurrence of a hematoma. General condition is satisfactory. Regression of cerebral and focal symptoms. The drainage system is removed after 11 days.

Sources of information

1. Likhterman LB, Khitrin L.Kh. Traumatic intracranial hematomas. M., 1973.

2. Martirosyan V.V. et al. The immediate and long-term results of surgical treatment of chronic subdural hematomas // In book: III All-Union. congress of neurosurgeons. M., 1982. S. 68-69.

3. Potapov A.A., Likhterman LB, Kravchuk A.D. Chronic subdural hematomas. M., 1997, 232 p.

4. Oleshkevich F.V., Rozhanets N.I. Traumatic subdural hematomas. Minsk, Belarus, 1980, 126 pp.

5. Kaufman H.H. et al. Posttraumatic subdural hydromas: Odservations concerning a surgical enigma // Acta neurochir. - 1984 / - Bd72, N 3/4 - S.197-209.

6. Probst, C. Peritoneal drainage of chronic subdural hematomas in older patients // J.neurosurg., 1988, 68: p. 908-911.

Claims (2)

1. A method of draining the subshell space of the brain, including applying a trephination hole and introducing drainage tubes, characterized in that a skin incision is made, starting from the projection of the focus, continuing it to the zygomatic arch, using a blunt way through the temporal muscle, a silicone sleeve is inserted with it is fixed with thin drainage tubes to the periosteum, the proximal ends of the drainage tubes are sent to the pathological focus, and their distal ends are carried out under the zygomatic arch and through microinfection tion chewing muscles in her column. 2. The method of draining the subshell space of the brain according to claim 1, characterized in that in the presence of several pathological foci, the proximal ends of the drainage tubes are introduced into each of them, and the distal ones are distributed in the superficial and deep layers of the masticatory muscle.