RU2543855C1 - Method of treating brain injuries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves performing a bone flap resection, incising a dura mater, inserting and suturing an artificial implant to the dura mater. The implant is inserted subdurally with overlapping cortical injury areas. Two openings are formed in the middle of the bone flap. A filament is delivered from the outside in the middle of the dura mater flap with suturing the implant, and brought out onto an outer surface of the dura mater with leaving the filaments ends free. The implant is anchored along the perimeter of the dura mater incision, and the dura mater is closed tightly. The filament ends are brought out through the two formed openings in the middle of the bone flap; the bone flap is placed into position of the defect, and the filament ends are tightened with pulling the dura mater and implant to an inner bone plate of the bone flap.

EFFECT: method enables reducing the postoperative meningocerebral cicatrisation that is ensured by shaping the implant spherical.

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Description

The alleged invention relates to medicine, namely to neurosurgery.

During surgical interventions on the brain for brain tumors, vascular pathology of the brain, with closed craniocerebral injuries, accompanied by damage to the integrity of the cerebral cortex, cerebral tissue, arachnoid membrane of the brain are mechanically damaged, and subarachnoid hemorrhage often occurs. In those places where the damaged areas of the cerebral cortex or areas with subarachnoid hemorrhage and damage to the arachnoid meninges are tightly attached to the dura mater, in the acute period the formation of meninges begins / fusion between the inner surface of the dura mater and brain tissue /, which are finally formed in the distant period and can lead to the occurrence of epilepsy, headaches, and impaired cerebrospinal fluid circulation. This entails the need for repeated surgical interventions aimed at excising scars. However, reoperation alone does not exclude the risk of re-development of scar-adhesions.

Scars can occur not only between the brain tissue and the inner surface of the dura mater, but also between the brain tissue, aponeurosis of the scalp and temporal muscle. This occurs in the case of defects of the dura mater, which may occur due to traumatic brain injury, during excision of the areas of the dura mater germinated by the tumor, its coagulation, and mechanical damage during operative access.

As a prototype, a method was selected that included access to a pathological focus and subsequent installation and hemming epidurally to a defect of the dura mater of an artificial implant - a self-adhesive medical film "Diplen" / RF patent No. 20152580, 1994 /.

However, the known method involves hemming the implant only along the perimeter of the defects and laying it epidurally on the outer surface of the dura mater, which does not allow the development of meninges in areas with damage to brain tissue outside the dura mater, since the collagen fibers included in the composition of the meninges is formed from the inner layer of the dura mater. The inner surface of the implant is sticky, which makes it difficult to move along the surface of the brain. Over time, the implant resolves with the formation of a bilayer fibrous plate, which leads to the formation of a scar with the inclusion of this fibrous plate. The implant is rigid and leads to mechanical effects on the cerebral cortex. In addition, the method does not provide sphericity of the form with large defects of the dura mater, which leads to contact between the implant and the cerebral cortex. All this can cause irritation of the cortex and, therefore, does not exclude the development of epiprots.

The objective of the proposed invention is the improvement of the method.

EFFECT: prevention of formation of shell-brain scars in the postoperative period, exclusion of deformation and irritation of the cerebral cortex, ensuring spherical shape of the implant.

The technical result is achieved due to the fact that in the method, including resection of the bone flap, incision of the dura mater and subsequent installation and fixation of the artificial implant to the dura mater, two holes are formed in the center of the bone flap, the implant is installed subdurally, blocking all areas of cortical damage of the brain, in the center of the flap of the dura mater, a thread is carried out from the outside, flashing the implant, the thread is brought to the outer surface of the dura mater without tying the ends of the thread, perform implant hemming along the perimeter of the dura mater section and hermetic closure of the dura mater, the ends of the thread are removed through two formed holes in the center of the bone flap, the bone flap is placed at the defect site and the ends of the thread are tied, pulling the dura and the implant to the inner the bone plate of the bone flap.

The method is as follows. Access to the pathological focus is performed: a bone flap is resected, two holes are formed in it, the semi-oval dura mater is cut, the pathological focus is removed - a tumor, hematoma or brain detritus in case of traumatic brain injury. After hemostasis, the sites of damage to the cerebral cortex, subarachnoid hemorrhage and damage to the arachnoid membrane of the brain are visually determined. Then, an artificial implant is placed subdurally, under the dura mater, it is displaced along the surface of the brain and covers all areas of damage to the cerebral cortex. In the center of the flap of the dura mater, a thread is carried out outside, flashing the implant. The thread is brought to the outer surface of the dura mater without tying the ends of the thread. Then the implant is hemmed along the perimeter of the dura mater section and the dura mater is hermetically sutured. After that, the ends of the thread, conducted through the center of the dura mater flap and stitched to the implant, are removed through the openings in the bone flap, the bone flap is placed in place of the defect, it is fixed and the ends of the thread are tied, pulling the dura mater and the implant to the inner bone plate of the bone a flap, which ensures the formation of a spherical shape of the implant. In the presence of defects of the dura mater, the implant is hemmed along the perimeter of the defects.

Clinical examples.

Example 1. Patient M., 35 years old, medical history No. 264523, was first operated on for a tumor - fibrillar-protoplasmic astrocytoma of the temporal lobe on the right. Hospitalized with complaints of headache, non-convulsive epipristes with a frequency of up to 5-6 p. per day, with a convulsive component with a frequency of 1 time per month. The frequency of attacks increased after the first operation. The state on the Karnowski scale upon receipt of 70 points. According to the EEG from 10.30.12, gross diffuse changes in the bioelectrical activity of the brain were revealed with a reduction in the main rhythm, a focus of pathological activity (slow-wave and epileptiform) in the fronto-central and temporal-parietal region of the right hemisphere. According to MRI from 12.06.2012, there are signs of the presence of meninges along the upper edge of the postoperative cyst.

Conducted anticonvulsant therapy did not lead to improvement. Operated repeatedly for continued tumor growth 10.11.2012. During the operation, it was revealed that between the upper edge of the brain wound from the previous operation (the superior temporal gyrus and the lower edge of the parietal lobe) and the inner surface of the dura mater dense membranous scars with a length of about 5 cm and a width of 0.5-1 cm were formed. were excised, the tumor was removed. After hemostasis, an artificial implant was installed subdurally, which completely covered the area of the resulting surgical wound, the area of cicatricial changes after the previous operation and was hemmed to the inner surface of the dura mater along the perimeter of its incision. The implant was also stitched in the center of the dura mater flap and sutured to the center of the bone flap. In the postoperative period for 4 months, the patient did not have a single epileptic seizure, headaches regressed. When the EEG from 01/30/2013 and 04/04/2013 in comparison with the EEG from 10/30/2012, there is a clear positive dynamics in the form of a weakening of the slow-wave and epileptiform activity in the right hemisphere. The patient stopped taking anticonvulsants. According to MRI from 04/04/2013 - there were no signs of the presence of meninges in the area of the operation.

Example 2. Patient A., 63 years old, medical history No. 265936, was first operated on for glioblastoma of the parietal lobe on the right of 12/14/11. In the postoperative period, a month later, the patient developed epiprises with a frequency of up to several times a month, which were not stopped by anticonvulsant therapy with finlepsin. The state on the Karnowski scale upon receipt of 60 points. Reoperated for continued tumor growth 12/13/2012. During the operation, excision of the meninges was formed between the brain tissue and the inner surface of the dura mater along the perimeter of the dissection of the cerebral cortex during the previous operation. After removal of the tumor, subdurally, according to the proposed method, an artificial implant was installed, which completely blocked the area of damage to the cerebral cortex. The implant was sutured to the inner surface of the dura mater and to the bone flap. The patient died after 4 months in the postoperative period against pneumonia. During this period, the patient had no epiprises.

A method for treating brain injuries prevents the formation of meninges in the postoperative period, eliminates deformation and irritation of the cerebral cortex, ensures sphericity of the shape of the implant, which follows the shape of the surface of the brain according to convex, eliminates damage to the cerebral cortex if necessary, repeated surgical interventions.

Claims (1)

A method for treating brain injuries, including resection of a bone flap, dura mater incision and subsequent installation and suturing of an artificial implant to the dura mater, characterized in that the implant is installed subdurally, overlapping areas of damage to the cerebral cortex, two holes are formed in the center of the bone flap, in the center of the flap of the dura mater, a thread is conducted outside, flashing the implant, the thread is brought out to the outer surface of the dura mater, without tying the ends of the thread, the implant is hemmed along the perimeter of the dura mater and hermetically sutured the dura mater, the ends of the filament are brought out through two formed holes in the center of the bone flap, the bone flap is placed at the site of the defect and the ends of the filament are tied, pulling the dura and the implant to the inner bone plate of the bone flap.