SU1697763A1 - Method for revascularization of encephalon - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery. The method allows to reduce postoperative complications, which is achieved by autotransplantation of the greater omentum on the brain and the imposition of an anastomosis between the superficial temporal artery and vein with the gastro-epiploic artery and vein, as well as greater occlusion between the distal ends of the gastro-epiploic artery and the vein with the affected artery branches and the same vein on the cerebral cortex.

Description

The invention relates to medicine, namely to neurosurgery.

The purpose of the invention is the reduction of postoperative complications.

The method is carried out as follows.

Upper median laparotomy is performed. Allocation of utautransplants by the gastric-omental artery and vein along the greater curvature of the stomach. The branches of the gastro-epiploic arteries and veins that go to the stomach and the omentum are ligated. After autograft, the wound is sutured tightly. The epiploon through the proximal end of the gastroepiploic artery is washed with warm saline solution with heparin, and the distal ends of the gastroepiploic arteries and veins are clipped with detachable clips. After which the autograft is placed in a physiological solution with heparin at T 34 ° C.

The next stage is the selection of the superficial temporal arteries and veins. The vessels are isolated with a lateral branch through which a catheter can be inserted for anastomosis.

Anastomoses are placed between the superficial temporal artery and the vein and the proximal ends of the gastroepiploic arteries and the vein, first the arterial anastomosis, and then the venous. The ripple of the gland and the pink color determine the consistency of the superimposed anastomoses. The bleeding branches of the omental vessels coagulate.

The final, final stage is osteoplastic trepanation of the skull in the fronto-parieto-temporal region, 4x4 cm in size. The dura mater is opened U-shaped. The cerebral cortex at the site of the intended autotransplantation is as free as possible from the arachnoid membrane; incisions are made on the choroid in the avascular zone (under 20x magnification) to improve vascular growth from the omentum to the cerebral cortex. The cortical artery is isolated and

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The vein, in this case, the branches of the middle cerebral artery and the vein of the same name, after their mobilization between the clips, anastomoses are placed between the distal ends of the ventricular epithelium and the veins and the cortical artery and the vein end in a side opening 10/0. After checking the condition of the anastomoses, the omentum is placed on the cortex. Impose layered seams on the wound.

Example. Ill T.L., 48 years old, Clinical diagnosis - meningioma of the anterior, middle, and posterior cranial cells on the right.

The patient underwent osteoplastic trepanation of the skull in the right frontal, temporal, and parietal regions. Tumor, meningioma, dense consistency, overgrown with the right internal carotid artery, the initial sections of the right middle cerebral artery. When the medial tumor was removed, a spasm of the right middle cerebral artery occurred, which could not be stopped by the application of gauze strips with novocaine, and the Artery acquired a bluish tint. At this stage, the operation had to be completed. In the immediate postoperative period, the patient developed a strut in the left arm and left foot. Drug therapy, including vascular treatment, novokainnye blockade of the right star-shaped node effect was not given.

An angiographic examination and computed tomography of the brain of the patient resulted in acute ischemic cerebral circulation in the posterior regions of the frontal and lower parietal and temporal areas.

After 40 days an autotransplantation of the greater omentum was performed on the right frontal, temporal, inferior parietal lobes with anastomosis between the superficial temporal artery and vein and proximal gastric-epiploic arteries and veins from the middle cerebral artery and the same vein (anastomatic). The bark of the posterior parts of the right frontal lobe, the lower parietal, temporal lobes had a yellow color, the vessels were sharply narrowed, which indicated their ischemic lesion. A branch of the middle cerebral artery was selected, its fusion portion, anterior to the affected area of the cortex. At the same time, the anastomatic vein site is selected.

A branch of the middle cerebral artery was mobilized for 6 mm, and a glove strip was laid under it. By both

the sides of the vessel are clipped by removable valves. The arteries were opened with microsurgical scissors for 1.5 mm, washed with saline. Adventica is removed from the distal end of the gastroepiploic artery over 0.5 mm. Under a 20-fold magnification, the vessels were matched and anastomosis was applied with a 10/0 thread produced by SharpPoint with the help of 12 stitches. Sn t clip

from the artery. The anastomosis pulsed, no bleeding was noted. An anastomatic vein was mobilized for 6 mm. A glove rubber strip was inserted, clipsa was applied, the vein was opened over 2 mm. Under a 20x magnification, a venous anastomosis was inserted between the gastroepiploic vein and the anastomatic vein, ending sideways with the help of 16 stitches with a 10/0 Charpoint monofilament thread. Vienna pouted, anastomosis pulsed. The arachnoid membrane in the infarction zone was removed, especially along the great vessels. Subsequently, scarification was applied with a micro-hook on a soft shell at eight points in the uncontrolled zone. After that, the omentum is expanded above the area of infarction and covered with a dura mater. Defects in the dura mater are covered with a gamostatichesky

a sponge.

The postoperative course was uneventful. On the first day after the operation, movements in the elbow joint of the left arm and in the left foot were observed. In the next day

movements in the left extremities increased and appeared in the left hand and shoulder joint. Strength reached 1-2 points. According to the EEG dynamics, the inter-hemispheric asymmetry that occurred before the operation disappeared

and the amplitude of biopervtial increased.

After confirming the functional significance of the created collateral circulation with the help of a large omentum, the next stage is planned - the total removal of the tumor.

Claims (1)

Formula and acquisition method of brain revascularization by autotransplantation of a larger omentum on the brain and anastomosis between the superficial temporal artery and the vein with the gastroepiploic artery and hernia, characterized in that, in order to reduce postoperative complications, additionally higher occlusion, anastomoses are produced between the distal ends of the gastroepiploic arteries and veins with the branches of the affected artery and the same vein on the cerebral cortex.