SU1743588A1 - Method for surgical treatment of hydrocephalus - Google Patents

Abstract

The invention relates to medicine, namely to neurosurgery, and can be used to restore the cerebrospinal fluid from the ventricles of the brain in occlusive forms of hydrocephalus, developed on the basis of inoperable tumors of the causal III ventricle, tumors of the brain and occluses of the aqueduct or cavity of the IV ventricle posterior cranial mk. The method allows to reduce the invasiveness of the operation and postoperative complications. For this, soft tissue is exposed to the occipital bone and the other Atlanta friend, and a fretting hole is placed at the Dandy point. A bone groove is made below the milling hole. A soft catheter drainage tube is inserted into the posterior horn of the lateral ventricle of the brain. Upon exiting the mill hole, an oval bend of the catheter is made in the bone groove. Below the grooves, a catheter is inserted under the occipital bone into the epidaral space and a bone defect in the posterior cranial bone is removed. In the area of the large occipital tank on the catheter make holes. At the level of the lateral surface of the spinous processes of the I-III cervical vertebrae, a valve is placed on the catheter. The distal section of the catheter is conducted in the subcutaneous tissue and is connected to a cisternoperitoneal or cisternoatrial shunt. (Ls

Description

The invention relates to medicine, namely to neurosurgery.

The purpose of the invention is to reduce the traumatic operation and postoperative complications.

The method is carried out as follows.

The cut of soft tissues exposes the occipital bone and the atlas arch. Impose a mill hole at the Dandy point. A soft drainage tube, an intraventricular catheter, is inserted into the posterior horn of the lateral ventricle of the brain and fixed by the cuff to the dura mater of the incisor opening. After that, an atlas arch and occipital bone scales are resected.

Open the dura mater above the cerebellum and the large occipital cistern. After that, through the epidural space under the occipital bone, a soft drainage tube — an intracranial catheter — is inserted into the wound of the occipital-cervical area below the bore hole and placed in a bone groove at a 90 ° angle. In the area of the large cistern, the intracranial catheter is fixed by the cuff to the hard and arachnoid membrane. In the area of the large cistern, 3-4 holes with a diameter of 1.0-1.5 mm are made on the catheter so that the CSF from the ventricles enters the large cistern through the catheter. A valve is placed on the catheter.

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the level of the lateral surface of the processes of the II-III cervical vertebrae. The intracranial catheter is connected with a valve (intermediate) system and a soft drainage tube, a distal catheter, using an adapter. Make a skin incision in the epibastric or subcostal area 3-5 cm long. Expose the peritoneum. Through the subcutaneous tunnel, the cisternoperitoneal catheter is inserted into the wound of the epigastric (or subcostal) area. The peritoneum is cut along the length of 0.5-1.0 cm, opened, and the peritoneal catheter is inserted into the abdominal cavity. Sew up muscles, aponeurosis and skin on the head. The wound in the abdominal cavity is sewn up tightly. When for one reason or another, the excretion of excess cerebrospinal fluid into the abdominal cavity is not shown, a cisternocardic shunt is formed after ventriculocystroma. For this purpose, the internal coronary vein is exposed using a skin incision in the carotid triangle. A distal catheter is inserted through the subcutaneous tunnel into the wound into the region of the carotid triangle, through a 2/3 incision of the common or thyroid vein wall is inserted into the lumen of the stratum vein and brought to the level of the right atrium. After controlling the position of the catheter (using ECG and X-ray), the wound is sutured tightly and in layers,

In cases where the tumor is located in the region of the III ventricle or / and the midbrain, ventriculocysticism is performed without trepanation of the posterior cranial dorsal cord. For this purpose, soft tissue is cut over a Dandy point 3 cm long. A cutter hole is laid at the Dandy point. A ventricular catheter is inserted into the cavity of the lateral ventricle. A midline incision is made in the occipital-cervical area 2.5–3.0 cm long. The arc of the atlas is exposed. Part of the atlanta arc was resected. A hard and arachnoidal membrane is opened over a large cistern, a tunnel is formed through the sub-neurotic space, and the extracerebral end of the catheter is inserted into the wound of the occipital-cervical area and fixed to the arachnoidal and dura mater by the cuff. The catheter produces 2-3 holes with a diameter of 1.0-1.5 mm so that these holes are located in a large cistern and located under the arachnoid membrane. The extrabrain end of the catheter is connected with an intermediate system and a distal catheter using an adapter. Wounds in the area of the Dandy point and the occipital-cervical region are sutured tightly and in layers. The remaining steps of the cisternoperitoneostomy or the cisternoatriostomy are performed as in the first variant of the operation.

Example. Patient M., 10 years. Surgery: trepanation of ocular ulcer, partial removal of the tumor. Overlay the fistula by Torquildsong on the left. Cysteroperitoneostomy on the left.

0 Diagnosis: tumor of the worm of the cerebellum. Operation: S-shaped incision in the neck and occipital region along the midline. Incision of the skin in the left occipital region, Imposed milling hole at the Dandy point. Opened

5 TMO, the last strained, bluish-colored, did not transmit the pulsation of the brain. From the first attempt, the posterior horn of the left lateral ventricle is punctured. At a depth of 3-4 cm, a clear CSF is obtained, which expires

0 jet. The skin edges of the wound in the cervical-occipital region are separated into sides, with the left occipital nerve isolated. Musculoaponeurotic flap is found. Skeletonized occipital scale, with a slight blood loss from the transient veins of the skin to the skull. The occipital scale was resected with an posterior fragment of the ring and the arc of Atlanta. The dura mater of the incision is a Y-shaped incision with ligation of the circular sinus. During the revision of the formation of occlusion, a thickening of the worm of the cerebellum was revealed; When moving them apart

5, the lower pole of the tumor is located at the same level. The color of the tumor is grayish-bluish. A biopsy of the tumor was performed at this location. Answer: medulloblomastoma. Coagulation produced

0 superficial veins in the region of the inferior scar, which is dissected. In this place, a partial removal of the tumor with slight diffuse bleeding was performed. Tumor volume removed approximately 2x3

5 cm. When attempting to remove a part of the tumor adjacent to the bottom of the IY ventricle, bradycardia was observed to be sharp. According to the proposed method, soft tissue incision was made, the occipital bone and arc were exposed.

0 Atlanta and the imposition of a milling hole at the Dandy point, a drainage tube catheter was inserted into the posterior horn of the lateral ventricle, a bone groove with a diameter slightly larger than 5 cm of the catheter, 1.5 cm long, was made below the milling hole, forming an oval bend softly after exiting the milling hole drainage tube catheter in the bone groove. Below the grooves, the catheter was inserted under the occipital bone into the epidural space, the atlas arch and scales of the occipital bone were resected, the dura mater above the cerebellum and the large cistern, under the occipital bone and above the transverse sinus was opened through the epidural space into the cerebral end of the soft drainage tube. The catheter was inserted into the wound of the occipital-cervical region. In the area of the large cistern, the catheter was fixed by the cuff to the hard and arachnoidal membranes. The catheter made 3-4 oval holes slightly smaller than the diameter of the tube section (approximately 1.0-1.5 mm in diameter) so that the liquor from the ventricles entered the large tank through the soft catheter drainage tube, a valve was placed on the catheter the lateral surface of the spinous processes IY-IH of the cervical vertebrae, the catheter was connected with a valve (intermediate) system and a distal catheter using adapters, a skin incision was made in the epitastric or subcostal area 4 cm long, the peritoneum was exposed, through the subcutaneous tunnel the true catheter was subcutaneously carried out in the epigastric (or subcostal) wound, the peritoneum was cut along the length of 0.5-1.0 cm, the iperitoneal catheter was opened and injected into the abdominal cavity. The neck and occipital muscles and aponeurosis and the skin on the head were sewn up in layers, the wound in the abdominal cavity was sewn up tightly. Stitches for soft fabrics and leather. In the bed of the remote. Tumor placed external drainage. Spirit-septic dressing.

Claims (1)

Claims The method of surgical treatment of hydrocephalus by trepanning the occipital bone, overlaying a bore hole, inserting a catheter into the posterior horn of the lateral ventricle and performing lumbar-peritoneal bypass surgery, in order to reduce the traumatic surgery and postoperative complications, the lodgement has a retractor. the bone groove and the epidural under the occipital bone are brought into the bone defect in the region of the large occipital tank, and the distal end of the catheter is guided into the subcutaneous tissue The tissue is connected to the peritoneal or atrial part of the shunt, while a valve is placed on its side surface at the level of 1-1II cervical vertebrae.