Method for detecting functional value of cerebral arteriovenous malformation vessel

FIELD: medicine, neurosurgery.

SUBSTANCE: one should measure blood pressure in afferent vessel of cerebral arteriovenous malformation (AVM). If measured pressure is above that of functionally insignificant vessel being 25% against systemic arterial pressure for AVM at blood flow of 1000 ml/min and 50% for AVM at blood flow of 500 ml/min one should conclude the vessel to be functionally valuable. The method enables to decrease complications due to increased reliability in detecting functional value of ABM-supplying vessels.

EFFECT: higher efficiency of detection.

1 ex

 

The invention relates to medicine, namely to neurosurgery, and can be used to determine the functional significance of an afferent vessel of a large arteriovenous malformation (AVM) of the brain.

There is a method of determining the functional significance of an afferent vessel of the AVM by the time its occlusion balloon and the subsequent evaluation of neurological symptoms (Khilko V.A., N. Zubkov. Intravascular neurosurgery. - L.: Medicine 1982. - P.53).

The disadvantages of the method:

technical complexity of the process;

- the possibility of injury of the vessel.

There is a method of determining the functional significance of an afferent vessel AVM according to pharmacological tests - amicalola test (Rauch R.A,, Vinuela f, Dion J. et al. Preembolization functional evaluation in brain arteriovenous malformations: the superselective Amytal test. // AJNR 1992. Vol.12. P.303-308), we adopted for the prototype. Through the microcatheter, established in afferent vessel AVM, make the introduction of the solution barbiturates short-acting (30-50 mg of thiopental sodium). Short-term development of focal neurological symptoms indicates the functional significance of this vessel.

The disadvantages of this method include:

- the need for intravascular introduction of alkaline chemicals;

- lack of precision the method because of the possibility of infusion of the drug in brain vessels of small diameter, not involved in the blood supply to the AVM;

the inefficiency of the sample to determine the functional significance of an afferent vessel of the deep AVM.

The invention is directed to a method of determining the functional value of the vessel AVM that reduce complications and improve the accuracy of the method.

It is known that one of the main pathophysiological manifestations of AVM is an arteriovenous shunt, the pressure in the afferent vessel, feeding only AVM and no functional value, much less systemic blood pressure: for AVM with a flow of 1000 ml/min it is 25% of systemic blood pressure (SBP), for AVM flow 500 ml/min 50% (Gao E. et al. A Theoretical Model of Cerebral Hemodynamics: Application to Arteriovenous Malformations. //J. of Cerebral Blood Flow and Metabolism. 1997. Vol.17. P.905-918).

The method consists in the following: the microcatheter set in the afferent vessel AVM, measure the pressure of blood in it. If the pressure in the afferent vessel is greater than the calculated theoretical models of cerebral hemodynamics in patients with arteriovenous malformations brain E.Gao, believe that the vessel is functionally significant.

The inventive method differs from the prototype in that produce direct measurement of blood pressure in the afferent vessel AVM golovnogo the brain and when data is higher than the calculated theoretical models of cerebral hemodynamics in patients with arteriovenous malformations brain E.Gao, believe that the vessel is functionally significant.

The method is as follows: through the microcatheter installed in the afferent vessel of the AVM, measure blood pressure and compare it with the calculated data for theoretical models of cerebral hemodynamics in patients with arteriovenous malformations brain E.Gao. Upon receipt of the digits of the blood pressure in the afferent vessel above the calculated believe that the vessel is functionally significant.

The inventive method is developed and clinically tested in the Polenov research neurosurgical Institute them. Professor A.L. Polenov in the treatment of 25 patients who were superselective embolization of the AVM.

Here is an example extract from the records:

B-I K., 27 years old, IB N1308-01, entered the Institute with a diagnosis of AVM medial divisions of the left frontal and parietal lobes spreading on the corpus callosum. The consequences of repeated subarachnoid hemorrhage.

9.06.2001 operation superselective embolization of the AVM histogram.

According to the claimed method operations performed catheterization of the anterior cerebral artery the microcatheter Magic 1.8F directly from malformation (Volume of shunt 500 ml/min). Measured GARDEN and blood pressure in this vessel, it was 96 and 30 mmHg, respectively. Calculation of the digits of the pressure in the afferent vessel on theoretical model of the cerebral hemodynamics in patients with arteriovenous malformations brain E.Gao: 50% is 48 mm Hg The blood pressure in the afferent vessel (30 mm Hg or 31.2%) are below the expected level. Conclusion: the vessel is not functionally significant. Superselective embolization of the AVM, the last completely off from circulation. Slew of neurological symptoms was not.

Using the proposed method allows us to evaluate the functional significance of afferent vessel of the AVM, to avoid complications that increase the risk of disability of the patient.

The method of determining the functional value of the vessel arteriovenous malformation (AVM) of the brain, characterized in that conduct direct measurement of blood pressure in the afferent vessel of the AVM and if it is above the pressure functionally insignificant vessel, comprising 25% of systemic arterial pressure for AVM with blood flow of 1000 ml/min and 50% for AVM with blood flow 500 ml/min, the vessel is defined as the functionally significant.



 

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