A method for the treatment of occlusive lesions of the vertebral artery

 

(57) Abstract:

The invention relates to medicine, namely to vascular neurosurgery, and can be used in the treatment of occlusive lesions of the vertebral artery. The purpose of the invention is the prevention of cerebral and spinal blood circulation during surgery. For this purpose, impose a vascular anastomosis between the external carotid and the distal extracranial part of the vertebral artery. Thus mobilize the distal extracranial part of the vertebral artery into the spinal canal to the level of a blood clot in the vessel, keeping radicular artery, cross vertebral artery immediately distal to the level of a blood clot, and placed on the proximal part of the rough artery clips. 1 Il.

The invention relates to medicine, namely to vascular neurosurgery, and can be used in the treatment of occlusive lesions of the vertebral artery.

There is a method of treatment of occlusive lesions of the vertebral artery, published in the article S. D. its juridical "Using carotid-vertebral anastomosis with vertebrobasilar insufficiency" in the book.Cervical osteochondrosis. Edited by Professor A. I. OCHA, Novokuznetsk, 1984, S. 122-130. the th and distal extracranial part of the vertebral artery at the site of the V4the end side. However, with this method of treatment anastomosis always overlaps between1-C2without taking into account the level of thrombosis of the vertebral artery. Temporary damming of blood flow in the vertebral artery during surgery can lead to disruption of retrograde blood flow in this artery in the side of radicular arteries supplying the medulla and cervical spinal cord. In addition, the occipital branch of the external carotid artery may not always provide adequate blood flow in the vertebral artery. There is also known a method for the treatment of occlusive lesions of the vertebral artery, published in the article Spetzler, R. F. et al. "Vertebrobasilar insufficiency. Part 1. Microsurgical treatment of extracranial vertebrobasilar disease". J. Neurosurg. 66:648-661,1987. With this method produce the transpose of the proximal vertebral artery common carotid artery at the site of V4. However, this method of treatment may be applied only when the occlusion of the proximal vertebral artery.

The prototype of the claimed method is a method of treatment of occlusive lesions of the vertebral artery, described in the article by S. D. its juridical "Using carotid-vertebral anastomosis with vertebrobasilar nedostatek, S. 122-130. With this method produce the imposition of anastomosis between the external carotid and extracranial part of the vertebral artery at the site of the V4the end side. At the same time impose two clip on this site without saving radicular arteries.

The disadvantage of this method is the cerebral circulation during surgery as a result of the shutdown of the circulation of radicular arteries krovosnabjaemah retrograde, which can lead to poor circulation in an oblong brain and spinal cord and thrombus formation in vertebral and radicular arteries: the anastomosis is imposed without regard to the level of thrombosis of the vertebral artery.

The aim of the invention is to reduce the frequency of postoperative complications by preventing cerebral and spinal blood circulation during surgery.

This objective is achieved in that in the method for the treatment of occlusive lesions of the vertebral artery, including the imposition of vascular anastomosis between the external carotid artery and extracranially distal part of the vertebral artery, the distal extracranial part of the vertebral artery mobilize in the spinal canal, sokhranyalis cut rough preliminary external carotid artery on the "end to end".

The essence of the invention illustrated by the drawing, which shows a scheme of the method.

The drawing shows: common carotid artery 1, the external carotid artery 2, vertebral artery 3, the internal carotid artery 4, exposed bone canal vertebral artery 5, radicular artery 6, crossed by branches of the external carotid artery 7, the anastomosis between the external carotid and vertebral arteries 8.

The method is as follows. Produce linear paramedian incision of soft tissue in the occipital region, which then goes to the front edge of the Sterno sternocleidomastoid muscle to its attachment to the clavicle. Cross Sterno sternocleidomastoid muscle at the junction of its upper and middle thirds. Mobilize the common carotid 1, the external carotid artery 2, the internal carotid artery 4. From soft tissues secrete the distal extracranial part of the vertebral artery 3, the level of output it from the bone channel (C2vertebra) before entering into the cavity of the skull (at high thrombosis of the vertebral artery). In the absence of thrombus in the vertebral artery at the level2vertebra produce the opening of the front wall of the bone canal vertebral arteriae 6. Then cross the vertebral artery right at the edge of the thrombus. 1 cm distal to cut off part of the vertebral artery impose somesailesose clips. This retro grapes of the blood flow in the vertebral artery to the level of the overlay clip is saved, enabling a distally located radicular arteries. To mobilize external carotid artery bandage and cut off its branches 7: front, top thyroid and language artery, limiting the mobility of the main trunk. After the application of vascular clips of the external carotid artery is crossed so that the proximal segment of the vessel was without tension to sew with the distal segment of the vertebral artery 8. After that, the artery is treated with a solution of heparin and sew the 2 external carotid and vertebral artery 3 "end to end" 8. Use of the operating microscope with magnification of 10xthe anastomosis impose threads 10/0. Then hold the control of hemostasis. Next, the ends of the cross-previously Sterno sternocleidomastoid muscles are sewn together, and the surgical wound is sutured closed.

P R I m m e R. Patient L. 53 years, history N 1336-88, was treated in the vascular compartment of LNHI ibot and decreased sensation in the right extremities. From the anamnesis of the disease it is known that sick with 08.06.88, when first appeared headaches. 10.06.88, against the background of severe headache speech, a right-sided hemiplegia. Was admitted to the neurology hospital, where he conducted conservative treatment, after which noted some improvement. 03.12.88, was hospitalized in LNHI. When receiving the status offset: neurological status divergent strabismus, paresis of upward gaze, ptosis of the left, Central paresis III, VII, XII nerves right, lower pharyngeal reflex on both sides, psychic disturbances, right-sided spastic hemiparesis, to plegia in the brush, hemihypesthesia right. The Department conducted a clinical and radiological examination. An angiographic examination revealed thrombosis of the left vertebral artery from the mouth to p4vertebra, atherosclerotic changes of cerebral vessels. 09.02.89, operation revision of the left vertebral artery, the imposition of anastomosis between the external carotid and the distal extracranial part of the vertebral arteries, stratageme. According to the proposed method produced linear paramedian incision of soft tissue in the occipital region, satelli Sterno-slicice-mastoid muscle at the junction of its upper and middle thirds. Mobilized to the common carotid, internal, and external carotid artery. Of the soft tissues was isolated distal extracranial part of the vertebral artery between1-C2the vertebrae. Made an autopsy of the front wall of the bone canal vertebral artery to p4vertebra. Using bipolar coagulation coagulated venous plexus, vertebral artery. Radicular artery saved. Vertebral artery after applying ramosarimaske clip clipped at the level of the thrombus. Made the mobilization of the external carotid artery, limiting her mobility front, top thyroid, language artery tied up and crossed. The external carotid artery is cut off from the bifurcation of the common carotid artery at a distance of 4 cm, the distal end her bandaged. The proximal end of the external carotid artery beneath the internal jugular vein. The ends of the artery treated with heparin solution. Using an operating microscope with magnification of 10xand the thread 10/0 imposed anastomosis end-to-end between the external carotid and the distal extracranial part of the vertebral arteries. Samanaikaisen clips removed, the control of hemostasis, ripple vertebral artery good (ovaska. The Collar Of The Trench. Postoperative for smooth, sutures were removed on the 10th day, healing by primary intention. The control angiogram anastomosis functions. Neurological status partially regressed.

A METHOD for the treatment of OCCLUSIVE lesions of the VERTEBRAL ARTERY, including the imposition of vascular anastomosis between the external carotid artery and the distal extracranial part of the vertebral artery, characterized in that, to reduce the frequency of postoperative complications by preventing cerebral and spinal blood circulation during surgery, the distal extracranial part of the vertebral artery mobilize in the spinal canal, keeping radicular artery to the level of a blood clot in a vessel, where it crossed, and the distal part anastomosing with the proximal segment of the cross pre-external carotid artery by type of end-to-end.

 

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