The method of treatment of acute hydrocephalus

 

(57) Abstract:

The invention relates to medicine, namely to neurosurgery, and can be used for the treatment of patients with ruptured aneurysms of the cerebral vessels and trauma of the Central nervous system. The method can prevent the development of inflammatory complications with long-term drainage of the ventricles of the brain, repeated administration of medicinal substances without additional trauma to the brain, to reduce the number of patients who have shown liquorshunting operation with permanent drainage systems. To do this, after applying prezioso holes in a typical place for ventriculotomy produce puncture of the lateral ventricle soft cannula, which is then connected to a flexible reservoir that fit in podporujici space of the head. Then the vessel percutaneous dotted line and set outside drain for continuous outflow of cerebrospinal fluid. If improvement options liquorrhea outside drain is removed by a simple pull and the tank in the process of treatment percutaneous dotted line and in line with emerging clinical symptoms to decide whether removal is ins, namely, neurosurgery and can be used mainly for the treatment of patients with ruptured aneurysms of the cerebral vessels, as well as patients with trauma of the Central nervous system.

There is a method of treatment of hydrocephalus using extracranial levorotatory operations /1/, the purpose of which the excretion of excess cerebrospinal fluid in underany bed for adsorbate. The application of these interventions involves permanent implantation in the body of patients special drainage systems that allow unidirectional and measured the output of cerebrospinal fluid from liquorstore system. In practical neurosurgery spread 3 levorotary operations: ventriculoperitoneal, lumboperitoneal. A significant drawback of the application of these interventions in the immediate aftermath of aneurysm rupture period is the danger of occlusion valve system of blood cells contained in the liquor. In addition,after implantation levorotatory system in the body, the patient becomes Paisano dependent on her.

A prototype of the proposed method is a method of treatment of acute hydrocephalus by naruemol overlay prezioso holes in a typical point / for anterior horn point Kocher, for the rear point Dandy/, dissect the Dura, and then punctilious ventricle of the brain of a soft vinyl chloride or silicone tube with a diameter of 1.5-2 mm metal mandrel. Cerebrospinal fluid flowing in a jar Arendt, set at the level of the frontal tubercles.

The known method has the following disadvantages:

-the possibility of infection of the ventricles of the brain with long-term / more than 4-5 days/ external drainage of cerebrospinal fluid;

the impossibility of long and repeated administration of drugs into the ventricles of the brain after removal of the drains;

-loss of use of existing drainage systems in the event of drenaazivesi state. A special drainage system is implanted in another place that requires additional trauma to the brain.

In view of the above disadvantages of the known method, there is a need to create a method that will allow to achieve the following technical result:

-will prevent the development of inflammatory complications with long-term drainage of the ventricles;

-will allow you to get the re-introduction of medicinal substances without additional traumati the Ana, liquorshunting operation with drainage systems, and, if necessary, the implantation of the last to use the existing drainage system.

This technical result is achieved by the fact that after puncture of the ventricle of the brain in podporujici space head implanted silicone elastic tank, connect it with ventricular cannula and external drainage, which reduce likvidatsii removed and further drainage of the ventricles of the brain, the introduction of medicinal substances, measurement of liquorrhea, dosed elimination of the liquor throughout the acute period is performed by percutaneous puncture of the remaining tank. Established in podporujici the head space of the tank prevents the development of inflammatory complications, as it allows you to avoid long / more than 3 days/ external drainage of cerebrospinal fluid, and will also allow you to create a permanent bacteriostatic antibiotics concentration inside the tank. Due to the elastic properties, the latter creates the possibility of multiple cutaneous its punctures for administration of medicinal substances, measurement liquorrhea and dosed removal of CSF from the ventricles neprovedenija above therapeutic manipulation in patients with acute hydrocephalus after rupture of aneurysms of the cerebral vessels is reduced, the number of patients requiring implantation of a permanent levorotatory system.

Comparative analysis of the proposed technical solution with the prototype showed that the proposed method differs from the known fact that podporujici space head set stretchy tank, connect it with ventricular cannula and external drainage, the latter with improved parameters of CSF dynamics is removed and the reservoir in the treatment of cutaneous dotted line, and then in accordance with fluttering clinical symptoms to decide whether to remove the drain or using it as an integral part of a permanent shunt system.

Thus, the proposed solution meets the criterion of "novelty". The method of treatment of acute hydrocephalus, characterized by the combination of the above characteristics in the available sources of information not found. The invention, according to the authors, is not obvious from the prior art. Thus, it meets the criterion of "inventive step".

The method is as follows.

Under local anesthesia or endotracheal anesthesia / in the case of a combination with surgery aneurysm is Anna point, cut crosswise slit Dura. Then the dotted line in the lateral ventricle soft ventricular cannula with a diameter of 1.5-2 mm with a sealed end and multiple side holes and a metal mandrel, the latter extract and measure the parameters of CSF dynamics. Then ventricular cannula connected to a reservoir, which represents the elastic silicone hemispherical vessel with a volume of 1-1,5 cm3with bezel for fixing it to nadkostnitse 2-3 stitches. Then suture the skin and the dotted line in the tank through the skin elastic tube with any sharp the mandrel. After removal of the mandrel the tube is lengthened and connect with a bottle of Arendt for external ventricular drainage system. During the first days after the operation, carry out continuous CSF drainage, the danger of Antsiferova at this time is reduced by a constant high concentration of antibiotics in the tank. With the improvement of the parameters of CSF dynamics / usually 2 day/ the outer part of the drainage is removed by a simple pull, the hole in the tank is closed due to the elasticity of its walls. The remaining subcutaneous reservoir daily / average within 10 days after the surgery/ the dotted line h which lead to excess CSF to normalize numbers liquor pressure. In the case of persistent clinical improvement and normalization of parameters of CSF dynamics in the ligation drainage removed. With the development of symptoms of chronic hydrocephalus existing drainage system is used as an integral part of the permanent shunt system / ventriculostomy, ventriculoperitoneal/.

The proposed method developed in LNHI them.Prof. Polenov, A. L. and passed clinical trials in 2 patients with aneurysms of the cerebral vessels. To confirm compliance with the criterion of industrial applicability of the present example is an extract from the history of the disease.

Example: Patient N. 57 years, IB N 177-92, was admitted to our Department with a diagnosis of subarachnoid hemorrhage in a serious condition. Neurological status: stunned, partial sensory aphasia, pravostoronnei pyramidal insufficiency with pathological stop signs, expressed meningeal syndrome. When lumbar puncture cerebrospinal fluid xanthochromia, the pressure of the liquor 300 mm Art. RT With selective angiography of all vascular regions identified 2 aneurysm RMA and arterially aneurysm IC ICA right, enlargement of the ventricular system. In the acute period, one week after admission, the patient had an operation:the creation of an artery. During the operation according to the proposed method produced the imposition prezioso holes at the point Kozera left, puncture the anterior horn of the left lateral ventricle produced monitoring of intracranial pressure, and then to the ventricular cannula attached elastic silicone tank, fixed 3 stitches for nadkostnitse. After layer-by-layer suture of the wound punctured through the skin elastic tank, outside drain is connected to a Bank of Arendt. Within 2 days after the operation, the liquor was drained continuously, separated 200 ml CSF, the patient's condition has stabilized, external drainage removed made of percutaneous puncture of the tank with the introduction of antibiotics. On the 6th day made measurements of CSF dynamics, elimination of CSF to normalize spinal fluid pressure. The patient was fully compensated by the wound healed by first intention. Inflammatory measurements in cerebrospinal fluid were noted. Drainage was not deleted in mind the need for the patient another operation, opraveny on clipping of the aneurysm SC BSA to the right,which will be done in 1-2 months. The described method is most appropriate to use in patients with multiple arterio the MS.

The method of treatment of acute hydrocephalus, including drainage of the brain ventricles, the removal of cerebrospinal fluid through the outer drainage and its removal after the improvement of parameters of CSF dynamics, characterized in that podporujici space head implanted elastic tank, connect it with ventricular cannula and external drainage, and after removal of the external drainage is the removal of the liquor and/or drug delivery is performed with the use of percutaneous puncture of the tank.

 

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