Evaluation method off of the circulation of arteriovenous malformations of the brain

 

(57) Abstract:

The invention relates to medicine, namely to vascular neurosurgery, and can be used to evaluate the radical removal or embolization of arteriovenous malformations. The patient produce pre - and postoperative Doppler examination of the internal jugular and vertebral veins. Indicators of postoperative average linear flow velocity of more than 30 cm/s at least one of the internal jugular veins and/or more than 15 cm/s in at least one of the vertebral veins indicate incomplete shutdown AVM from blood circulation. The method allows to increase the precision of the estimate off of blood flow arteriovenous malformations.

The invention relates to medicine, namely vascular neurosurgery, and can be used to evaluate the radical removal or embolization of arteriovenous malformations.

Evaluation of radical removal or embolization of arteriovenous malformations was and remains an important issue in the treatment of this pathology. Incomplete removal (or embolization) arteriovenous malformation (AVM) with open intracranial intervention leads to a re-Gravois the Xia not always, especially when deep AVM.

Known angiographic evaluation method off of the circulation of the AVM after open surgery or superselective embolization (Yasargil, M. A. Microneurosurgery. Vol.3. - Stuttgart, New York, 1984). Residual fragments of the vascular network malformation, the presence of contrasting draining veins arterial phases are clear signs of functioning of the AVM. The disadvantages of the method are: a) high invasiveness; b) apply only in the postoperative period, when removal of the identified residual fragment pathological education will require a second operation; C) when intravascular operations may experience difficulty in determining completeness of embolization in developed spasm with poor contrast leading vessels, when filling malformations of other vascular pools, etc.

There is a method of assessing off from circulation AVM according to the gas content of blood from draining cerebral vein (Patent RF №2179723, g 01 m 33/48, 2002, bul. No. 5). Intraoperative monitoring of the completeness of the removal of the AVM carried out after collection of blood from draining veins of the AVM and a peripheral vein. Identical Zelenyi AVM. The disadvantages of this method include (a) the possibility of obtaining a response only after a significant period of time during which surgical procedures should be suspended; b) the need to puncture draining veins, which in the case of preserved functioning of the AVM can cause bleeding; C) when ineradicable remote AVM, as a rule, does not detect all draining veins, which negates the possibility of adequate application of the method; d) impossibility of the use in intravascular procedures.

Known way to assess shutdown of the circulation of the AVM using Doppler carotid and vertebral arteries in the neck (whistles D. C. peri-operative transcranial Doppler with arteriovenous malformations of the brain: Diss.. Kida. the honey. Sciences. - Saint-Petersburg., 1993. - 206 S.), consisting in the evaluation of linear blood flow velocity and indexes resistance in carotid and vertebral arteries. Increased blood flow velocity in the artery while reducing pulse index and index of resistance (pattern shunt) serves as the basis for the conclusion on the functioning of the malformation. The disadvantage of this method is that at low levels controlactive functioning of the AVM. This method is adopted for the prototype.

The invention is directed to a method of assessing the shutdown of the circulation of the AVM, providing increased accuracy of the method.

The invention consists in the following. The patient produce pre - and postoperative Doppler examination of the internal jugular and vertebral veins. Indicators of postoperative average linear flow velocity of more than 30 cm/s at least one of the internal jugular veins and/or more than 15 cm/s in at least one of the vertebral veins indicate incomplete shutdown AVM from blood circulation.

The inventive method differs from the prototype in that they measure the average linear velocity of blood flow in the internal jugular and vertebral veins, indicators of postoperative average linear flow velocity of more than 30 cm/s at least one of the internal jugular veins and/or more than 15 cm/s in at least one of the vertebral veins indicate incomplete shutdown AVM from blood circulation.

The method is as follows: the patient after conducting the standard Doppler examination of the arteries in the supine position, produce a location of the internal jugular vein, then POS is at least one of the internal jugular veins and/or more than 15 cm/s in at least one of the vertebral veins indicate incomplete shutdown AVM from blood circulation.

The inventive method is developed and clinically tested in the Polenov research neurosurgical Institute them. Professor A. L. Polenov in the treatment of 5 patients with arteriovenous malformations of the brain and 10 healthy volunteers. A survey of volunteers was performed to confirm the accepted norms of the average linear velocity of blood flow in the veins in healthy people. Examples of extracts from the history of the disease.

Example 1

Patient M 38 years old, and a/b No. 2534-2001. Arteriovenous malformation of the frontal lobe. Epileptic syndrome.

According to the claimed method for evaluation of such exclusion from circulation and the patient was held Doppler examination before and after intravascular surgery (superselective embolization of the AVM). Linear average velocity of the blood flow in the right jugular vein before surgery was 81 cm/s, after - 60 cm/s in the left jugular vein: before surgery, 50 cm/s, after - 48 cm/sec. In the right vertebral veins: before surgery - 28 cm/s after 20 cm/s in the left vertebral veins: up to 36 cm/s, after - 21 cm/S. Thus, in jugular vein blood flow velocity decreased only up to 48 cm/s, in vertebrates veins up to 20 cm/s, which meant a partial shutdown malformation of blood flow. Data on the partial function="ptx2">

Patient M 56 years old, and a/b No. 198-2002. Arteriovenous malformation of the left temporal lobe epileptic syndrome.

The patient was made open surgery - osteoplastic trepanation in the left temporal region, removal of the malformation. According to the claimed method for evaluation of such exclusion from circulation of the patient was held Doppler examination before and after surgery. Linear average velocity of the blood flow in the right jugular vein before surgery was 60 cm/s, after - 29 cm/s in the left jugular vein: before surgery 37 cm/s, after 26 cm/sec. In the right vertebral veins: before surgery - 30 cm/s, after - 14 cm/s in the left vertebral veins: before surgery 28 cm/s, after - 14 cm/S. Thus, none of jugular vein blood flow velocity did not exceed 30 cm/s, in vertebrates veins - 15 cm/s, which meant the complete cessation of functioning of the malformation.

Use saleemul method allows for precise, quick and non-invasive monitor the efficacy of removal or embolization of arteriovenous malformations.

Evaluation method off of the circulation of arteriovenous malformations of the brain by Doppler examination, atleastone postoperative average linear flow velocity of more than 30 cm/s at least one of the internal jugular veins and/or more than 15 cm/s in at least one of the vertebral veins indicate incomplete shutdown of arteriovenous malformations of the circulatory.

 

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1 tbl

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3 ex

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6 tbl, 1 ex

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