Method for revascularization of cerebral infarction foci

FIELD: medicine, neurosurgery.

SUBSTANCE: one should perform canals in cerebral tissue along the perimeter of lesion at the border of affected and intact tissues, perpendicularly to cerebral tissues due to puncturing for the depth of up to 0.5 cm against the border of lesion focus with the help of high-intensive laser radiation at wave length ranged 805-1064 nm and power ranged 50-800 mW at impulse mode. The innovation creates additional vascular bonds between affected and intact cerebral tissues.

EFFECT: higher efficiency.

2 ex

 

The invention relates to medicine, namely to neurosurgery, and can be used for revascularization infarction foci brain.

The known method of revascularization brain with appliques on the surface of the cortex of the temporal muscle on the supply foot, Dura membrane in combination with a change of the superficial temporal artery (see Neurol. Med. Chir. 1977, v.17. p.29-37, Karasawaj et al. A surgoontuatmont of "moyamoya" dicease "encephalo-mio-synangiosis").

The method has the following disadvantages: the graft covers the surface of the cerebral cortex in a limited area; after transplantation noted the development of spasms.

Known method of revascularization brain by autotransplantation of a fragment of a large gland on the brain to create an anastomosis between an artery and a vein omentum and the superficial temporal artery and vein (see publication Yasarqil M.G. et al. "Experinental, intracranial transplantation of autoqonic omentum transposed majus " in the journal J.Neurosurg, 1974, v.40, p.213-217).

However, this method also has its disadvantages: innervation of the vascular graft, is reborn in the connective tissue, decreased blood flow in the autograft, which prevents the formation anastomoticheskih vascular network between the brain vessels, does not provide compensation acute impairment of cerebral blood is brasenia in the late postoperative period.

The known method of revascularization of the brain, is selected as the closest analogue, consisting in the creation of additional vascular network and providing autologous graft of omentum with the artery and vein and a branch of the posterior trunk of the vagus nerve on the vascular membrane of the brain, laying the anastomosis between the superficial temporal artery and vein and the gastro-duodenal artery and vein and staple branch of USNO-temporal nerve branch of the posterior trunk of the vagus nerve (see EN No. 2061413, IPC-6: 61 17/00, publ, 10.06.1996).

The advantage of this method is that recovers innervation of the vascular graft, it prevents the degeneration of the gland in connective tissue, increases blood flow in the graft, as recovery innervation continuing education anastomoticheskih vascular network between the vessels of the gland and brain, and it provides compensation for acute disorders of cerebral circulation in both the near and long-term postoperative period.

However, this method is quite traumatic, time-consuming, unsafe, and ineffective.

Thus, the technical result for the solution of which directed this invention is to eliminate the above to enter the deficiencies, namely reducing the morbidity, duration and improving the safety and efficiency of the method.

The above technical result is achieved by the fact that in the known method of revascularization infarction foci of the brain, consisting in the creation of additional vascular connections between the unmodified and the affected brain tissue, according to the invention provides for the implementation of non-through channels on the border between the affected and non-brain tissue, carried out using high-intensity laser radiation with a wavelength in the range from 805 to 1064 nm and the radiated power from 50 to 800 mW in pulsed mode.

Running blind channels on the border between the affected and non-brain tissue, carried out using high-intensity laser radiation, contributes to the creation of better conditions for the full development of collateral blood flow to the lesion and, as a consequence, the decision put before the invention of the tasks was to reduce the morbidity and duration of the method and the increase of its safety and effectiveness.

This is ensured by the fact that the implementation of non-through holes on the border of the affected and non-brain tissue, carried out using high-intensity laser radiation, is R is Staraya brain tissue procedure, which eventually leads to a permanent increase in blood flow to the fire damage.

In addition, the irritation of brain tissue, in particular of high-intensity laser radiation, reduces hypertension, helps prolonged strengthen blood circulation and metabolic processes in his irritation.

This high-intensity laser radiation activates microcirculation in tissues, normalizes permeability of the vessel walls, reduces swelling, stimulates blood flow on existing vessels due to the inclusion of reserve capillaries.

The basis of the biostimulating effect of high-intensity laser radiation are two processes: the increasing geometrically and activation of neoplasms of the capillaries.

In addition, the influence of the laser radiation is characterized by a short, painless, aceptic and well tolerated by the claimed category of patients.

The mechanism of action of laser radiation it is necessary to note the presence of photoactivity and normalizing effect on the activity of key enzymes of metabolism, biosynthesis of proteins, DNA, RNA, cell proliferation, tissue regeneration, the activity of microcirculation of blood and lymph. Laser radiation enhances the activity of mitochondria, increases the enzymatic activity of neurons, in particular the level of ACE ilpolistirene, catalase. K - ATPASE and Na, as well as other energetically important enzymes.

The laser eliminates the imbalance in the Central nervous system, interfering sanogenetic brain function. It is laser radiation at the subcellular level activates nuclear device, normalize the redox processes, activates the processes of regulation. At the cellular level - changes the membrane potential of cells, restores damaged blood-brain barrier (BBB). At the tissue level - changes the pH of the interstitial fluid, can prevent the development of edema or swelling of the brain, improves microcirculation, provides complex compensatory reactions to maintain hemostasis, has immunomodulatory effects, which is especially important for the claimed category of patients.

The authors experimentally found that the use of high-intensity laser radiation with a wavelength in the range from 805 to 1064 nm and the radiated power from 50 to 800 mW in pulsed mode provides achieve specified by the applicant of the technical result.

The method is as follows.

Under balanced endotracheal anesthesia produce a linear skin incision in the area revealed brain damage.

On saletramadol bone impose F. tavoe hole and using drills "Codman" form bone-periosteal flap of the desired size; Dura moderately strained. Last reveal the H-shaped slit. Make puncture of the brain at a depth of 0.5 cm from the border of the lesion is strictly perpendicular to the tissues of the brain monovacancy quartz fiber with a fiber diameter of 0.4 mm, thereby not through the channels on the border between the area of infarction (diseased tissue) and unaltered brain tissue in increments of 1.5 cm around the perimeter of the lesion.

The channels formed in the following manner.

The fiber is immersed perpendicularly to the brain tissue in the brain substance to a depth of 0.5 cm, serves laser radiation with a duration of 4 seconds and no movement of the fiber, not stopping the feed radiation begin to extract the fiber at a rate of approximately 1 mm per second. The feed radiation stop when the light remains immersed in the fabric of the brain to a depth of 0.5 mm, the Total time of the radiation in the formation of one channel is 10 seconds.

To create a non-through channels on the boundary between damaged and intact brain tissue using high intensity laser radiation with a wavelength in the range from 805 to 1064 nm in pulsed mode. The radiation power is from 50 to 800 mW.

The number of current non-through holes (channels) depends on the size of the hearth damage. The step between channels part of AET approximately 1.5 cm around the perimeter of the lesion.

Extraction speed fiber during formation of the channels is about 1 mm/sec.

The method is confirmed by the examples.

Example 1. The patient So 53 years of age, suffering from hypertensive heart disease for several years, early in the morning suddenly developed right faciomaxillary hemiparesis and speech disturbances on the background of high blood pressure 200 and 130 mm Hg on the same day arrived at the hospital at the place of residence. On computer tomography brain revealed an ischemic focus is on the border of gray and white substance with a diameter of 4 cm of mixed type. On the day 3 after preliminary preparation made the operation.

Under balanced endotracheal anesthesia produced a linear skin incision in the left parieto-temporal area. On saletramadol bone imposed Presevo hole and using drills "Codman" formed bone-periosteal flap 3×4 see Dura moderately strained. The latter opened the H-shaped slit. Produced by the puncture of the brain at a depth of 0.5 cm is strictly perpendicular to the tissues of the brain monovacancy quartz optical fiber by diametral fiber 0.4 mm to create a laser channel at the boundary between the affected area and unaltered brain tissue in increments of 1.5 cm around the perimeter of the ischemic focus.

Used a diode laser with wavelength of 1064 nm. Power is ity radiation 50 mW in pulsed mode. The exposure time was 10 seconds per channel. Put the fiber into the brain substance to a depth of 0.5 cm from the border of the lesion. When immersing the fiber was applied laser radiation with a duration of 4 seconds (without moving the fiber). Not stopping the feeding radiation, pull the fiber at the rate of about 1 mm per second, which took 6 seconds. Supply of laser radiation was stopped when the fiber remained immersed in the fabric of the brain to a depth of 0.5 mm, the Total number of channels 7.

Dura stitched atraumatic needle 5/0 "Ethicon" Prolen. The bone flap is laid in position and fixed 2 bone joints. The wound is sutured in layers tightly single interrupted sutures. Imposed aseptic bandage.

Example 2. The patient 58 years old, suffering from hypertension for several years, after exercise suddenly developed right-sided hemiparesis and speech disturbances on the background of high blood pressure 180 and 130 mm Hg on the same day the patient arrived at the hospital at the place of residence. On computer tomography brain revealed an ischemic focus in subcortical areas in the projection of the internal capsule with a diameter of 7 see On the 2nd day after preliminary preparation produced by the operation of the claimed method.

The sequence of the operating power is s identical to that described in example 1.

Used monovacancy quartz fiber fiber diameter of 0.4 mm

Used laser radiation from a diode laser with a wavelength of 805 nm. The radiation power of 800 mW in pulsed mode. The exposure time was 10 seconds per channel.

The fiber was immersed in the substance of the brain to a depth of 0.5 mm from the border of the lesion. Laser radiation was applied for 4 seconds. The fiber was extracted at a rate of approximately 1 mm per second. The total number of channels 11.

The revascularization method infarction foci of the brain, including the execution of the channels in the brain tissue, characterized in that the channels do not, on the perimeter of the hearth damage on the border of the affected and unmodified tissue perpendicular to the tissues of the brain by puncture of the brain at a depth of 0.5 cm from the border of the lesion using high-intensity laser radiation wavelength in the range of 805 - 1064 nm and a power of 50 to 800 mW in pulsed mode.



 

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