Zhurnal voprosy neĭrokhirurgii imeni N. N. Burdenko
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Zh Vopr Neirokhir Im N N Burdenko · Apr 2009
Clinical Trial[Modern potentialities of minimally invasive management of chronic non-malignant pain].
In this retrospective investigation we demonstrated our results of treatment of chronic pain of nonmalignant etiology. The long-term effects of neuromodulation systems were examined in 215 patients with chronic nonmalignant pain syndromes. The mean follow-up period was 4 years. ⋯ We reported about the standards of implantation, the side effects and complications and failures of treatment. Our experience with the long-term administration of spinal opioid medications and SCS for nonmalignant pain encouraged us to use methods of neuromodulation for carefully selected patients. Good results with significant pain reduction demonstrated the consideration this kind of treatment about the conservative therapy.
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Zh Vopr Neirokhir Im N N Burdenko · Jan 2009
[Intracranial pressure, cerebral perfusion and metabolism in acute period of intracranial hemorrhage].
Estimation of the volume of cerebral lesion, reversibility of ischemia and prognosis of the disease determinate management tactics in patients with severe head injuries and non-traumatic intracranial hemorrhages. Data of multimodal neuromonitoring in patients with intracranial hemorrhage in the earlier stages of comatose period were analyzed in this paper. They included incracranial pressure, cerebral perfusion pressure, bulb oxymetry, brain oxygen tension, tissue microdialysis. Typical parameters for different types of neurological outcomes were defined.
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Zh Vopr Neirokhir Im N N Burdenko · Jan 2009
Case Reports[Stage-by-stage treatment of multiple cerebral aneurysms using endovascular and microsurgical techniques].
Aim of the study was to substantiate effectiveness of stage-to-stage application of microsurgical and endovascular techniques in treatment of patients with multiple cerebral aneurysms (MA). 22 patients with MA were included in this study. 70 aneurysms of different location were found in this series. Aneurysms of MCA were the most frequent. Unilateral aneurysms were found in 6 patients, bilateral -- in 7, unilateral with aneurysm of vertebro-basilar system -- in 4, bilateral with aneurysm of vertebro-basilar system -- in 5. ⋯ Obtained results of stage-to-stage surgical treatment of MA are the evidence of high effectiveness of multimodal approach with integration of endovascular and microsurgical techniques. This tactics allows to decrease mortality and disability in acute period of SAH as well in cold period. Described approach can be the treatment of choice in surgical management of MA.
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Zh Vopr Neirokhir Im N N Burdenko · Oct 2008
[Direct carotid-cavernous fistulas: clinical presentation, angioarchitectonics and endovascular management].
Since 1992 till 2007 233 male and 125 female patients (total--358) with direct carotid-cavernous fistulas (CCF) were operated. Mean age was 36.3 years. 88.5% of all cases were traumatic, 10.6% spontaneous, 0.3% congenital and 0.6% iatrogenic. CCF occlusion was performed via arterial, venous and combined endovascular approaches using balloon-catheters, coils and stents. ⋯ Transarterial endovascular occlusion is treatment of choice in management of CCF. Modern endovascular techniques allowed significant advances in effectiveness of endovascular treatment of CCF. The problem of development and treatment of pseudoaneurysms after balloon occlusion of CCF claims for separate detailed analysis.
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Zh Vopr Neirokhir Im N N Burdenko · Oct 2008
[Microsurgical treatment of partially thrombosed giant cerebral aneurysms--technique of endoaneurysmal thrombectomy].
Surgical technique of endoaneurysmal thrombectomy in microsurgical treatment of giant partially thrombosed cerebral aneurysms is described. The suggested method implies removal of thrombotic masses using the same technique as in endarterectomy. The goal of this manipulation is clipping of aneurysm neck with reconstruction of affected artery during a shortened time. ⋯ Authors applied this technique in 9 patients with giant partially thrombosed aneurysm of different localization. Bloodflow cessation period varied from 4 to 12 minutes (mean--6 minutes), which was significantly shorter than in thrombectomy using CUSA. No mortality and ischemic complications were observed in our series.