4 research outputs found
The successful treatment of primary brain echinococcosis
The case of successful treatment of primary brain affection by echinococcus with formation of giant unicameral cyst in patient 28 year-old is documented. Epidemiological data on echinococcosis occurence in the world, in Ukraine, and in Dnipropetrovsk region is specified. Main focus is given to two aspects: preoperative brain echinococcosis diagnosing through noninvasive neuroimaging methods (brain CT and MRT), and the special features of surgical approach aimed at total removal of giant capillary echinococcal cyst without damaging its integrity.Total echinococcal cyst removal using hydrodynamic expulsion method with maximum head bend to the trepanation side without cyst puncturing was proved the optimal treatment method in cyst localization closer to cerebrum cortex. Specific nature of echinococcal cysts lies in the fact that, in case of expansive growth, their chitinous membrane does not grow into brain tissue, but they rather βmove the brain tissue apartβ. The cyst is easily removed as it is loosely bound to brain cortex. Knowledge of abovementioned brain echinococcal cysts diagnostics and treatment features enables their preoperative detection and total removal
Successful surgical treatment of a patient with combined gunshot shrapnel injuries in the heart and brain complicated by middle cerebral artery pseudoaneurysm
Successful step-by-step treatment of a combined gunshot shrapnel injury of the brain, damaging
the left middle cerebral artery (MCA) branches, and penetrating myocardium injury is discussed.
Open brain and heart surgeries were performed. A left MCA pseudoaneurysm was formed
postoperatively. Endovascular exclusion of the left MCA pseudoaneurysm was performed using
detachable micro coils. Finally, plastic reconstruction of the posttraumatic cranial vault defect
was performed using a dynamic titanium plate.
Treatment of severe combined gunshot shrapnel brain injury with formation of MCA pseudoaneurysm and a penetrating myocardium injury requires a multimodal approach involving
related specialists (neurosurgeon, cardiosurgeon and interventional radiologist)
Π£ΡΠΏΡΡΠ½Π΅ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ ΠΏΠ΅ΡΠ²ΠΈΠ½Π½ΠΎΠ³ΠΎ Π΅Ρ ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ·Ρ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ
The case of successful treatment of primary brain affection by echinococcus with formation of giant unicameral cyst in patient 28 year-old is documented. Epidemiological data on echinococcosis occurence in the world, in Ukraine, and in Dnipropetrovsk region is specified. Main focus is given to two aspects: preoperative brain echinococcosis diagnosing through noninvasive neuroimaging methods (brain CT and MRT), and the special features of surgical approach aimed at total removal of giant capillary echinococcal cyst without damaging its integrity.Total echinococcal cyst removal using hydrodynamic expulsion method with maximum head bend to the trepanation side without cyst puncturing was proved the optimal treatment method in cyst localization closer to cerebrum cortex. Specific nature of echinococcal cysts lies in the fact that, in case of expansive growth, their chitinous membrane does not grow into brain tissue, but they rather βmove the brain tissue apartβ. The cyst is easily removed as it is loosely bound to brain cortex. Knowledge of abovementioned brain echinococcal cysts diagnostics and treatment features enables their preoperative detection and total removal.ΠΠΏΠΈΡΠ°Π½ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠΌ Ρ ΠΎΠ±ΡΠ°Π·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ Π³ΠΈΠ³Π°Π½ΡΡΠΊΠΎΠΉ ΡΠΎΠ»ΠΈΡΠ°ΡΠ½ΠΎΠΉ ΠΊΠΈΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° 28 Π»Π΅Ρ. ΠΡΠΈΠ²Π΅Π΄Π΅Π½Ρ ΡΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΡΡΠΈ ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ·Π° Π² ΠΌΠΈΡΠ΅, Π£ΠΊΡΠ°ΠΈΠ½Π΅ ΠΈ ΠΠ½Π΅ΠΏΡΠΎΠΏΠ΅ΡΡΠΎΠ²ΡΠΊΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ. ΠΡΠ½ΠΎΠ²Π½ΠΎΠ΅ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ ΡΠ΄Π΅Π»Π΅Π½ΠΎ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅ ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ·Π° Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° Ρ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π½Π΅ΠΉΡΠΎΠ²ΠΈΠ·ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ (ΠΠ’, ΠΠ Π’ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°), Π° ΡΠ°ΠΊΠΆΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°ΠΊΡΠΈΠΊΠΈ, Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ Π½Π° ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ Π³ΠΈΠ³Π°Π½ΡΡΠΊΠΎΠΉ ΡΠΎΠ½ΠΊΠΎΡΡΠ΅Π½Π½ΠΎΠΉ ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΠΎΠΉ ΠΊΠΈΡΡΡ Π±Π΅Π· Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π΅Π΅ ΡΠ΅Π»ΠΎΡΡΠ½ΠΎΡΡΠΈ.ΠΡΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΊΠΈΡΡΡ Π±Π»ΠΈΠΆΠ΅ ΠΊ ΠΊΠΎΡΠ΅ Π±ΠΎΠ»ΡΡΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠΎΡΠ°Π»ΡΠ½ΠΎΠ΅ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΠΎΠΉ ΠΊΠΈΡΡΡ ΠΏΡΡΠ΅ΠΌ Π³ΠΈΠ΄ΡΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²ΡΡΠ°Π»ΠΊΠΈΠ²Π°Π½ΠΈΡ ΠΏΡΠΈ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΌ Π½Π°ΠΊΠ»ΠΎΠ½Π΅ Π³ΠΎΠ»ΠΎΠ²Ρ Π² ΡΡΠΎΡΠΎΠ½Ρ ΡΡΠ΅ΠΏΠ°Π½Π°ΡΠΈΠΈ Π±Π΅Π· ΠΏΡΠ½ΠΊΡΠΈΠΈ ΠΊΠΈΡΡΡ. Π‘ΠΏΠ΅ΡΠΈΡΠΈΠΊΠ° ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΡΡ
ΠΊΠΈΡΡ Π² ΡΠΎΠΌ, ΡΡΠΎ ΠΏΡΠΈ ΡΠΊΡΠΏΠ°Π½ΡΠΈΠ²Π½ΠΎΠΌ ΡΠΎΡΡΠ΅ ΠΎΠ½ΠΈ Π½Π΅ ΠΏΡΠΎΡΠ°ΡΡΠ°ΡΡ Ρ
ΠΈΡΠΈΠ½ΠΎΠ²ΠΎΠΉ ΠΎΠ±ΠΎΠ»ΠΎΡΠΊΠΎΠΉ ΡΠΊΠ°Π½Ρ ΠΌΠΎΠ·Π³Π°, Π° Β«ΡΠ°Π·Π΄Π²ΠΈΠ³Π°ΡΡΒ» Π΅Π΅. ΠΠΈΡΡΡ Π»Π΅Π³ΠΊΠΎ ΡΠ΄Π°Π»ΠΈΡΡ, ΠΏΠΎΡΠΊΠΎΠ»ΡΠΊΡ ΠΎΠ½Π° ΡΠ»Π°Π±ΠΎ ΡΠ²ΡΠ·Π°Π½Π° Ρ ΡΠΊΠ°Π½ΡΡ ΠΌΠΎΠ·Π³Π°. ΠΠ½Π°Π½ΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΡ
ΠΈΠ½ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΡΡ
ΠΊΠΈΡΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°ΡΡ ΠΈΡ
Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ ΠΈ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎ ΡΠ΄Π°Π»ΡΡΡ.ΠΠ°Π²Π΅Π΄Π΅Π½Π΅ ΡΠΏΠΎΡΡΠ΅ΡΠ΅ΠΆΠ΅Π½Π½Ρ ΡΡΠΏΡΡΠ½ΠΎΠ³ΠΎ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ ΠΏΠ΅ΡΠ²ΠΈΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΠΆΠ΅Π½Π½Ρ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠΌ Π· ΡΡΠ²ΠΎΡΠ΅Π½Π½ΡΠΌ Π³ΡΠ³Π°Π½ΡΡΡΠΊΠΎΡ ΡΠΎΠ»ΡΡΠ°ΡΠ½ΠΎΡ ΠΊΡΡΡΠΈ Ρ ΠΏΠ°ΡΡΡΠ½ΡΠ° Π²ΡΠΊΠΎΠΌ 28 ΡΠΎΠΊΡΠ². ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ Π΅ΠΏΡΠ΄Π΅ΠΌΡΠΎΠ»ΠΎΠ³ΡΡΠ½Ρ Π΄Π°Π½Ρ Π· ΠΏΠΎΡΠΈΡΠ΅Π½Π½Ρ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ·Ρ Ρ ΡΠ²ΡΡΡ, Π£ΠΊΡΠ°ΡΠ½Ρ ΡΠ° ΠΠ½ΡΠΏΡΠΎΠΏΠ΅ΡΡΠΎΠ²ΡΡΠΊΡΠΉ ΠΎΠ±Π»Π°ΡΡΡ. ΠΡΠ½ΠΎΠ²Π½Ρ ΡΠ²Π°Π³Ρ ΠΏΡΠΈΠ΄ΡΠ»Π΅Π½ΠΎ Π΄ΠΎΠΎΠΏΠ΅ΡΠ°ΡΡΠΉΠ½ΡΠΉ Π΄ΡΠ°Π³Π½ΠΎΡΡΠΈΡΡ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ·Ρ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ Π· Π·Π°ΡΡΠΎΡΡΠ²Π°Π½Π½ΡΠΌ Π½Π΅ΡΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΡ
ΠΌΠ΅ΡΠΎΠ΄ΡΠ² Π½Π΅ΠΉΡΠΎΠ²ΡΠ·ΡΠ°Π»ΡΠ·Π°ΡΡΡ (ΠΠ’, ΠΠ Π’ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ), Π° ΡΠ°ΠΊΠΎΠΆ ΠΎΡΠΎΠ±Π»ΠΈΠ²ΠΎΡΡΡΠΌ Ρ
ΡΡΡΡΠ³ΡΡΠ½ΠΎΡ ΡΠ°ΠΊΡΠΈΠΊΠΈ, ΡΠΏΡΡΠΌΠΎΠ²Π°Π½ΠΎΡ Π½Π° ΡΠΎΡΠ°Π»ΡΠ½Π΅ Π²ΠΈΠ΄Π°Π»Π΅Π½Π½Ρ Π³ΡΠ³Π°Π½ΡΡΡΠΊΠΎΡ ΡΠΎΠ½ΠΊΠΎΡΡΡΠ½Π½ΠΎΡ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ²ΠΎΡ ΠΊΡΡΡΠΈ Π±Π΅Π· ΠΏΠΎΡΡΡΠ΅Π½Π½Ρ ΡΡ ΡΡΠ»ΡΡΠ½ΠΎΡΡΡ.ΠΡΠΈ Π»ΠΎΠΊΠ°Π»ΡΠ·Π°ΡΡΡ ΠΊΡΡΡΠΈ ΠΏΠΎΡΡΠ΄ Π· ΠΊΠΎΡΠΎΡ Π²Π΅Π»ΠΈΠΊΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΈΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ Ρ ΡΠΎΡΠ°Π»ΡΠ½Π΅ Π²ΠΈΠ΄Π°Π»Π΅Π½Π½Ρ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ²ΠΎΡ ΠΊΡΡΡΠΈ Π±Π΅Π· ΠΏΡΠ½ΠΊΡΡΡ ΠΊΡΡΡΠΈ ΡΠ»ΡΡ
ΠΎΠΌ Π³ΡΠ΄ΡΠΎΠ΄ΠΈΠ½Π°ΠΌΡΡΠ½ΠΎΠ³ΠΎ Π²ΠΈΡΡΠΎΠ²Ρ
ΡΠ²Π°Π½Π½Ρ ΠΏΡΠΈ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΌΡ Π½Π°Ρ
ΠΈΠ»Ρ Π³ΠΎΠ»ΠΎΠ²ΠΈ Π² Π±ΡΠΊ ΡΡΠ΅ΠΏΠ°Π½Π°ΡΡΡ. Π‘ΠΏΠ΅ΡΠΈΡΡΠΊΠ° Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ²ΠΈΡ
ΠΊΡΡΡ Π² ΡΠΎΠΌΡ, ΡΠΎ Π·Π° Π΅ΠΊΡΠΏΠ°Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΠΎΡΡΡ Π²ΠΎΠ½ΠΈ Π½Π΅ ΠΏΡΠΎΡΠΎΡΡΠ°ΡΡΡ ΡΠΊΠ°Π½ΠΈΠ½Ρ ΠΌΠΎΠ·ΠΊΡ Ρ
ΡΡΠΈΠ½ΠΎΠ²ΠΎΡ ΠΎΠ±ΠΎΠ»ΠΎΠ½ΠΊΠΎΡ, Π° Β«ΡΠΎΠ·Π΄ΡΠ»ΡΡΡΡΒ» ΡΡ. ΠΡΡΡΡ Π»Π΅Π³ΠΊΠΎ Π²ΠΈΠ΄Π°Π»ΠΈΡΠΈ, ΠΎΡΠΊΡΠ»ΡΠΊΠΈ Π²ΠΎΠ½Π° ΡΠ»Π°Π±ΠΎ ΠΏΠΎΠ²βΡΠ·Π°Π½Π° Π· ΡΠΊΠ°Π½ΠΈΠ½ΠΎΡ ΠΌΠΎΠ·ΠΊΡ. ΠΠ½Π°Π½Π½Ρ ΠΎΡΠΎΠ±Π»ΠΈΠ²ΠΎΡΡΠ΅ΠΉ Π΄ΡΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ ΠΉ Π»ΡΠΊΡΠ²Π°Π½Π½Ρ Π΅Ρ
ΡΠ½ΠΎΠΊΠΎΠΊΠΎΠ²ΠΈΡ
ΠΊΠΈΡΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·ΠΊΡ Π΄ΠΎΠ·Π²ΠΎΠ»ΡΡ Π΄ΡΠ°Π³Π½ΠΎΡΡΡΠ²Π°ΡΠΈ ΡΡ
Π΄ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΡΡ ΡΠ° ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎ Π²ΠΈΠ΄Π°Π»ΡΡΠΈ
Successful surgical treatment of a patient with combined gunshot shrapnel injuries in the heart and brain complicated by middle cerebral artery pseudoaneurysm
Summary: Successful step-by-step treatment of a combined gunshot shrapnel injury of the brain, damaging the left middle cerebral artery (MCA) branches, and penetrating myocardium injury is discussed. Open brain and heart surgeries were performed. A left MCA pseudoaneurysm was formed postoperatively. Endovascular exclusion of the left MCA pseudoaneurysm was performed using detachable micro coils. Finally, plastic reconstruction of the posttraumatic cranial vault defect was performed using a dynamic titanium plate.Treatment of severe combined gunshot shrapnel brain injury with formation of MCA pseudoaneurysm and a penetrating myocardium injury requires a multimodal approach involving related specialists (neurosurgeon, cardiosurgeon and interventional radiologist). Keywords: Gunshot wound, Craniocerebral shrapnel injury, Shrapnel injury of the heart, False aneurysm, Dissectional aneurysm, Middle cerebral arter