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)

Optimization of surgical treatment of combination of cerebral aneurysms and head magistral arteries stenosis and occlusion

Objective. Determination of the optimal strategy of surgical treatment of patients with a combination of cerebral aneurysms and head magistral arteries stenosis.Methods. 26 patients with combination of cerebral aneurysms and head magistral arteries stenosis, whose age was between 44 and 84 years, have been examined and treated in the Cerebrovascular Clinic of the Dnipropetrovsk Regional Hospital for the last 4 years. 21 of them were operated, 5 – abstained. 24 endovascular and 8 open operations were performed in different combinations.Results. All cases were divided into 3 groups according to the application different tactics of surgical treatment. Group 1 - 10 patients were operated in order to exclude cerebral aneurysm and revascularize head magistral arteries. Group 2 - 5 patients were operated to remove only the head magistral arteries stenosis. Group 3 - 6 patients were operated to exclude cerebral aneurysm alone. Functional outcomes evaluated by the modified Rankin scale and were the best in group 1.Conclusion. Surgical risks in case of treatment only one of pathology in case of combination of head magistral arteries stenosis and cerebral aneurysms may cause clinical manifestation of the other one. One-session surgical treatment of cerebral aneurysms and head magistral arteries stenosis based on data about the peculiarities of collateral bloodcirculation, cerebrovascular reserves, degree hemoperfusion deficit in different arterial basins is the best strategy of surgical treatment

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