cerebral aneurysms - this is a limited local expansion of one or more of intracerebral vessels, wherein the rapid progressive increase in the size and tendency to form intraluminal thrombotic deposits.
When a person says a local expansion of the venous vessel, accompanied by a violation of cerebral circulation and is manifested by headache, paresthesia, increased convulsive readiness and a violation of the motor function, the diagnosis is established "arteriovenous aneurysm."Under arteriovenous aneurysm is considered a local bulging of the vascular blood vessel wall such as a spherical or spindle-shaped.
aneurysmal dilation of the brain subjected to tearing or delamination of the vessel walls, is the most common cause of formation of non-traumatic subarachnoid hemorrhage signs of nature.
Causes brain aneurysm
In a situation where a child has an abnormal structure or arrangement of the vascular wall, developing a brain aneurysm, which in most cases combined with oth
acquired forms of brain aneurysm often formed on the background of traumatic injury of the vessel wall, which is the case in severe traumatic brain injury.In addition, atherosclerotic vascular lesions can provoke the development of aneurysmal extension of the vascular wall.
In neurological practice used a separate nosological form of a brain aneurysm, entitled "mycotic", the basis of which, it should damage the vessel wall infectious emboli.In addition to direct exposure to traumatic vascular wall, of great importance in the development of aneurysm are hemodynamic disturbances in the form of systemic arterial hypertension and irregular blood flow.
the predisposing factors that alone do not cause the formation of an aneurysm, but contribute to the development of intraluminal hemodynamic disturbances is a systematic increase in blood pressure, as well as changes in vessel wall under the influence of nicotine on prolonged smoking.
pathogenesis of brain aneurysm develops as a result of underdevelopment or mechanical damage to one or all layers of the vessel wall and is manifested degenerative changes, thinning and loss of elasticity of the vascular wall in the exposed area.As a result of these changes the conditions for local protrusion which develops under high pressure of the circulating blood as well as in branch vessels projection maximum pressure gradient, the portion of the vessel is affected most often.
Although aneurysmal expansion that can form on almost any part of the vascular wall, still favored localization of this disease is vascular bifurcation site, i.e. a site where larger vessels are divided into small branches.
Currently, there is increasing incidence of cerebral aneurysms, and this trend is due to the use of advanced imaging techniques precise, allowing even in the early stages of the disease reliably verify the diagnosis.
symptoms of brain aneurysm
Depending on the prevalence of certain manifestations, and the nature of disease progression, and is divided apoplectic tumoroidny current version.For tumoroidnoy form a brain aneurysm is characterized by progressive enlargement of the aneurysmal expansion, sometimes to gigantic proportions.Clinical manifestations of neurological symptoms develop as a result of compression of the aneurysm exposure to certain brain structures.Tumoroidnaya cerebral aneurysms in almost a hundred percent of cases provokes manifestations of intracranial hypertension.
Aneurysms localized in the cavernous sinus, to achieve large-sized provoke the development of oculomotor disturbances and destruction of the trigeminal nerve with severe pain and impaired sensitivity.In the long tumor aneurysm can develop bone-destructive changes skull recognized by X-ray examination.Note that if the aneurysm localized in the cavernous sinus, it is impossible to develop intracavitary bleeding even when they break, because of their location extradural.
specific symptoms, accompanying for aneurysms, localized in the projection of the internal carotid artery to the localization of its part supraklinovidnoy is the electoral defeat of the oculomotor nerve, manifested in expressed pain syndrome in the projection of the orbital area.
When localization aneurysmal expansion in the projection of the anterior branch cerebral artery develop severe psycho-neurological disorders in the form of paresis, speech impediments, and all kinds of sensitivity.Localization of aneurysms in the vertebrobasilar arterial segment is shown in the form of dysarthria, dysphagia, nystagmus, ataxia, and alternating syndromes.In situations where the patient has multiple development aneurysmal extensions in cerebral vessels, clinical manifestations specificity depends on which part of the ruptured vessel wall.
At rupture of the aneurysm is noted lightning growth of clinical symptoms, which prevails in the structure of severe pain, which initially is limited according to the location of the projection of the aneurysm, and subsequently became widespread.Indication that the development of subarachnoid hemorrhage as a complication of rupture brain aneurysm is repeated episodes of nausea and vomiting, which has no connection with the meal, the emergence of positive meningeal symptoms and neck stiffness, increase the propensity to seizure.
characteristic "clinical companion" rupture brain aneurysm is a disturbance of consciousness of varying severity from momentary fainting coma.Many patients before the onset of subarachnoid hemorrhage caused by rupture of a brain aneurysm, there is a long diffuse aching pain in the head.
Due to the fact that when rupture of the vessel wall in the projection of the aneurysm, there is a compensatory artery spasms in the projection of the affected area, the conditions for the development of ischemic stroke that is at least 60% of cases.In a situation where aneurysm rupture provokes no subarachnoid and intracerebral hemorrhage, to the fore as the clinical manifestations of acts focal neurological symptoms, which greatly increase the weight of the patient and can cause death.
When using different instrumental imaging techniques, such as angiography, in most cases it is possible to determine not only the size but also the shape of histopathology aneurysm (saccular, lateral, fusiform).The most common pathologic embodiment is saccular aneurysm, which has a round shape and a narrow neck, through which it is attached to main vessel.Side option aneurysm is visualized as a protrusion of tumor vascular wall, and fusiform is a local vasodilation.
Any of pathological variants of the same aneurysm often causes rupture and the development of intracerebral or subarachnoid hemorrhage, so the fundamental criterion is the definition does not form, and the size of the aneurysm.The critical size of the aneurysm is to achieve its 25 mm, which is an absolute indication for surgery.In a situation where a person has contraindications to angiography as the most reliable method of verification of the aneurysm should be applied computer or magnetic resonance tomography.
In a situation where all patients have clinical signs of rupture of a brain aneurysm, it is necessary to analyze the cerebrospinal fluid for the presence of blood, which is the main diagnostic marker for cerebral hemorrhage.
Treatment of brain aneurysm
If you find any pathological variants of a brain aneurysm initial task is to determine the doctor patient management tactics and volume of necessary medical assistance.The prevailing majority of cases of aneurysm detection does not require specific treatment, and needs only a dynamic monitoring tool.However, there are absolute indications for the use of emergency surgery by clipping or embolization, and these states include aneurysm rupture of cerebral vessels and the development of signs of subarachnoid hemorrhage.In this situation, one of the operational benefits to be applied within 72 hours from the moment of rupture.
Patients with severe brain aneurysm with signs of profound disturbance of consciousness, are not subject to surgical treatment, and in need of pre-medication correction of neurological disorders.And yet, the only effective method of draining the brain ventricles, followed by aneurysmal occlusion of the vessel is surgical, and with massive damage of brain tissue should be preferred to the use of coils instead of clips.
dynamic monitoring of cerebral aneurysms involves the passage of a planned annual tool inspection, which does not increase the parameters should be celebrated aneurysm.Surgical treatment should be recommended to patients who have aneurysm is critically large size combined with clinical signs.
Symptomatic conservative treatment involves the use of antiemetics (Reglan in a daily dose of 30 mg), antihypertensive drugs (enalapril 10 mg), calcium channel blockers (fenigidin 10 mg per day orally).These drugs are used to relieve the patient's condition and reducing hemodynamic disturbances, but not a means of treating aneurysms.
brain aneurysm surgery
surgery for removal of the aneurysmal dilatation of vessels of the brain can only be performed in a specialized neurosurgical department.Quick access in this situation is a craniotomy performed under general anesthesia.Direct surgery involves the implementation of surgical procedures in the projection of the aneurysm through a burr hole in the skull vault.Method aneurysm clipping means the application of a constant clip made of a nonmagnetic material of nature to the neck region of the aneurysm, thereby stopping the blood flow in its lumen.In a situation where you can not reliably distinguish the neck of the aneurysm, the imposition of the clip is carried out on the vessel before and after the aneurysmal expansion.In addition, the possibility of microsurgical techniques allow you to completely excise the aneurysm and impose anastomosis between the vessels.In some situations, clipping the aneurysm combined with the strengthening of the vascular wall by means of a special medical gauze, but this operational manual may provoke bleeding in the early postoperative period, which limits its use.
Difference endovascular embolization as microsurgical intervention is that to accomplish it is not necessary to enter the patient's general anesthesia, but rather only the use of sedatives, since during manipulation there is a need to assess the neurological status of the patient.Embolization is performed by introduction of a modified vessel under mandatory supervision catheter angiography followed by microspiral in the aneurysm, thereby turning off the modified portion of the vessel from the general circulation.As with any surgery, there is a specific embolic scope: the diameter of the aneurysmal neck expansion not exceeding 4 mm, subarachnoid hemorrhage in the acute period when existing patient of severe chronic diseases, restricting the use of direct surgical intervention.
limiting factor in the application of the classical version of endovascular embolization of aneurysm is excessive tortuosity of the vessel, making it difficult to insert a catheter.In this situation, neurosurgeons use the additional funds in the form of intracranial stent or balloon, allowing to expand the lumen of the vessel and facilitate the advancement of the catheter.
In the late postoperative period after the application of endovascular embolization may develop recurrence of a brain aneurysm due to compression microspiral inside the aneurysm high blood pressure, which further leads to recanalization of the aneurysm.In this situation, patients should be re-executed diagnostics brain aneurysm to further address the issue and use of another procedure, embolization.
To prevent a possible aneurysm recanalization in the late postoperative period, currently used microspiral impregnated with a special substance that forms the collagen mass in contact with the endothelium of the vascular wall, which provides a tight closure of the lumen of the aneurysm.
consequences of a brain aneurysm
forecast brain aneurysm is most dependent on the metric parameters of the expansion vessel.For example, the small size of the aneurysm is almost never provoke the development of complications such as bleeding, while a large aneurysm is considered extremely unfavorable pathological condition requiring immediate treatment.
Keep in mind that even the successful removal of a brain aneurysm may be in the early and late postoperative period with the possible complications of disease recurrence or bleeding.Numerous randomized studies on the question of tactics of patients with unruptured cerebral aneurysms, confirmed the inappropriateness use of surgery for patients who have no signs of rupture, due to the high percentage of complications in the postoperative period.
Even a not invasive procedures like endovascular embolization is associated with the possibility of serious complications in a patient, especially for violations of technology of its implementation (an allergic reaction to the introduction of a contrast agent, a vascular wall perforation, thromboembolism).However, the greatest danger has intraoperative rupture of the aneurysm at the time of the catheter or establishing microspiral that 40% provokes detailed outcome.
Rehabilitation after brain aneurysm, subjected to surgical treatment takes a few days if the method used embolization, after which the patient marked the full restoration of health.