Further Development of Serbinenkoís Endovascular Method

S.B. Yakovlev

(Burdenko Research Institute of Neurosurgery, Moscow)

F.A. Serbinenko was the first to make successful endovascular operation on October 29, 1970. It was stationary reconstruction of the cavernous internal carotid artery in carotid-cavernous anastomosis, performed with applying a detachable balloon-catheter of his own design. This date has every right to be considered a birthday of a new method for treatment of vascular pathology, i.e. endovascular surgery. During 3-4 years F.A. Serbinenko used the balloon-catheter for therapeutic occlusion of cerebral vessels practically in all types of vascular neurosurgical pathology and demonstrated absolutely new potentialities and prospects of endovascular neurosurgery.

A new step in development of intravascular neurosurgery was made in 1991, when Guglielmi proposed use of guided microcoils for occlusion of arterial aneurysms. Today there are a lot of occluding devices and materials of a new generation. Use of new polymers led to appearance of hydrophilic microcatheters at the end of the 90s. They allow to perform superselective catheterization of cerebral vessels quite easily.

A total number of cases, operated in the Burdenko Research Institute of Neurosurgery in 1970-2003 with applying an endovascular method, was 3463. They had arteriovenous malformations (AVM) of the brain (1133), carotid-cavernous anastomoses (1066), aneurysms of cerebral vessels (454), artery-sinus anastomoses of different localization (451), profuse nasal bleeding (118). Preoperative embolization of tumors, localized in different areas, was performed in 241 cases. A total number of endovascular operations exceeded 4000.

Up-to-date technologies were used in 599 cases (1996-2003). Superselective embolization with histoacryl was performed in 226 patients (44.4%) with cerebral AVM. Aneurysmal cavity occlusion with microcoils was made in 63 cases (10.5%) with aneurysms of cerebral vessels. Superselective embolization of artery-sinus anastomoses was used in 69 cases (11.5%). Valvular balloons were applied in 96 patients (16.1%) with carotid-cavernous anastomoses. Embolization was made in 61 cases (10.2%) with tumors and 44 patients (7.3%) with profuse nasal bleeding.

Combined use of endovascular instruments and digital subtraction angiography made it possible to study cerebral hemodynamics and angioarchitectonics of pathologic vascular formations of the brain in detail. There appeared functional tests, used in superselective catheterization and embolization of the ECA and ICA branches. All these factors allowed to plan endovascular operations more adequately and with a smaller risk of complications, as well as to use an absolutely original ideology of treatment of the most complex pathology. Besides, we introduced such new methods, as transvenous embolization and occlusion of dural arteriovenous fistulas and AVM of Galenís vein (5 cases), selective transarterial chemotherapy of cerebral lymphomas with breaking through the blood-brain barrier (11 cases).

Use of modern endovascular technologies permitted to increase efficacy of endovascular operations and to reduce not only postoperative mortality (from 3.6% up to 3%), but also a rate of complications (from 9% up to 5%).

Thus, the endovasal method is a highly effective means of treatment, used in neurosurgery. Interventions should be based on principles of superselective catheterization and embolization, physiologic expediency and logic stage-by-stage treatment.