P.I. Nikitin, O.V. Emelyanov, B.M. Nikiforov, F.S. Teplitsky, M.Yu. Podgornyak, B.I. Zaichenko
(Mariinsky Hospital, Saint Petersburg
Polenov Research Neurosurgical Institute, Saint Petersburg)
The goal of the present report is to demonstrate a system of rendering urgent care to patients in an acute period of intracranial hemorrhages.
The 75-bedded neurosurgical department of the Kuibyshev Hospital was founded on March 29, 1960 and opened on October 9, 1961. According to Order N 217, issued by the Ministry of Public Health and entitled On Measures of Further Improvement of Neurosurgical Care of Russian Population, it was reorganized into a specialized neurovascular department.
Today it is a 45-bedded department, situated on the 3rd floor of one of the buildings of the Mariinsky hospital. It has 13 wards (6 of them are first-class), a dressing room, a room for angiographic examination and an operating room. Every day there are 2 neurosurgeons on duty, which lasts 24 hours. All the members of the staff can carry out urgent angiographic examination. Some of them can perform open and endovascular operations for exclusion of aneurysm from blood circulation. Urgent methods, used for examination of patients, include CT, spiral CT with a function of angiography (Somatom Emotion tomograph), EEG, sonography (Simens Sonoline J60S apparatus). Computed tomographs operate 6 days a week and soon they will be used in a twenty-four-hour mode. The hospital has 2 neurological departments with 60 beds each and a 7-bedded neuroresuscitative unit, which work in cooperation with the above neurosurgical department. It allows to examine a patient in compliance with existing modern standards and to render them expert medical care.
There were 1927cases, treated in the neurosurgical department in 2003; 1305 of them were delivered by ambulances and 372 patients were transferred from the neurological departments of the Mariinsky hospital and other medical establishments. A number of cases, subject to planned hospitalization, was 250.
A number of interventions, performed in patients with vascular pathology in 2003, was 113 (26%). They were as follows: aneurysm clipping – 32 (28.3%), aneurysm embolization – 21 (18.6%), AVM embolization – 2%, endoscopic removal of hypertensive intracerebral hematomas – 14%, lysing of hematoma with prourokinase – 10%.
Operations for cerebral tumors were performed in 44 cases; intravascular interventions were made in 18.2% of them.
Urgent embolization of aneurysms was performed in 21 cases, including 11 males and 10 females, aged 30-40 (6), 41-50 (5), 51-60 (8), 61 and more (2). Operations were made on the 1st-7th day after hemorrhage in 9, the 8th-15th day in 8 and the 15th-30th day in 4 cases.
Localization of aneurysms was as follows: ACoA-ACA – 8, an infraclinoid area – 4, a supraclinoid area – 3, MCA - 2, ICA bifurcation - 1, upper bifurcation of the basilar artery - 1, multiple aneurysms – 2 cases.
Intravascular interventions led to total, subtotal (95%) and partial exclusion of aneurysms from blood flow in 13, 5 and 3 cases respectively. A favorable outcome was watched in 19 cases.