léčba aneurysmat, avm, kavernomů · small aneurysm -wide neck -mca -failure of evt (10%) limit...
TRANSCRIPT
![Page 1: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/1.jpg)
Léčba aneurysmat, AVM, kavernomů
Sameš M., Hejčl A., Vachata P., Bartoš R., Pavlov V., Cihlář F., Derner M.
Neurosurgical Department, Department of Radiology, Masaryk Hospital, Ústí nad Labem, Czech Republic
![Page 2: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/2.jpg)
SAH Management Coil Clip Higher age, ASA risk Younger ageBrain edema, HH 4-5
Location-post circ (post inf BA) Location-ant circ (MCA)Size 2-7 mm Size > 7 mmNeck (5/2 = fundus/neck) Wide, complex neck
ICH, hydrocephalus, FisherKink, atherosklerosis
Symptomatol (CN III)
experience surg x endovascopinion of pts
![Page 3: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/3.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:
- giant (5%)- small aneurysm (5%)- wide neck (10%) - MCA ( 25%)- failure of EVT (10%)
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 4: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/4.jpg)
Giant aneurysms
Dept. NeurosurgeryÚstí nad Labem
![Page 5: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/5.jpg)
Case report – trap M2+bypass
Dept. NeurosurgeryÚstí nad Labem
![Page 6: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/6.jpg)
Case report - postop
Dept. NeurosurgeryÚstí nad Labem
![Page 7: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/7.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:
- giant- small aneurysm < 2 mm (5%)- wide neck- MCA- failure of EVT
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 8: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/8.jpg)
![Page 9: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/9.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:
- giant- small aneurysm- wide neck (5%)- MCA- failure of EVT
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 10: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/10.jpg)
![Page 11: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/11.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:
- giant (5%)- small aneurysm (5%)- wide neck (5%) - MCA ( 25%)- failure of EVT (10%)
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 12: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/12.jpg)
![Page 13: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/13.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:
- giant- small aneurysm - wide neck - MCA - failure of EVT (10%)
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 14: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/14.jpg)
![Page 15: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/15.jpg)
![Page 16: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/16.jpg)
BOT
Carotid-opthalmic aneurysmsBOT, superior direction, TCD, suction blood from CCA
![Page 17: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/17.jpg)
Opthalmic aneurysm-CT postop
![Page 18: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/18.jpg)
MRA postop-no residual neckPerimeter intact, no neurol deficit
![Page 19: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/19.jpg)
Dept. NeurosurgeryÚstí nad Labem
Uncoilable aneurysms:- giant (5%)- small aneurysm (5%)- wide neck (10%) - MCA ( 25%)- failure of EVT (10%)
- ----------------------------------------------------- uncoilable 55%
Limit and Benefit Endovascular vers. Mininvasive surgery
![Page 20: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/20.jpg)
Advances of surgeryHernesniemi Prague 2007
1. CTA2. Approaches – simple, fast3. Killing the aneurysms4. Navigation, 3D models5. Intraoperative AG (ICG)6. Prevention of vasospasms – Nicardipine – release
pellets7. Bypass – surgery, selana, elana, strip8. Subspecialization9. Strong experience – video, courses, education
![Page 21: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/21.jpg)
Intradural drilling of ant clin proc carotid opthalmic aneurysm
![Page 22: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/22.jpg)
Summary of isolated dissecting PICA aneurysm: Location
Anterior medullary segment 38%Lateral medulary segment 27%Tonsilomedullary segment 9%Telovelotonsilar - perfor to BG 9%Cortical segment 13%
Korematsu K.et al., Acta neurochirurgica 150: 77-81, 2008
![Page 23: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/23.jpg)
![Page 24: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/24.jpg)
![Page 25: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/25.jpg)
![Page 26: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/26.jpg)
![Page 27: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/27.jpg)
Postop DW MRI
![Page 28: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/28.jpg)
Postop – approach, clip, follow up 6 months
![Page 29: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/29.jpg)
Follow up studyaneurysm a.basilaris - coil
![Page 30: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/30.jpg)
recanalization after 6 months, recoil
![Page 31: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/31.jpg)
clipping
Dept. NeurosurgeryÚstí nad Labem
coiling
75% 25%
![Page 32: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/32.jpg)
MNUL UVN Homolka LBC
klip 63 33 35 24
coil 21 66 37 2
celkem 84 99 72 26
Počet ošetřených aneurysmat na vybraných pracovištích, 2010
![Page 33: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/33.jpg)
AVM
![Page 34: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/34.jpg)
Léčba AVM
![Page 35: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/35.jpg)
Léčba AVM - LGK
rok % obliterace
1 20%2 60%3 70%4 80%
Spetzler- MartinLGK Homolka
Gr 1 12%Gr.2 49%
![Page 36: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/36.jpg)
Kavernózní angiom
1. Supratentoriální – epilepsie, krvácení2. Kmen mozkový
- dotyk s pia mater- recididivující krvácení
LGK neúčinný, pokud léčba - resekce
![Page 37: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/37.jpg)
T.E., 45, kolapsové stavy, hemihypestézie
![Page 38: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/38.jpg)
![Page 39: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/39.jpg)
Pooper CT, bez komplikací
![Page 40: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/40.jpg)
V.R., 59, recidivující krvácení z kavernomu, LGK bez efektu
![Page 41: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/41.jpg)
![Page 42: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/42.jpg)
Po operaci bez okohybné poruchy
![Page 43: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/43.jpg)
F.M, 85, bolesti hlavy, Parinaud, diplopie, na CT/MR hematom v tectu, kavernom
![Page 44: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/44.jpg)
Pooper kontrola 4/11
![Page 45: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/45.jpg)
Pooper kontrola 4/11
![Page 46: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/46.jpg)
j.o., 70, diplopie vertigo, v době termínu na operaci recidiv krvácení s hemiparézou a plegií VII dx, oper 12/08
![Page 47: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/47.jpg)
3/09 pooper kontrola
![Page 48: Léčba aneurysmat, AVM, kavernomů · small aneurysm -wide neck -MCA -failure of EVT (10%) Limit and Benefit Endovascular vers. Mininvasive surgery. BOT. Carotid-opthalmic aneurysms](https://reader033.vdocument.in/reader033/viewer/2022050604/5fabe97610f65155845f2949/html5/thumbnails/48.jpg)
MNUL Poruba UVN Homolka HK Plzeň LBC
2669 2642 2640 2433 2027 1641 1568
Neurochirurgická klinika MN UL 1968 - 2010