The emergency DSA examination revealed an aneurysm in the anterior and anterior communication junction of the right side of the brain. There was a pseudocyst at the top of the tumor, and the top of the tumor pointed to the upper left front, which was consistent with the distribution of spider blood shown by CT. The front A1 of the left brain was visualized. It is planned to further embolize the stent assisted coil.
Surgical instruments and models used8F MPA guide catheter; 6F Sofia distal access catheter; Headway21 microcatheter; Headway17 microcatheter; Traxcess14 microguide wire; 3.5mm×15mm Lvis stent; MicroVention coil 1 *2, 2*2, 1.5*2, 1*1.
Traxcess14 micro-guide ribbon Headway21 stent catheter enters the right anterior cerebral artery A2-3 segment.
The Headway17 embolization catheter is pre-shaped.
Intraoperative cerebral vasospasm and poor imaging of angiographic aneurysms.
The road map shows the approximate location of the aneurysm, and the embolization catheter is in place.
The 1ml syringe embolization catheter is slowly pushed by hand for angiography, and it is confirmed that the tip is located in the aneurysm.
MicroVention 1*2 first fills the false sac on the top of the aneurysm, then half releases the 3.5mm×15mm Lvis stent to cover the neck of the aneurysm. The stent is released and 8ml of tirofiban is injected intravenously, and then continues at 6ml/h Pump in.
The distal end of the stent is not well opened. Push the stent catheter and guide wire to promote the distal opening.
Continue to complete the proximal tumor packing .
After embolization, the angiography work position is enlarged, the work position is reduced, the standard front position and the standard lateral position image.
It can be seen that the Lvis stent opened well after the operation.
After the operation, the patient was awake under general anesthesia, with normal limbs, and the speech response was the same as before the operation. The dual anti-platelet aggregation drugs were connected within 24 hours after the operation (3h before the discontinuation of tirofiban, aspirin 100mg, clopiper Gray 75 mg; aspirin 100 mg and clopidogrel 75 mg 1 hour after tirofiban is stopped).
The surgeon’s experience
1. Front traffic movementThe position of the aneurysm is relatively close to the distal end, and the shaping of the microcatheter is very important. The primary and secondary bends should be properly shaped, and if necessary, the tertiary bend should also be properly shaped.
2. During the operation, severe cerebral vasospasm was encountered, the aneurysm was not well visualized, and it was impossible to determine whether the microcatheter was embolized in the tumor cavity or the artery bearing the tumor. In order to avoid unnecessary microcatheter operations and accurately determine the artery The location of the aneurysm, after the embolization of the microcatheter is in place, microcatheter angiography is performed to confirm that it is inside the aneurysm. The microcatheter should be pushed slowly to prevent the aneurysm from rupturing.
3. After the release of the Lvis stent, it must be ensured that the distal and proximal ends are well opened to prevent secondary thrombosis.
The Department of Neurosurgery, The Third Affiliated Hospital of Xinxiang Medical College
The Department of Neurosurgery of the Third Affiliated Hospital of Xinxiang Medical College is composed of a famous neurosurgery expert in my country and a national second-level professor Zhang Xinzhong is the leader of the discipline. The department takes full advantage of the teaching hospital, and continuously improves the quality of the department by comprehensively improving its own service capabilities, cooperating with relevant departments to establish a first-class brain disease diagnosis and treatment center, and building a high-level consultation platform for difficult neurological diseases.
There are currently more than 70 professional and technical personnel in neurosurgery, including 6 senior titles (three senior titles and three deputy senior titles), more than 20 intermediate titles, and a reasonable echelon of personnel; more than ten are hired An advisory group composed of well-known experts in various sub-specialties of domestic neurosurgery provides technical support all year round. The department currently has NsICU, neurosurgery, and neurosurgery of Yanjin County Hospital of Traditional Chinese Medicine. There are three wards with more than 80 beds, including 20 NsICU beds.
Neurosurgery is equipped with stereotactic instrument, surgical simulation planning system, radiofrequency ablation system, intracranial electrode programming instrument, invasive intracranial pressure monitor, video EEG monitor, EEG Detection system, multi-channel monitor, hemodynamic monitoring, electronic cooling system, fiber bronchoscope, ventilator, rapid biochemical instrument, nitric oxide monitor, deep vein thrombosis treatment instrument, infusion pump, micro pump and various rehabilitation More than 400 sets of professional equipment such as instruments. The hospital is equipped with large-scale DSA with 3D imaging, 128-slice spiral CT, 1.5T and 3.0T magnetic resonance, electromyography and other equipment; the operating room is equipped with multiple Leica surgical microscopes, intraoperative navigation equipment, C-arm, and radiofrequency ablation instrument , Neuroendoscopy, ventriculoscopy, automatic retractors, laser knives, microsurgery instruments and surgical power systems, etc., which can meet the needs of neurosurgery for various diseases diagnosis, differential diagnosis and minimally invasive surgical treatment, and standardize professional neurosurgery for severe cases The intensive care unit effectively guarantees the safety of postoperative care and treatment for critically ill patients and major operations.
Chief physician, doctoral supervisor, national second-level professor, expert enjoying special government allowances from the State Council, outstanding talents in scientific and technological innovation of Henan Province, vice president of Henan Medical Association, vice president of Henan Stroke Association, world Member of Chinese Neurosurgery Association; Special reviewer of Chinese Journal of Neurosurgery, academic leader of neurosurgery of Xinxiang Medical College, founder of Neurosurgery of the Third Affiliated Hospital of Xinxiang Medical College. He has been engaged in clinical medicine, teaching, and scientific research for more than 30 years. He has solid theoretical knowledge of neurosurgery and strong scientific research ability, and has rich experience in the diagnosis and treatment of neurocritical diseases and intractable diseases. He has published dozens of national-level papers, won 4 provincial-level scientific research achievement awards, and edited and published five monographs.
Director of Department
Chief physician, member of the Nerve Injury and Repair Branch of the Chinese Medical Promotion Association, member of the Chinese Peripheral Neurosurgery Committee, member of the Henan Provincial Critical Medicine Association, member of the Henan Provincial Neurosurgical Society, member of the Standing Committee of the Pain Branch of the Henan Provincial Committee of Integrated Traditional Chinese and Western Medicine , Member of the Standing Committee of Neurosurgery Committee of Henan Stroke Society, Deputy Chairman of Xinxiang Neurosurgery Branch, Deputy Director of Xinxiang Critical Medicine Branch, Director of Neurosurgery of the Third Affiliated Hospital of Medical College. He has been engaged in medical treatment, teaching, and scientific research for a long time, and routinely performs various neurosurgery operations such as nervous system tumors, cerebrovascular diseases, spinal cord diseases, hydrocephalus and Parkinson's disease, trigeminal neuralgia, epilepsy, mental illness, etc., especially in severe neurological diseases. Rich experience in emergency treatment. He has published dozens of national-level papers, won two provincial scientific research achievement awards, and edited and published three monographs.
Attending physician, master of medicine, good atSurgical treatment of common neurosurgery diseases such as long head injury, hypertensive intracerebral hemorrhage, intracranial aneurysm, sub-specialized neurointervention, studied in the neurointervention department of Beijing Tiantan Hospital, good at intracranial aneurysm, cerebral infarction, Intervention, clinical diagnosis and treatment of cerebrovascular stenosis and spinal cord vascular malformations.
Attending physician, master's degree student, good at surgical treatment of common neurosurgery diseases such as brain injury, hypertensive cerebral hemorrhage, intracranial aneurysm and so on. Sub-specialty in the treatment of cerebrovascular diseases, specializing in interventional and surgical treatment of intracranial aneurysms, cerebral infarction, cerebrovascular stenosis and spinal vascular malformations. Obtained the Critical Care Medicine Specialty Qualification (5C certification) of the Critical Care Medicine Branch of the Chinese Medical Association.
Attending physician, master of medicine, sub-specialty in cerebrovascular disease, good at the comprehensive diagnosis and treatment of hemorrhagic and ischemic cerebrovascular diseases, focusing on the intervention of cerebrovascular diseases, intracranial and extracranial vascular anastomosis and bypass and Hybrid surgical treatment. Published 3 SCI papers and 3 Chinese core papers.
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