Grafting of cerebral vessels: operation, indications and implications
Bypass arteries of the brain can restore normal blood flow in the affected arteries and blood vessels of the brain. Due to bypass surgery fails to connect the artery with the vessel in which for any reason was a disruption of normal blood supply.
All in the mind has four major arteries, which blood flow delivers nutrients and oxygen. Arteries are divided into two left and two right (carotid and vertebral). The normal state of the brain is completely dependent upon the regular cycle of blood, as the processes occurring in it, require a large amount of energy and nutrition. Lack or aberrant blood flow leads to ischemia, which can be both local and global. It causes disruption in the normal functioning of the brain and leads to vascular insufficiency, which, in turn, negatively affects the body.
If you do not have health care and not a treatment
What is ischemia?
The lack of blood in the brain is ischemia. There are two characteristic stages of this extremely unpleasant phenomenon:
- Ischemia occurs in the background of the outage of one of the four arteries. This phenomenon is called ischemic attack can be as temporary and evolve to regular ischemia. The cause of the disease may be blood clots, tumors, atherosclerosis. Provokes ischemic attack lack of sleep, unhealthy lifestyle, a large number of alcohol, tobacco, and stress and chronic fatigue.
- The second stage occurs when ischemia of the time turns into a long disease. There comes a critical phase, which begins necrosis of neurons, which leads to cerebral infarction with the death of a huge number of brain cells. This can lead to fatal and can cause disability.
Indications for surgery
Bypass surgery is usually prescribed in these situations:
- For tumors that caused the damage or contraction of the carotid artery.
Who needs surgery?
Surgery may be the only way to get rid of several diseases:
- Occlusion of the carotid artery located in the brain. Due to its narrowing or blockage may occur ischemia, which will lead to the death of neurons. Therefore, in the case of such disease bypass surgery is the only possible means of getting rid of degenerative processes.
- Occlusion of the carotid artery in the cranial cavity, which invariably leads to bleeding in the brain or the appearance of a heart attack.
- Aneurysm – bulging of the artery wall, which leads to its extension. An aneurysm can be huge, more than 2.5 cm in circumference, expanded throughoutarteries or accompanied by stratification of the arterial walls. In any of these cases, the artery must be partially removed and in its place installed a shunt, which will allow you to maintain a normal blood flow.
- Tumors located in the cranial cavity, or the basis thereof, in the path of the arteries and blood vessels, can surround or invade directly into the arteries. In order to remove the tumor is often required to partially remove the artery, and to maintain a normal blood flow is to install a shunt.
Preparation for surgical intervention
In order to fully prepare for surgery and possible complications, the patient must give up bad habits. Period without Smoking and alcohol needs to exceed two weeks before the day of surgery and the same after its success. Otherwise, you may open bleeding of the operated blood vessels, leading to serious complications and even death. So the doctors highly recommend in the week before surgery stop taking non-steroidal drugs aimed at suppressing inflammation.
In the process of preparations will be necessary at least once to take a blood test and urine tests, an electrocardiogram and chest x-rays, even if it was done recently. In some cases, doctors refer patients to additional surveys to clarify all the details of the diagnosis.
How to prepare for surgery?
Double-take a shower: the night before and immediately before surgery how to wash your hair. In some cases, because of the awkward localization of the artery in need of bypass surgery, your doctor may need to partially or completely shave his head. Of course, to part hair for girls can be a real problem, but it will help the doctor to perform the surgery is most clearly and correctly, and the risk of infection will be much lower.
If on the day of surgery you will need to take pills prescribed by your doctor, they should drink small amounts of water.
All jewelry, including piercings and false nails and contact lenses and dentures must be removed. All communications given to either relatives, or the senior nurse, as after the operation the patient is placed in ICU, where the use of equipment is prohibited.
How is it performed?
The bypass may be performed in two different ways, the choice of which will depend on the affected artery, which disease was caused by this deviation and what is the patient's brain volume.
The first mode of operation implies that the shunt is taken a fragment of a vein or artery of limbpatient. The shunt is sewn into the affected artery like around the patient's portion, giving the blood a chance to flow not through the diseased tissue, and through the new path.
The resulting shunt is inserted in the external carotid artery of the patient, carried out in the temporal region of the head, remove part of the skull and through the resulting hole is injected shunt inside. Thus, it connects with diseased arteries of the brain. This method is applicable in case if the damaged artery diameter about 2 cm, through which passes a large amount of blood. Use it rarely.
In the second case, as the donor tissue will be the vessel of the soft tissues of the head. When there is an allocation of the affected area of the artery, the free end of the vessel is conducted to it through the hole and sewn. Thus, one of the many arteries that supply blood to the shell of the brain, supplies nutrients in the blood directly to the brain itself, as if to bypass the damaged artery. This method is applicable, if the affected was a small section of a small artery with a small amount of blood.
Given the fact that there are two types of donor shunt, surgery may be slightly different. Since the most common operation is one in which the donor material is taken from the arteries feeding the brain membrane, the following description will relate to her. The whole operation takes no more than 5 hours and consists of 8 stages.
The patient is placed on the operating table, administered drugs, relaxing muscles and contributing to the early sleep. After that, the anesthesiologist puts the patient's trachea a tube apparatus that provides artificial respiration. After having introduced anesthesia and the patient goes to sleep, his head turning one side up, which will be produced by the operation. To do this, use rigid fixation, which eliminates the possibility of accidental movement of the patient.
- The first incision
The neurosurgeon marks the flow surface of the donor artery, then the patient's head handles with antiseptic and draped with sterile cloth. Is the first skin incision at the level of the neurosurgeon.
- The allocation of the arteries
The selection of the artery of the donor is performed from the parietal branches to the temple, where dissected muscle fibers and opens the temporal bone.
In the temporal bone make a hole in which to enter a bone saw, with which the surgeon cuts out bone part of the required size. The bone flap is temporarily removed, exposing the Dura of the brain over the affected artery. An autopsyshell, its edges neatly apart, giving access to the affected artery.
- Preparation of the artery
At this stage, I used a special microscope in which the brain surgeon will conduct further surgery. Select the branch diseased arteries suitable for anastomosis (connection of donor and diseased artery).
On the parietal branch of the donor artery and the branch of the affected cerebral artery superimposed clamp for temporary stoppage in the circulation of blood through this artery. Starts one of the most difficult stages of the operation: the surgeon opens the artery peregudau recipient and begins to impose the anastomosis with special micronite.
- Check for blood flow
After the anastomosis is formed, the temporary clamps are removed. The neurosurgeon examines how well the seams hold the anastomosis and the flow through the blood. In that case, if the stitches are dense enough and blood flows, repeated overlay micronite.
- The closure of the Burr hole
On the Dura is sutured from mikronite, sawed the bone gently back into place. In some cases, required the simulation of special pliers to the bone to prevent compression or kinking of the donor vessel. In the place of the bone fixed either due to a special bone joint or due to special titanium plates. Split the skin and muscles are sewn over the seams covered with a sticker with the antiseptic. Large is placed in the intensive care unit.
Period after surgery
In General, after the surgery, the patient should feel well, but may become irritated or sore throat. This is due to the fact that at the time of surgery in the throat tube is inserted ALV (artificial lung ventilation), which allows breathing to take place during serious operations on the brain.
Frequent consequence of the operation becomes stupid
The rehabilitation period
Due to the fact that brain surgery is always associated with high risk and possible complications, need to observe a number of rules that will allow you to recover and the normal state in the shortest possible time after surgery.
Therefore, during rehabilitation should follow a list of all the strict rules and doctor's recommendations regarding diet, lifestyle and taking the prescribed medicines. The same people that have recently undergone brain surgery, not drive a car until the doctor is satisfied that the person fully restored normal coordination of movements.
It is forbidden to drink alcohol and to smoke, as this can lead to complications in the form ofbleeding in the brain, to keep fluids in the body and cause an allergic reaction because of the incompatibility with medication.
Prohibited any physical activity: do not lift heavy objects, bend over and just strain. Therefore, even household chores need to leave: the man after such an operation have to comply with bed rest.
It is recommended to spend more time in the fresh air, but a lot of walking should not be.
Brain surgery may lead to serious complications, even if was quite successful. Any surgery is dangerous, and in 10% of cases leads to the discovery of bleeding, thrombosis, infection or an allergic reaction to the anesthesia. Of course, thanks to modern methods of treatment and high professionalism of doctors, the mortality rate was near zero, however, even such an operation like bypass surgery, may cause serious consequences or even death. The most common complications in the case of bypass surgery are either hemorrhage or blood clots.
Therefore, in order to minimize the risk of complications during and after surgery, it is necessary to follow all doctor's recommendations, diet and give up bad habits. This will help you better to postpone the surgery and rehabilitation period.
As well advised to avoid potential allergens and to follow therapeutic diet, eliminating from the diet of fatty, fried, spicy, salty and citrus fruits and nightshades. The doctor himself will be a sheet with the required products, which will need to strictly adhere to the entire period of rehabilitation.
The cost of the operation
The average price for this operation in Moscow can vary depending on the area, clinics and medicines that will be applied during the operation and rehabilitation of the patient. The minimum price at the moment is about 15,000 rubles, the maximum can go up to 60 000-65 000.
There is a widespread view, according to which the best neurosurgeons in Israel, so brain surgery should go there. However, bypass surgery is the most complex and most dangerous operation, and in Russia there are excellent specialists able to conduct this procedure is not worse than their foreign colleagues.
Of course, human health is priceless, and every person has a right to decide where and who will conduct the surgery, especially brain surgery. However it should be borne in mind that the cost of bypass surgery abroad will be significantly higher than in Russia, plus the need to apply for a passport, get a visa, pay for flights and accommodation. Do not forget about the insurance, without which you will not take in any foreign clinic. So if it is not possible to give a roundamount for bypass surgery abroad, it is best to contact the Russian clinic where the surgery will be worse.
And don't forget about that bypass surgery, despite the fact that is a major operation, only addresses the symptoms and not the cause. To avoid relapse, and there was a need for a second surgery, you must strictly adhere to all the advice of a doctor. For those who have undergone such an operation, it is extremely important to lead a healthy lifestyle and get rid of all bad habits. Unfortunately, bypass surgery could be a major reason for rejection of sports: physical activity can cause bleeding or a number of other unpleasant complications.