ABSTRACT
OBJECTIVE: To assess the main performance indicators of neurosurgical departments in surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed 22 neurosurgical departments (19 regional and 3 federal hospitals) in 2017 and 2021. The study enrolled 6.135 patients including 3.160 ones in 2017 and 2.975 ones in 2021. We studied the features of surgical treatment of cerebral aneurysms in different volume hospitals and factors influencing postoperative outcomes. RESULTS: The number of surgeries for cerebral aneurysms decreased from 2.950 in 2017 to 2.711 in 2021. Postoperative mortality rate was 6.3% and 5.6%, respectively. The number of microsurgical interventions decreased from 60% in 2017 to 48% in 2021. The share of endovascular interventions increased from 40% to 52%, respectively. Endovascular embolization was accompanied by stenting in 55% of cases. Simultaneous revascularization was carried out in 2% of cases. In 2021, the number of patients undergoing surgery in acute period of hemorrhage increased to 70% (in 2017 - 61%). The number of hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased from 14 in 2017 to 17 in 2021. CONCLUSION: Certain changes in neurosurgical service occurred in 2021 compared to 2017. Lower number of surgical interventions for cerebral aneurysms, most likely caused by the COVID-19 pandemic, is accompanied by lower postoperative mortality. Endovascular interventions and revascularization techniques became more common. The number of surgeries in acute period after aneurysm rupture and hospitals performing more than 50 surgical interventions for cerebral aneurysms annually increased.
Subject(s)
Aneurysm, Ruptured , Embolization, Therapeutic , Endovascular Procedures , Intracranial Aneurysm , Subarachnoid Hemorrhage , Humans , Intracranial Aneurysm/surgery , Pandemics , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Treatment Outcome , Embolization, Therapeutic/methods , Aneurysm, Ruptured/surgery , Endovascular Procedures/adverse effects , Endovascular Procedures/methods , Subarachnoid Hemorrhage/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: The objective of this study was to evaluate the results of surgical treatment of cerebral aneurysms in the Russian Federation. MATERIAL AND METHODS: We analyzed performance indicators in neurosurgical departments of regional and federal health institutions of the Russian Federation for 2017. The results of surgical treatment of cerebral aneurysms (CAs) were analyzed in 19 regional vascular centers (RVCs) in several federal districts and in 3 federal centers (FCs) with the most dynamically developing vascular neurosurgery and smoothly running system of statistical data processing. RESULTS: The study included 3160 patients hospitalized to 22 medical institutions in 2017. Of these, 1808 patients were treated in RVCs, and 1352 patients were treated in FCs. We analyzed factors affecting the treatment outcome in CA patients. We identified features of CA treatment in clinics with a different amount of surgical intervention. CONCLUSION: An increase in the surgical activity in centers and simultaneous development of microsurgical and endovascular treatments for cerebral aneurysms reduce postoperative mortality. Due to the presence of a RVC network in the Russian Federation, many patients could receive necessary specialized treatment. The number of operations for cerebral aneurysms has increased 6-fold for the past 10 years.
Subject(s)
Aneurysm, Ruptured , Intracranial Aneurysm , Subarachnoid Hemorrhage , Embolization, Therapeutic , Humans , Intracranial Aneurysm/surgery , Neurosurgical Procedures , Retrospective Studies , Russia , Treatment OutcomeABSTRACT
Concentrations of thyroid hormones (thyrotrophic - TTG, T3, T4) were measured with radioimmunological assay in the blood serum of 69 operated patients with supratentorial stroke interbrain hematomas. Hematomas were removed using a puncture/ aspiration method with local fibrinolysis. The lethality was 19%. It has been shown that medial hematomas lead to the decrease in TTG secretion while lateral and lobar ones inhibit T4 and T3 synthesis. Replacement therapy with thyroid hormones is needed to improve results of operative treatment of non-traumatic interbrain hematomas.
Subject(s)
Hematoma, Subdural, Intracranial/metabolism , Hematoma, Subdural, Intracranial/surgery , Thyroid Gland/metabolism , Thyrotropin/metabolism , Thyroxine/metabolism , Triiodothyronine/metabolism , Adult , Aged , Aged, 80 and over , Hematoma, Subdural, Intracranial/blood , Humans , Middle Aged , Thyrotropin/blood , Thyroxine/blood , Triiodothyronine/blood , Young AdultABSTRACT
Radioimmunoassay using was used to study the blood concentrations of thyroid hormones (thyroid-stimulating hormone (TSH), T3, and T4) in patients with hemorrhagic stroke as intracerebral hematoma. The authors analyzed two patient groups: 1) those operated on for intracerebral hematoma removal; 2) those receiving medical treatment. Surgical intervention resulted in local fibrinolysis of a hematoma remnant. The level of thyroid hormones was studied over time from the 1st day to the 28th day of therapy. Each group was then divided into 2 subgroups: survivors and dead patients. Mortality group was 77.2% in the medical treatment group and 17.2% in the surgical treatment group. The performed studies established elevated concentrations in cases of good outcome of stroke. All the patients were found to have low T3 concentrations that were more pronounced in patients with a poor outcome. The level of T4 did not differ from the control values in patients with good results. Hematoma removal contributed to an increase in the concentrations of TSH and triiodothyronine.
