[Significance of magnetic resonance imaging in the diagnosis and surgical treatment in patients with intracranial arterial aneurysmal ruptures]. / Znachenie magnitno-rezonansnoi tomografii pri diagnostike i khirurgicheskom lechenii bol'nykh s razryvami vnutricherepnykh arterial'nykh anevrizm.

In 123 patients with arterial aneurysms, brain MRI was performed in the routine and vascular modes. Ninety-five patients were hospitalized. Of them, 73 patients were operated on. Among the patients operated on, the diagnosis was verified and it corresponded to preoperative MRI diagnosis. In a group of patients who had died without being operated on, the diagnosis was verified at autopsy. In 11 cases, the diagnosis should be clarified by direct cerebral angiography. Analyzing MRI criteria that may be used to diagnose an aneurysm has indicated that the detection rate of some aneurysmal elements is not equal. The greatest problems arise in identifying the aneurysmal neck and carrying vessel, particularly in the presence of intracerebral hematoma that surrounds the aneurysm. The neck of aneurysm and its carrying artery could be visualized in 63 and 80% of cases, respectively. Nevertheless, aneurysmal clipping was successfully performed in 64 cases as shown by only MRI data. Aneurysmal MRI criteria were systematized, MRI signs being classified into direct and indirect and their rates presented. According to MRI, including MR angiography, the accuracy of diagnosis ranged from 61 to 88%. If there are no direct MRI signs of aneurysm, its preoperative diagnosis should be clarified by traditional cerebral serial angiography.

[Cerebral hemodynamics and metabolism in the acute stage of cerebral aneurysm rupture]. / Tserebral'naia gemodinamika i metabolizm v ostroi stadii razryva anevrizm golovnogo mozga.

The relationship between lipid peroxidation products and the severity of arterial spasm was studied in 86 patients. For this, the level of radical production, the content of the end lipid peroxidation product malonic dialdehyde and the overall antioxidative activity of lumbar cerebrospinal fluid were determined during 24-hour Doppler monitoring of blood flow in the middle cerebral and internal carotid arteries. Following subarachnoidal hemorrhage, the activation of lipid peroxidation processes was shown to correlate with the severity of arterial spasm and it is likely to contribute to the development of late ischemias. Nimotop used to treat patients with significant arterial spasm caused a reduction in the rate of free radical lipid peroxidation to that characteristic for patients with moderate spasm. The findings suggest that it is expedient of including antioxidants into the combined therapy of patients with acute subarachnoidal hemorrhage.

[The postoperative monitoring of intracranial pressure in patients in the acute period of aneurysmatic hemorrhage]. / Posleoperatsionnyi monitoring vnutricherepnogo davleniia u bol'nykh v ostrom periode anevrizmaticheskogo krovoizliianiia.

Changes in intracranial pressure (ICP) and cerebral circulation were evaluated from Doppler transcranial ultrasound (DTU) in 29 patients with spontaneous aneurysmal hemorrhage in acute rupture. There is a tendency for the pulse wave amplitude (PWA) of ICP to increase concurrently with higher ICP values (r = 0.768, p < 0.01), the tendency being smoother in patients with severe diffuse spasm (r = 0.573, p < 0.01). There was also a linear correlation between the ICP values and the pulse index of blood flow velocity (r = 0.783, p < 0.01). Evidence is given for the possibility of indirect assessment of ICP from DTU data and for that of indirect evaluation of cerebral perfusion from ICP monitoring data. In the latter case, the authors used a ICP PWA ratio. The findings suggest that the decrease in PWA/ICP values by less than 0.2 during intracranial hypertension and severe diffuse arterial spasm corresponds to the reduction in cerebral blood filling beyond the critical values.