Saturday, 6 august 2016
On prevalence strokes in Kazakhstan strongly take the third place, slightly conceding to myocardial infarction and malignant new growths. From the patients who have endured stroke, only 10% are subject to surgical treatment. The modern medicine for treatment of stroke offers some methods, among which - surgical intervention which can offer the advanced center of surgery dealing with problems of vessels of brain. The neurosurgeon Asylbek Kaliyev tells about opportunities of department of vascular and functional neurosurgery of the National center of neurosurgery.
- Asylbek Baktbekovich in what treatment of pathologies department of vascular and functional neurosurgery is engaged?
- First of all, it is patients with aneurisms of vessels of brain. Aneurism represents the small, reminding mumpish balloon protrusion of wall of artery of brain which can bring - and often leads - to extensive hematencephalon. It is very important as at repeated hemorrhages 75% of patients perish already. At the third hemorrhage perishes to 98%. Under the influence of different factors (idiopathic hypertensia, smoking, genetic predisposition) there is growth of aneurism and thinning of its wall. All this as a result leads to rupture of aneurism and hematencephalon. More than a half of patients have no hemorrhage and perish, despite intensive care even in the best clinics. For this reason practically in all cases the preventive operation aiming at switching off of aneurism from blood-groove is recommended.
At timely operation after "switching off" of aneurism which neurosurgeons sometimes compare to neutralization of bomb, in most cases there comes treatment.
About 30% of patients arrive to us with arteriovenous malformation of head and spinal cord (AVM) - inborn vascular pathology which is ball randomly of the bound vessels. These vessels have thinner wall, than in norm therefore can become torn and lead to intracraneal hemorrhage. The lethality at rupture of AVM at not operated patients reaches 30%, invalidism to 50%. If to undertake nothing, the person should live constantly with thought that in his brain the bomb capable to become torn in any second has hidden.
For example, I would like to tell about interesting case from my practice. To us in the emergency order the woman with hemorrhage has come to brain. The situation was complicated with that the patient was on late duration of gestation. At inspection it has been revealed that the arteriovenous malformation of brain became the reason of hemorrhage. Thus, on us double responsibility for life of mother and her future child has reclined. In the emergency order we have executed endovascular embolization of arteriovenous malformation with the subsequent rehabilitation of the patient. After the treatment which is carried out in our center the patient has been written out home in good shape. In the subsequent she has safely given birth to the child and now leads full-fledged life and rejoices to happiness of motherhood. Therefore neurologists and neurosurgeons are faced by task in time to diagnose pathology and not to allow hemorrhage.
Besides, we are engaged in treatment of other vascular pathologies: fistulas of head and spinal cord, stenoses of carotid and vertebral arteries, cavernous angiomas and other pathologies. Separate category of patients are patients with Parkinson's illness, dystonia, essential tremor, epileptiform neuralgia, gemifatsialny spasm and other functional disturbances of the central and peripheral nervous system. Functional neurosurgery - rather new direction in medicine which at this stage our center actively develops.
- What modern technologies you use in fight against vascular pathologies?
- In our clinic the modern endovascular interventions at vascular pathologies consisting in embolization of aneurism by anemic transcutaneous puncture method through femoral artery are carried out. Such operations would be impossible without modern operational angiographs, we have such devices. It should be noted that we carry out all manipulations with brain blood vessels only by means of high-precision operational microscopic tools. For exact definition of the pathological center in brain fabric we use neuronavigation. At neuronavigation the technology similar to global system of positioning (GPS) providing to the surgeon opportunity to see anatomy of the patient in three measurements is used and also with high precision to define pathology site in head or spinal cord.
- Tell about the main symptoms of vascular disorders in brain. On what it is worth paying attention?
- The headache, noise and dizziness, memory impairment, increased fatigue, decrease in working capacity - similar symptoms meet not only at elderly, but also at people of average and even young age. Often patients not really seriously treat such complaints. Meanwhile they can testify to chronic insufficiency of cerebral circulation.
- What when carrying out neurosurgical operations preliminary survey of the patient matters?
- Carrying out such most difficult operations would be simply impossible without modern diagnostic methods. Without data of computer tomography and angiography the neurosurgery cannot exist. The computer tomography allows to see, what part of brain was lost, defeat is how great. The angiography allows to define, what vessels and at what level are damaged. These modern researches are capable to determine the real level, and also extent of disturbance of brain blood-groove with high precision, to define condition of vessels of neck and head, to measure blood-groove speed, to notice availability or lack of atherosclerotic plaques. After the corresponding researches physicians can be defined, what type operation can be required for the specific patient. All these methods of inspection can be passed in reception and diagnostic department with day hospital of our center.
- What number of operations annually passes in your department? How it is possible to get on treatment to your center?
- In our department more than 300 operations at pathology of vessels of the central nervous system are annually performed. For 8 flyings we have performed more than 2500 successful operations. The national center of neurosurgery gives help to citizens of the Republic of Kazakhstan from all regions of the country in the presence of indications to hospitalization and the direction on treatment in our clinic received in residence. Our patients can receive both out-patient, and hospitalization. Except unique diagnostic methods and treatment, the clinic guarantees comfortable conditions of stay. In the presence of indications and personal desire of the patient, our center gives opportunity of receiving medical care on paid basis. The clinic accepts patients without quotas and in full provides for them the quality profile help. By the way, all August in the center works action minus 30% for bed day. To us on treatment come not only citizens of our country, but also patients from the USA, Kyrgyzstan, Uzbekistan, Georgia and border regions of Russia. That is anyone can get to us.
- With what problems to you how to the vascular neurosurgeon, it is necessary to face? What measures of prevention you would advise the patients who are in risk zone?
- First of all, we face the late request of patients for the help to us. Often patients address at late stage of disease that considerably complicates treatment process. Also part of our patients are not disciplined, often do not carry out our appointments and recommendations that in certain cases leads to aggravation of symptoms and repeated hospitalization. First of all we recommend to observe the principles of healthy lifestyle, sports, whenever possible to avoid emotional stresses, to refuse from alcohol intake and smoking, to reduce the use of fat, fried, salty food, and, of course, to control the arterial pressure, level of cholesterol and sugar of blood.
- Thanks a lot for conversation!
Rashilya Ospanova, SOURCE: KAZINFORM