Netlyukh A. Surgical treatment of cerebral aneurysms' rupture with a complicated disease course

The dissertation explores methods to improve effectiveness of treatment of patients with intracranial arterial aneurysms' ruptures, through development of measures of surgical complications management, and specification of terms and methods of surgical treatment. The study is based on the analysis of dynamics of biochemical, angiometric and haemodynamic perioperative parameters. The analysis of angiometric and haemodynamic perioperative parameters in 284 patients with subarachnoid hemorrhages is performed. A theoretical explanation and clinical confirmation of the adavantages of the early endovascular treatment is obtained. A new method of an invasive arterial pressure measurement in extracranial and intracranial arterial segments, as well as of the diagnostics and estimation of intraoperative angiospasm severity is proposed. Determination of ventricular indexes is reasonable giving an opportunity to distinguish clearly the group of patients with the early signs of hydrocephalus and to begin the drainage of cerebrospinal fluid, aimed to it's sanation, control of intracranial pressure and prevention of ischemic complications. Complex mosaic morphollogical changes in meninges, the sensomotor cortex, arteries and the microvascular bed after subarachnoid hemorrhage is experimentally observed at rats using the light and electron microscopy. A positive influence of NO-donors (L-arginine) for the prophylactic of the pathomorphological changes in the form of a reliably reduced thickness of the dura, and for a reliable normalization of the vertical size and microstructure of the luminal surface of endotheliocytes is demonstrated. The presented special choice of optimal timings and methods of operation allowed us to bring down the level of postoperative lethality from 17,4 % to 7,7 %, and to reduce the patients' degree of disability at discharge to 1,9±0,1 points on the modified Rankin scale.