[Two-stage contralateral combined microvascular and wide-lumen anastomosis inTwo-stage contralateral combined microvascular and wide-lumen anastomosis in a patient with acute ischemic stroke patient with acute ischemic stroke]

Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.

[INFLUENCED ARBEPOETINALFA TO REDUCE THE NUMBER OF BLOOD TRANSFUSION IN CHILDREN WITH NON-SYNDROMIC CRANIOSYNOSTOSIS.]

BACKGROUND

According to the literature, the prevalence of non-syndromic forms of craniosynostosis in children is very high. Given that the treatment of this pathology and surgery performed only at an early age of the child, the need for transfusion arise very often.

THE AIM

To study the efficacy ofpreoperative use of darbepoetin alfa in combination with intraoperative normovolemic hemodilution to reduce the number of blood transfusions during surgery and in the early postoperative period.

MATERIALS AND METHODS

The study included 70 children between the ages of 6 months up to 12 months, divided into two groups: a control group (n=34) without stimulation of erythropoiesis and the study group (n =36) using apre-stimulation oferythropoiesis darbepoetin alfa.

RESULTS

In the control group, blood transfusion was performed in 79% of cases, compared with the test group-22% of cases. Also, the patients ofthe study group determined a statistically significant (p<0. 05) increase the level of red blood cells, hemoglobin and reticulocytes.

CONCLUSION

In children up to a year with various forms ofnon-syndromic craniosynostosis preoperative stimulation of erythropoiesis in conjunction with normovolemic hemodilution reduces the number of blood transfusions 3 times, or to opt out of its holding.

[The clinical picture of nonsyndromic craniosynostosis in children]

OBJECTIVE

to study clinical presentations of nonsyndromic craniosynostosis (NCS) in children.

MATERIAL AND METHODS

Authors analyzed 56 cases of different forms of NCS. To verify the diagnosis, all children underwent computed tomography with 3D cranial reconstruction.

RESULTS AND CONCLUSION

The distribution of diagnoses was as follows: scaphocephaly - 28 (50%) patients, trigonocephaly - 21 (38%), different forms of plagiocephaly - 7 (12%). On admission to the hospital, 25 (43%) patients were diagnosed with perinatal CNS damage, 10 (18%) were born premature, 33 (59%) had neurological deviations. The clinical picture of NCS was polymorphic that might explain an increase in the number of children with late-diagnosed craniosynostosis. The early diagnosis of NCS which is the basis for using less invasive surgical methods is particularly important for prognosis.