RUDN neurosurgeons have developed a method for more accurate diagnosis of vertebrobasilar insufficiency. This will help to take into account the individual characteristics of the patient and choose the right method of surgical intervention. Results published in Frontiers in surgery .
Newswise — If the blood supply to the brain is disturbed, vertebrobasilar insufficiency (VBI) may occur. The disease was named after the arteries - basilar and vertebral - through which blood enters the brain. If the blood flow is weakened, the brain stops receiving the right amount of oxygen. The range of possible consequences is wide: from dizziness to impaired movement, and depends on the depth of the lesion. The elderly are the most affected by VBI. In severe cases of VBI, surgical treatment is recommended, but the exact procedure depends on each individual case. The correct choice of surgical tactics is influenced by many factors, so this becomes a serious problem. An incorrectly chosen method can lead to worsening of symptoms. Doctors described a procedure that takes into account the characteristics of the patient and choose the right tactics.
“VBI is one of the most common cerebrovascular pathologies. The progression of VBI, especially due to inadequate therapy, often leads to permanent impairment of neurological functions. The choice of the type of surgical treatment for patients with VBI remains an unresolved medical problem. The key difficulty in this process lies in the large number of possible causes of this pathology,” said Gennady Chmutin, MD, Head of the Department of Nervous Diseases and Neurosurgery, RUDN Medical Institute.
Doctors examined data on one hundred patients who were treated between 2009 and 2019. Among them, there were 58 men and 42 women, the average age of patients was 72.2 years. All of them were diagnosed with VBN and various lesions in the vertebral artery were noticed. In 50 patients, encephalopathy was observed - a decrease in the volume of nervous tissue in the brain and dysfunction. 7 had had ischemic attacks in the past. Almost all (98) had comorbidities. RUDN doctors have formulated a diagnostic algorithm that helps to take into account the characteristics of the patient and choose the right treatment tactics.
The diagnostic algorithm consists of three stages. First, a general and neurological examination is performed. Then the level of blockage of the vessels is determined, the diameter of the arteries, the speed and volume of blood flow are measured. At the third stage, radiological diagnostic methods are used - computed tomography, magnetic resonance imaging, angiography, and others. With the help of this three-stage diagnostics, physicians identified four groups among the studied patients, which correspond to four types of operations. For each group, the authors listed a set of features.
“We have shown the importance of objective examination methods for the choice of surgical treatment. The optimal procedure for diagnosis allows you to correctly determine the individual type of surgical intervention. In addition to traditional diagnostic methods, the importance of radiological methods is invaluable. It is also extremely important to conduct cerebral angiography and consultations of multidisciplinary specialists. This is necessary to exclude pathologies with a similar clinical picture,” said Boris Oleinikov, neurosurgeon, RUDN University postgraduate student.
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