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Wednesday, December 20, 2006

Neurosurgical novelty.

Left :Drawing, courtesy of NYT.

In a pioneer neurosurgical operation in USA, Chris Ratuszny (26), mechanic of Lindenhurst, New York, was operated successfully of a giant aneurysm (seated in a segment of 7,62 cm of long, among the cerebral branches of the arteries : internal left carotid, posterior communicant branch and initial divison of brain medial artery), thoroughly ballooned and coil back, like a golf ball. I) Usually (standard surgery), the aneurysms are clamped (1/2 - 1 hour), in their extreme borders. After it, the remainder borders of the aneurysm, are sewn to a venous bypass. As it will be understood, after the retirement of the clamps (because of the hipoxemia), it is possible to attend 10-15%, of severe strokes. II) The novelty in this case consisted in that there was not clamping of arterial ends of the aneurysm. In their place a team (composed by the Dr. Cornelius Tulleken that has carried out 300 operations of this type in Europe and Dr. Michael Münker, physicist of the Danish company Elana that manufactures laser tubes laser), headed by the Dr. David J. Langer, director of surgery cerebrovascular in Saint Luke's-Roosevelt, Beth Israel and Long Island College Hospital, carried out a previous revolutionary venous bypass.

For it, they sewed rings (connected to venous segments), to arterial distant walls of the arterial aneurysm. A excimer laser (See graphic, courtesy of NYT), content in the tip of a thin catheter was introduced by the interior of the venous segment, until touching the internal area of the ring. There, light laser , made circular perfect holes, without burning near tissues and without interrupting the arterial flow of the aneurysm. Connecting the ends of the venous segments, a venous bypass was built. With the blood flowing for the venous bypass, the team proceeded to the clamping of the ends of the aneurysm (not extirpating it), but promoting their gradual occlusion, for lack of blood flow.

Neurocirugía revolucionaria.

En una operación neuroquirúrgica de nuevo cuño y pionera en USA, Chris Ratuszny (26), mecánico de Lindenhurst, New York, fué operado exitosamente de un aneurisma gigante (asentado en un segmento de 7,62 cm de largo, entre las ramas cerebrales de las arterias carótida interna izquierda, comunicante posterior y parte anterior de la basilar), ampliamente balonado y enrollado sobre si mismo, como una pelota de golf. I) Normalmente (cirugía standard), los aneurismas son clampeados (1/2 - 1 hora), en sus bordes extremos. Trás extirpar el aneurisma, los bordes remanentes arteriales son cosidos a un bypass venoso. Como se comprenderá, trás el retiro de los clamps (a causa de la hipoxemia), es posible asistir a un 10-15 %, de casos de accidentes cerebro vasculares, severos. II) La novedad en este caso consistió en que no hubo clampeo de los extremos arteriales del aneurisma. En su lugar un team (compuesto por el Dr. Cornelius Tulleken que ha realizado 300 operaciones de este tipo en Europa y el fisico Michael Münker, fisico de la compañía danesa Elana, que fabrica tubos laser), encabezado por el Dr. David J. Langer, director de cirugia cerebrovascular en el Saint Luke’s-Roosevelt, Beth Israel y Long Island College Hospital, realizó un revolucionario bypass venoso previo.

Para ello, cosieron anillos (conectados a segmentos venosos), a paredes arteriales distantes del aneurisma arterial. Un dispositivo laser (ver grafico, cortesía del NYT), contenido en la punta de un cateter delgado fué introducido por el interior del segmento venoso, hasta tocar el área interna del anillo. Alli, luz laser (haz fotónico coherente, estrecho, polarizado, con luz de una sola longitud de onda, amplificada a potencias extremadamente altas), hizo hoyos circulares perfectos, sin quemar tejidos cercanos y sin interrumpir el flujo arterial del aneurisma. Conectando los extremos de los segmentos venosos se construyó un bypass venoso. Con la sangre fluyendo por el bypass venoso, recien se procedió al clampeo de los extremos del aneurisma (no extirpándolo), sino promoviendo su oclusión paulatina, por falta de riego sanguineo.


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