Ali YILMAZ, Mücahit AVCİL, AYÇA ÖZKUL, ABDULLAH TOPCU, Bayram ÇIRAK, Feridun ACAR, Erdal COŞKUN

The Role of Neurosurgeons in Neurointerventional Surgery

Amaç: Endovasküler teknik serebrovasküler hastalıklara yaklaşımda önemli, minimal girişimsel bir yol olmasına karşın, sadece birkaç beyin cerrahı intrakraniyal vasküler patolojilerde hem endovasküler hem cerrahi yöntemde eğitildi. Amacımız hastalarımızdaki serebral dijital çıkarma anjiyografisi bulgularını analiz ederek, beyin cerrahide endovasküler yaklaşımın önemini vurgulamaktır. Gereç ve Yöntemler: Şubat 2011-Haziran 2014 arası üniversitemiz nöroşirurji ve nöroloji ünitelerinde serebral anjiyo olmuş 207 hastayı analiz ettik. Hastalar önceden bilgisayarlı tomografi/manyetik rezonans bulgularına göre anevrizma, arteriovenöz malformasyon (AVM), karatiko kavernöz fistül, vaskülit ve Moyamoya hastalığı gibi serebrovasküler hastalık tanısı almıştı. Demografik bulgular, serebral anjiografi endikasyonları, endovasküler ve cerrahi tedaviler, komplikasyonlar ve sonuçlar analiz edildi. Bulgular: Bu çalışma 57,43±11,14 (17-83) yaş aralığında 108 erkek ve 99 kadın içerir. Toplam 234 selektif anjiyografi yapıldı. Prosedürlerin endikasyonları; serebral anevrizma (n=118, %57), Moyamoya hastalığı (n=3, %1,4), AVM (n=13, %6,3), karatiko kavernöz fistül (n=2, %1) ve intrakraniyal vasküler stenozdu (n=2, %1). Altmış dokuz hastada (%33,3) hiçbir patoloji bulunmadı. Sonuç: Serebral anjiografi serebrovasküler hastalıkların sadece tanısında değil tedavisinde de önemlidir. Nörogirişimsel cerrahi, henüz beyin cerrahi eğitim programında olmamasına rağmen, titiz güvenli prosedürlere dayanan minimal girişimsel bir tedavi yöntemidir.

Nöro-Girişimsel İşlemlerde Beyin Cerrahlarının Rolü

Objective: Although the endovascular technique represents an important, minimally invasive approach to cerebrovascular diseases, only a few neurosurgeons are trained in both endovascular and surgical management of intracranial vascular pathologies. Our aim was to emphasize the importance of the endovascular approach in neurosurgery by analysing the cerebral digital subtraction angiography findings in our patients.Materials and Methods: We analysed 207 patients who underwent cerebral angiography between February 2011 and June 2014. They had previously been diagnosed with cerebral vascular pathology including aneurysm, arteriovenous malformation (AVM), carotid cavernous fistula, vasculitis and Moyamoya disease according to computed tomographic angiography/magnetic resonance angiography findings. Demographic data, indications for cerebral angiography, endovascular and surgical treatments, complications and results were analyzed.Results: This study included a total of 207 patients (108 males and 99 females) with a mean age of 57.43±11.14 years. A total of 234 selective angiographies were performed. The indications for procedures were as follows: cerebral aneurysm (n=118, 57%), Moyamoya disease (n=3, 1.4%), AVM (n=13, 6.3%), carotid cavernous fistula (n=2, 1%), and intracranial vascular stenosis (n=2, 1%). No pathology was found in 69 patients (33.3%).Conclusion: Cerebral angiography is important not only in the diagnosis but also in the treatment of cerebrovascular diseases. Neurointerventional surgery is a safe and minimally invasive treatment option based on meticulous protocols, however, it has not been included in the neurosurgery residency program yet. Developing training programs for endovascular neurosurgeons provididing comprehensive patient care should be considered.

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