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TRENTO. In recent days it has been successfully carried out at Trento Hospital the first intervention with an innovative technique on brain aneurysms.
The operation concerned the exclusion of intact aneurysm of the middle cerebral artery of the left hemisphere in a patient upon waking (waking operation), a method used in the surgical removal of brain tumors in critical areas of the brain.
Perform the intervention the operating unit of neurosurgery of Trento. The technique, applied to intact brain aneurysms, called a sleep cut, provides the patient with intraoperative awakening to monitor the linguistic, complex, visual and emotional processing functions when applying the metal clip in order to close the dilated vessel.
The Director General ofell Apss Paolo Bordon expressed its satisfaction for this result, the result of the "very high level of professionalism and specialization present in the neurosurgery team, which, thanks to the synergy and collaboration of all the operators, neuroanesthesia and neuroscience. resuscitation, to the departmental staff and operating room, has allowed to implement an innovative treatment of brain aneurysms, diseases that can have very debilitating results.We present today what the operating unit of the neurosurgery of the Trento Hospital, a department at the national level, can offer in terms of complexity of execution, specializations and skills and, last but not least, advanced technological level in the treatment of cerebrospinal diseases ".
"The intervention carried out in recent days – concluded Bordon – is a new step forward for all staff of the neurosurgery unit of Trento and for the Aps, in the path to optimize the treatment of complex pathologies potential impact on the quality of life of patients ".
To illustrate The new technique was Franco Chioffi, director of the operating unit of neurosurgery. "The cerebral aneurysms," Chioffi said, "are conbad or acquired malformations of the cerebral artery walls that occur most often after rupture, leading to cerebral or subarachnoid hemorrhage, and sometimes randomly discovered by testing. diagnosis performed for other pathologies such as headaches, head trauma and carotid district diseases.If the aneurysm is detected before rupture, it is referred to as "accident" and surgical or endovascular treatment is proposed to prevent potential cerebral hemorrhage.
The surgical treatment involves positioning a metal clip to close the dilation, restoring the normal profile of the vase from which it is derived. This treatment is, in most cases, definitive in the sense that the patient can be considered cured but carries significant risks, especially if we consider that the patients candidates for treatment are generally young, without neurological deficit or major medical problem and who have an absolutely normal life. The main possible complications are generally related to the imperfect closure of the aneurysm with stenosis of the carrier vessel or its divisional branches and the resulting ischemic events in the brain territories that are particularly relevant from a functional point of view.
There is good intraoperative technology, such as video-angiography and fluximetry (which the neurosurgery unit has been equipped with for years), which helps to understand if the normal flow to the inside of the vessels involved in the crisis is preserved and unchanged, before and after the exclusion of the aneurysm. Although many valid intraoperative control techniques have been introduced (video angiography, flowmeter, motor and psychic evoked potentials), the absolute guarantee of the absence of intraoperative complications following aneurysmal cutting can only be obtained by the patient collaboration during the operation.
The awake cutting method allows to monitor not only primary motility and sensitivity, but also the control of higher and more complex cognitive functions, such as language, comprehension, emotion processing, vision, motor organization. To date, only seven studies on this methodology have been published in the international literature, of which only one is a series of 30 cases and the others are individual cases (case reports).
Based on these early experiences and consolidated skills that the operating unit of S. Chiara Hospital of Neurosurgery developed during these years in the field of "awake surgery", used for the removal of tumors in critical areas of health. On November 14, the first intervention, in the patient's waking state, was performed for the surgical treatment of a cerebral aneurysm ("sleep snapshot"). The surgery was perfectly successful, the patient tolerated the surgical procedure and no complications occurred. The woman came out of the hospital after a few days at home, under perfect neuro-clinical conditions, and completely cured of her cerebral aneurysm. "
Expressing satisfaction was also theProvincial Councilor for Health, Social Policy, Disability and the Family Stefania Segnana who said: "Good news that should be welcomed, even if, it was rightly said, it is not an arrival point but a starting point. to recognize that these news materialize if the conditions are met and I refer to the potential of excellence that the health of Trentino is able to express.In this particular case, we can talk about a result that results both the professionalism of the operators and the other technological level of the instrumentation used, proving that research and technology are formidable tools that, combined with expertise, should help us to find the best solutions to the needs of citizens.This beautiful story also teaches us that it is by working together that we go beyond goals often regarded as impossible.Here, too, we have the will to work together, to create the conditions for a good job and, at the same time, to suggest the stimuli that can make our territory a new pledge of quality ".
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