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CNAA / Theses / 2017 / May /

Surgical treatment of spontaneous supratentorial intracerebral hemorrhage


Author: CONDREA Eugeniu
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2017
Scientific adviser: Valerii Timirgaz
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Stanislav Groppa
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:

Status

The thesis was presented on the 26 May, 2017
Approved by NCAA on the 31 May, 2017

Abstract

Adobe PDF document – 1.26 Mb / in romanian

Thesis

CZU 616.831-005.1-089.816+616.151.5+615.273

Adobe PDF document 4.52 Mb / in romanian
179 pages

Keywords

spontaneous intracerebral hemorrhage, supratentorial intracerebral hemorrhage, minimally invasive surgical treatment, puncture and aspiration, local fibrinolysis

Summary

Structure of thesis: the work is presented on 179 pages of printed text and includes an introduction, 4 chapters, conclusions and practical recommendations, a bibliography list of 277 references as well as summaries in Romanian, Russian and English. The thesis contains 43 figures, 21 tables, 4 formulas and 2 annexes. The materials have been presented and discussed at the 6 local and international scientific conferences, being also published within 6 articles, including 2 publications as a single author and 5 publications in peer-reviewed journals.

The purpose of the study: Assessment of the efficiency of minimally invasive surgical treatment with puncture and aspiration of SICH applying local fibrinolysis.

Objectives: evaluation of the usefulness and effectiveness of puncture and aspiration method with application of local fibrinolysis in the treatment of spontaneous supratentorial intracerebral hemorrhage (SICH). Evaluation of results and development of postoperative hospitalization in patients with SICH treated using puncture and aspiration method with local fibrinolysis, compared to those treated by conventional methods. Establishing of the selection criteria for the optimal type of treatment depending on the location SICHs and algorithm development for the treatment of SICH in neurological and neurosurgical specialized units.

Novelty and scientific originality. The results of this study have allowed developing a treatment strategy for supratentorial SICH of different locations, as well as defining the role of the puncture and aspiration method with application of local fibrinolysis among the treatment options of such patients. A protocol of local fibrinolysis based on the locaton of supratentorial SICH has also been developed. Relying on complex evaluation of a variety of factors such as detailed evaluation of perifocal brain tissue and cerebral meninges as well as close monitoring of cerebral hypertensive and dislocation syndrome using dynamic cerebral CT scans, we demonstrated the effectiveness and safety of puncture and aspiration method with the use of local fibrinolysis. A formal protocol for minimally invasive surgical treatment of supratentorial SICH using puncture and aspiration method with local fibrinolysis is being proposed in this regard.

Scientific problem solved in thesis: It was determined the usefulness of surgical treatment of supratentorial SICH using puncture and aspiration method with local fibrinolysis. It was developed an efficient algorithm of the process of treatment of patients with supratentorial SICH in neurological and neurosurgical specialized units in Moldova..

Theoretical significance of the study was related to outlining a variety of surgical approaches suitable for puncture and aspiration treatment method with local fibrinolysis, depending on the location of supratentorial SICH. The thesis has also provided a foreground for a variety of new studies related to minimally invasive neurosurgical techniques.

The translational research value consists of technique suitability for treating supratentorial SICH in a wide variety of patients, including in those with serious underlying diseases as well as the option of being performed under local anesthesia in such situations.

Implementation of scientific results. The results of the study have been applied to the therapy guidelines of SICH used at the Institute of Neurology and Neurosurgery in the Republic of Moldova as well as to the study curriculum at the State University of Medicine and Pharmacy "Nicolae Testemițanu" from the Republic of Moldova.