Interventional radiology has traditionally been at the forefront of the modern medicine, offering minimally invasive alternatives to surgical treatment with reducing of the length of hospital stay. The problem of medical waste and the recycling of medical supplies to support sustainable development goals in the health sector has entred a “green revolution” that aims to overcome global warming and fight with environmental pollution. Operating waste accounts for 20 to 70 % of all hospital waste, and many of them require special disposal. On the other hand, revenues for health care companies continue to rise, as do patient care costs, which are a huge burden for families and health systems, especially in low-income countries during COVID-19 pandemic. The issue of disposal and reuse of unique, expensive disposable radiological profile instruments is not widely reported in the scientific literature, but surveys among interventionists indicate that reuse exists even in countries where it is officially prohibited. Despite the emergence of regulations on the reuse of disposable instruments, it is largely carried out outside the quality standards. Also, manufacturers are not interested in reusing disposable instruments and often refuse to provide information on how they can be properly recycled and sterilized. Although well-remanufactured tools have significant promise, both for reducing healthcare costs and environmental pollution, and for spreading modern interventional technologies to the critical places where resources are limited and they can save lives.
Multiple cerebral aneurysms are found in one among four patients with aneurysmal subarachnoid hemorrhage. Nowadays, there is no clear consensus regarding the optimal treatment of multiple cerebral aneurysms. The papers published up to December 2021 containing the results of endovascular treatment of multiple cerebral aneurysms. Treatment strategy, surgical methods, complications associated with the procedure, and mortality rates were analyzed. The treatment of multiple cerebral aneurysms remains an unresolved problem of vascular neurosurgery, in particular, there is no consensus on the optimal method of treatment and timing. Current evidence-based data indicate the advantage of minimally invasive techniques in the treatment of multiple cerebral aneurysms due to the low risk of complications and the possibility of one-session procedure. The question of treat or not to treat of unruptured aneurysms in the presence of multiple aneurysms is a matter of debate. The choice between surgical methods (microsurgical clipping or endovascular coiling) or observation requires a multidisciplinary approach, taking into account the risks of rupture and the corresponding procedures.
20 years have past since the publication of the results of the International Subarachnoid Aneurysm Trial (ISAT), which changed the worldwide clinical practice of the treating of ruptured cerebral aneurysms. ISAT lasted almost 8 years until May 30, 2002, in many centers all around the world and included 2143 patients. This first prospective randomized multi-center study confirmed the superiority of endovascular treatment for ruptured cerebral aneurysms. Further, long term follow-up study of ISAT groups confirmed these results. Development of the endovascular method was possible due to pioneers in this field, including professor V.I. Shchehlov, founder of the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine», who made his first endovascular procedure using detachable latex balloons for the treatment of aneurysm on November 27, 1974 at the Kiev Institute of Neurosurgery. His contribution in development of endovascular neurosurgery was highly appreciated by the author of the ISAT study, Andrew Molyneux, during his lecture at the world congress of the European Society of Minimally Invasive Neurological Therapy.
Background. Surgical treatment of space-occupying orbital masses and cranio-orbital tumors is relevant due to the features of the diagnosis and surgical stage of treatment because of the dense arrangement of neurovascular and muscular structures in a small orbital space. The purpose was to determine the features of the surgical treatment of orbital and cranio-orbital tumors. Materials and methods. A retrospective analysis of 102 patients (76 women, 26 men) with orbital and cranio-orbital tumors who were treated at the Department of Neurosurgery 2 at Kyiv City Clinical Emergency Hospital from 2000 to 2016 was carried out. Results. Eighty-six (84.3 %) patients had benign tumors, 16 (15.7 %) — malignant. Pterional craniotomy with orbitotomy was performed in 72 (70.6 %) cases, lateral orbital approach was used in 20 (19.6 %) patients, and anterior orbitotomy — in 10 (9.8 %). Total tumor resection was achieved in 71 (69.6 %) cases. After the removal of tumors located in the anterior 2/3 of the orbit and orbital apex, a satisfactory and good result was achieved in 93.9 and 92.4 %, respectively. The worst results were obtained after surgical treatment of tumors located in the posterior third of the orbit, which were intra- and extraconal, unsatisfactory results was observed in 37.5 % of cases in each group (II and III). In the early postoperative period, 18 (17.6 %) patients had complications, the most frequent were: visual impairment — 8.8 %, oculomotor disorders — 8.8 %, and ptosis — 5.9 %. However, in 6 patients they regressed by the time of discharge. The risk of complications was higher after the removal of intraconal tumors of the posterior third of the orbit (odds ratio 5.71 (95% confidence interval 1.28–25.55), p = 0.012), and did not depend on histological structure. Conclusions. The choice of a surgical approach for removing orbital and cranio-orbital tumors depends on the relation of the tumor to the plane of optic nerve, muscular cone, optic canal, superior orbital fissure. The results of the treatment for orbital and cranio-orbital tumors depended primarily on the location and spread of the process at the time of surgery. Worsening of symptoms after surgical treatment was found mainly in patients with tumors of the posterior third of the orbit.
Interventional neuroradiology (INR) has not yet received official certification as a surgical subspecialty in Ukraine. Consequently, there is uncertainty surrounding the availability of a neurosurgical internship and a structured INR training program to provide neuroendovascular procedures. In recent years, mechanical thrombectomy has become the standard of care for acute ischemic stroke caused by large vessel occlusion, as supported by evidence-based guidelines. This emphasizes the need for INR specialists, which far exceeds the current supply. Although stroke centres with interventional neuroradiological facilities have been established to address this shortage in Ukraine, they lack highly skilled staff. Following the relaxation of COVID-19 migration restrictions, the Ukrainian medical system faced new limitations due to ongoing wartime conditions. In such circumstances, international cooperation becomes crucial to ensuring the safe and effective implementation of new technologies into routine medical practice. We successfully integrated teleproctoring into our hands-on course and found it to be an effective and promising approach, especially considering the uncertainty of the future and the presence of wartime migration restrictions in Ukraine. Teleproctoring hands-on course has the potential to provide young specialists with experienced mentors and valuable initial experience and can serve as a valuable adjunct for the improvement of surgeons confidence.
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