NEUROSURGICAL CARE FOR PATIENTS WITH CEREBROVASCULAR PATHOLOGY IN RUSSIAN FEDERATION

Objective — to analyze the dynamics of status of neurosurgical care for patients with cerebrovascular diseases in Russian Federation in framework of implementation of Program aiming on reduction of mortality from cerebrovascular diseases.

Material and methods. The working data from departments of vascular neurosurgery of regional and federal centers along whole Russian Federation in 2007, 2014 and 2016 years were analyzed to study the surgical activity for treatment of the most widespread cerebral vascular pathology (aneurysms, arteriovenous malformations, cavernous malformation, hypertensive hemorrhages) based on previously determined number of operations which are needed to be performed per year in each region and in whole country per population. The postoperative lethality indicators were also examined in 15 regional vascular centers (RVC) of various federal regions and in 5 federal centers with the most active development of vascular neurosurgery and well-adjusted statistical process control system.

Results. The number of neurosurgical operations for treatment of cerebral aneurysms increased in 5,2 times from 2007 to 2016, arteriovenous malformation — in 5,8 times, hypertensive hematomas — in 5,3 times. Microsurgical treatment exceeds endovascular methods for treatment of aneurysms and AVMs in regional vascular centers however these methods are used equally as often in Federal centers. The numbers of operations for cavernous malformations are still insufficient in RVC. Surgery for hypertensive hemorrhages is carried out in RVC with some minor exceptions, moreover most of patients operated in EVC were in more severity state that is why the postoperative lethality was higher in RVC.

Conclusion. The surgical activity for cerebrovascular pathology increased in 9 times within 9 years of implementation of Program aiming on reduction of mortality from cerebrovascular diseases. The priority of neurosurgical care was moved from federal to regional centers where 75% of operation are performed nowadays. 

1. Bonita R., Beaglehole R., Asplund K. The worldwide problem of stroke. Current Opinion in Neurology. 7(1):5-10, February 1994. https://doi.org/10.1097/00019052-199402000-00003

2. Go A., Mozaffarian D., Roger V., Benjamin E., et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. / American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 2014; 129: e28—e292. https://doi.org/10.1161/01.cir.0000441139.02102.80

3. Stakhovskaya L.V., Klyuchikhina O.A. Bogatyreva M.D., Kovalenko V.V. Epidemiology of stroke in Russia according to the results of the territorial — population registry (2009-2010). Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova 2013; 5: 4—10. (In Russ.)

4. Gusev E.I., Skvortsova V.I., Stakhovskaya L.V. Epidemiology of stroke in Russia. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2003; 103(8) (Suppl. Stroke): 4—9. (In Russ.)

5. Yakovleva T.V. The priority of General health examination of the population in the conditions of modernization and development of health of the Russian Federation. (In Russ.) Available at: http://zdrav74.ru/files/zdrav74/T.V._Yakovleva.pdf. Accessed December 06.2017]

6. Krylov V.V., Konovalov A.N., Dash’yan V.G., et al. The current state of neurosurgery in Russian Federation. Russian Journal of Neurosurgery. 2016; 3: 3-44. (In Russ.)

7. Приказ Министерства здравоохранения «Об утверждении Порядка оказания медицинской помощи больным с острыми нарушениями мозгового кровообращения» от 15 ноября 2012 года №928н (Зарегистрировано в Министерстве юстиции Российской Федерации 27 февраля 2013 года, регистрационный N 27353). Доступно по https://rg.ru/2013/04/25/mozg-dok.html. Ссылка активна на 06.12.17

8. Guidelines for the treatment of patients with vascular diseases of the brain. (In Russ.) Available at: http:// www.ruans.org/Documents. Accessed December 06.2017]