쉐도잉 연습: (English) Middle meningeal artery (MMA) embolization in cSDH - 영상으로 영어 말하기 배우기

Hello dear colleagues, my name is Al -Muhammad,

and today we have a chronic subdural hematoma in an 86 years old male patient who came with headaches and seizures.

On the first non -enhanced CT of the brain, we have seen a chronic subdural hematoma on the left side of the brain,

and the upper right CT scan is the first one after the operation.

41 days after the operation, the patient came with a large recurrence of the hemorrhage seen in the lower left CT scan.

And here we have performed an MMA embolization, and the lower right CT scan is at the six -month follow -up.

And for the embolization, we have used a dual -lumen micro -balloon catheter Scepter Mini

2 .2 by 9 millimeters with Onyx 18 as an embolic agent.

And here we go, we push the long sheath Neuromax with the select catheter in the aorta,

and configurate the tip of the select catheter at the aortic arch, and start the navigation of the left common carotid artery,

and now we need a roadmap to see the anatomy and navigate into the left internal carotid artery.

At first we push the teroma wire and then the select catheter,

and here we need an overview of the internal carotid artery to exclude anastomosis to the intracranial branches

and normal variants of the middle meningeal artery.

And as we can see, there is no anastomosis to the internal carotid artery and no normal variants of the middle meningeal artery.

We can zoom a little bit into the orbiter to see whether there is any anastomosis to the..

but even if we don't see the anastomosis, it doesn't mean that it is not there.

And now we turn to the external carotid artery,

we have the intermediate catheter SOFIA 5F with the stiff wire teromo,

and now we start the navigation of the external carotid artery using the teromo stiff and then the intermediate catheter,

and now we need a 2D angiogram, and very important anastomosis are to the ophthalmic artery and to the fascial nerves,

which can cause blindness or fascial palsy.

And now we zoom a little bit to guarantee a smooth navigation of the middle meningeal artery,

and here we see the frontal and parietal branches of the middle meningeal artery.

And now we prepare the Scepter mini balloon catheter attach it to the saline,

and now we flush the hub with contrast agent,

and push the Mirage microwire into the balloon catheter, and shape the tip of the microwire,

and now we remove the air from the balloon as usual,

and after that we push both balloon and microwire into the intermediate catheter SOFIA5F,

and start the navigation of the middle meningial artery.

And now we perform a test, we push the balloon without the microwire, and look which branch it will take,

and it's taking the paretal branch, and now with the microwire it goes to the frontal branch,

and we start the embolization in the branch which needs a microwire and turn to the other branch without the microwire,

and that's how we can embolize both branches with one balloon.

And we place the balloon distally to the anastomosis to the ophthalmic artery.

And now we need a larger overview to see the embolization,

and now we inflate the balloon and perform a 2D angiogram through the balloon,

and this is the way that we need for the onyx embolization.

We let the contrast agent a little bit flow, and as you can see,

this is the typical MMA blush in chronic subdural hematomas.

And now we start the embolization with onyx, and in the coronal projection we have reached the phalx cerebri, which is a good sign of penetration,

and now we deflate the balloon and pull it back and try to navigate into the paretel branch, and as you can see the balloon is a little bit deformed,

that's why it doesn't go easily in this branch.

There is a tip here, we inflate the balloon a little bit with contrast agent, and then it goes in this branch easily.

And now we are in the paretial branch, we inflate the balloon and continue embolization.

And with the balloon occlusion, we can reach a very deep penetration of the middle meningeal artery.

And as you can see, we have reached every distal branch of the middle meningeal artery and now we deflate the balloon,

because we are getting a little bit reflex, we can give a drop of onyx on our way back and remove the balloon,

but without any pressure to not reach the dangerous anastomosis.

And now we need a 2D angiogram of the external carotid artery, and as you can see, the middle meningeal artery is completely occluded.

And as we have seen at the very beginning, there was no anastomosis to the internal carotid artery and the intracranial branches.

That's why we're not expecting any complications.

And this is the last angiogram of the internal carotid artery.

No occlusions, no hemorrhage, no extravasation.

And thus we've reached the end of our intervention.

As always, if you have any questions, please put them down in the comments below.

You can contact us per email.

Two email addresses and further contact options are in the video description below.

Thanks for watching, Dawes Al -Muhammad, see you next time, peace out.

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법

쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.

쉐도잉 연습: (English) Middle meningeal artery (MMA) embolization in cSDH - 영상으로 영어 말하기 배우기

이 레슨에 대해

쉐도잉이란? 영어 실력을 빠르게 키우는 과학적 방법