Microsurgical management of clipping cerebral aneurysms of complex anatomical form, large and giant sizes

Abstract

Objective – to improve the results of surgical treatment of cerebral arterial aneurysms (AA) of complex anatomical form, large and giant sizes by developing a rational microsurgical strategy. Materials and methods. A retrospective analysis of results of surgical treatment of AA in the period from 2011 to 2016 in 70 patients (38 women, 32 men, mean age – 48 years), were treated in Institute of Neurosurgery named after acad. A.P. Romodanov of NAMS of Ukraine is made. A set of diagnostic procedures included neurovisualization (computed tomography, computed tomography angiogram, magnetic resonance imaging, cerebral angiography) and functional methods of diagnostics (Doppler ultrasound of vessels of head and neck, electroencephalography). All surgical interventions were carried out with the use of intraoperative Doppler ultrasound control. Results. Acute violation of cerebral circulation in hemorrhagic type at the onset of disease – 64 cases, other manifestations – 6. Localization of AA: the complex of the anterior cerebral – anterior communicating artery – 34 cases, 32 of them in the group of stroke, the middle cerebral artery – 18, the internal carotid artery – 16, the main artery – 2. Using of such technique of clipping AA: simple clipping – 26, the remodeling of the affected arterial segment with devascularization AA – 44. According to the modified Rankin scale (MRS) the results were: good recovery (from 0 to 2 points) – 38 (54.3 %) cases, moderate impairment (from 3 to 4 points) – 18 (25.7 %), severe impairment of functioning (5 points) – 12 (17.1 %). Two (2.9 %) death are fixed. Conclusions. The best results were obtained with AA of ophthalmic segment of the internal carotid artery with a pseudo-tumor clinical manifestations in which the applied technique of remodeling clips without the temporary blocking of AA proximal to the arterial segment. In cases of multiple AA were surgically clipped of a ruptured AA and AA asymptomic diagnosed during the same operation was performed in 16 (22.9 %) cases followed good and satisfactory recovery that gives you the opportunity to make assumptions about the security and feasibility of this surgical approach in cases of multiple AA in accounting for the individual patient.

Keywords

• arterial aneurysm, brain, microsurgical treatment