neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"neurosurgery-132Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEУспешное хирургическое лечение гигантской аневризмы офтальмического сегмента левой внутренней сонной артерииThe successful surgical treatment of giant left ophthalmic aneurysmДубовойАндрей ВладимировичDubovoyA. V.noemail@neicon.ruОвсянниковКонстантин СергеевичOvsyannikovK. S.noemail@neicon.ruРзаевДжамиль АфетовичRzaevD. A.noemail@neicon.ruАмелинМихаил ЕвгеньевичAmelinM. A.noemail@neicon.ruФГБУ «Федеральный центр нейрохирургии»Russian Federation201405102017047074Copyright © Дубовой А.В., Овсянников К.С., Рзаев Д.А., Амелин М.Е., 20172017Дубовой А.В., Овсянников К.С., Рзаев Д.А., Амелин М.Е.Dubovoy A.V., Ovsyannikov K.S., Rzaev D.A., Amelin M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/132

Описано клиническое наблюдение успешного микрохирургического лечения редкой и сложной сосудистой патологии головного мозга - гигантской частично тромбированной аневризмы внутренней сонной артерии, проявившейся дислокационным синдромом с развитием правостороннего гемипареза. Размеры аневризмы офтальмического отдела левой внутренней сонной артерии, по данным МСКТ головного мозга, 49х52х49 мм (сагиттальный/вертикальный/аксиальный); дислокация срединных структур головного мозга вправо на 16 мм. Проведено оперативное лечение под эндотрахеальным наркозом: Костно-пластическая птериональная левосторонняя краниотомия, наложение экстра-интракраниального микрососудистого анастомоза (ЭИКМА) между лобной ветвью левой поверхностной височной артерии и корковым сегментом левой средней мозговой артерии, клипирование шейки и удаление мешка частично тромбированной аневризмы офтальмического сегмента левой внутренней сонной артерии. Представленное наблюдение демонстрирует оправданность наложения ЭИКМА в случаях необходимости длительного временного треппинга при реконструктивных операциях на гигантских аневризмах.

This article presents the clinical case of successful surgical treatment of patient suffered from rare and complex cerebrovascular pathology - giant partially thrombosed ophthalmic aneurysm of left internal carotid artery, manifesting with dislocation syndrome and development of right-sided hemiparesis. The aneurysm dimensions were 49х52х49 mm (sagittal/vertical/axial) according to brain CT data, the midline shift was 17 mm to the right. The following operative treatment was performed: left-sided pterional craniotomy, performing of extracranial-to-intracranial low flow bypass between frontal branch of left superficial artery and cortical branch of left middle cerebral artery (STA-MCA bypass); the clipping of aneurismal neck, thrombectomy and resection of aneurismal sac. This presented clinical case demonstrates the defensibility of STA-MCA bypass in case of necessity of long temporary trepping while performing the reconstructive operations because of giant cerebral aneurysms.

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The authors declare that there are no conflicts of interest present.