neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2024-26-2-15-25neurosurgery-1524Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTЭндоваскулярный метод лечения пациентов с дистальными аневризмами мозжечковых артерийEndovascular treatment of patients with distal aneurysms of cerebellar arterieshttps://orcid.org/0000-0002-3904-2393КоломинЕ. Г.KolominE. G.

Егор Геннадьевич Коломин 

197341 Санкт-Петербург, ул. Аккуратова, 2

Egor G. Kolomin 

2 Akkuratova St., St. Petersburg 197341

neurokolomin@yandex.ruhttps://orcid.org/0000-0001-7297-3213ГорощенкоС. А.GoroshchenkoS. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0003-0956-6994БобиновВ. В.BobinovV. V.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0002-3112-6584ПетровА. Е.PetrovA. E.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0002-0974-460XРожченкоЛ. В.RozhchenkoL. V.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

https://orcid.org/0000-0001-5295-4912СамочерныхК. А.SamochernykhK. A.

197341 Санкт-Петербург, ул. Аккуратова, 2

2 Akkuratova St., St. Petersburg 197341

ФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииРоссияV.A. Almazov National Medical Research Center, Ministry of Health of RussiaRussian Federation2024060620242621525Copyright © Коломин Е.Г., Горощенко С.А., Бобинов В.В., Петров А.Е., Рожченко Л.В., Самочерных К.А., 20242024Коломин Е.Г., Горощенко С.А., Бобинов В.В., Петров А.Е., Рожченко Л.В., Самочерных К.А.Kolomin E.G., Goroshchenko S.A., Bobinov V.V., Petrov A.E., Rozhchenko L.V., Samochernykh K.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/1524

Цель исследования – оценить ближайшие и отдаленные ангиографические и клинические результаты внутрисосудистого лечения пациентов с дистальными аневризмами мозжечковых артерий.

Материалы и методы

Материалы и методы. Проанализированы результаты эндоваскулярного лечения 6 пациентов с дистальными аневризмами мозжечковых артерий, оперированных в нейрохирургическом отделении № 3 РНХИ им. проф. А.Л. Поленова в период с 1 января 2017 г. по 31 марта 2023 г.

Результаты

Результаты. Применялись следующие эндоваскулярные методы: окклюзия мешка аневризмы только отделяемыми спиралями (n = 2); окклюзия спиралями со стент‑ассистенцией (n = 3); деконструктивное вмешательство с окклюзией несущей артерии (n = 1). В 1 из 2 случаев окклюзии аневризмы только спиралями выполнена доокклюзия аневризмы со стент‑ассистенцией в связи с возникновением рецидива. Из 6 аневризм радикально выключена из кровотока (класс А) 1 (16,65 %) аневризма, субтотально (класс В) – 4 (66,7 %), частично (класс С) – 1 (16,65 %). Контрольная ангиография в срок не ранее 6 мес продемонстрировала радикальное выключение аневризмы из кровотока (класс А) у 5 (83,3 %) пациентов, субтотально (класс В) – у 1 (16,7 %). Клинический исход был отличным у 5 (83,3 %) пациентов (0 баллов по модифицированной шкале Рэнкина), у 1 пациента после деконструктивной операции отмечалось нарастание неврологической симптоматики с последующим частичным ее регрессом (2 балла по модифицированной шкале Рэнкина). Осложнения во время деконструктивной операции наблюдались у 1 (16,7 %) пациента.

Заключение

Заключение. Деконструктивная хирургия аневризм дистальных отделов мозжечковых артерий может быть сопряжена с высокими рисками послеоперационных ишемических осложнений с развитием стойкого грубого неврологического дефицита. Оперативные вмешательства с сохранением просвета артерии (в том числе реконструктивные операции) должны быть методом выбора при эндоваскулярном лечении дистальных аневризм мозжечковых артерий ввиду минимизации рисков ишемических осложнений и улучшения клинических исходов оперативного лечения.

Aim

Aim. To evaluate short- and long‑term angiographic and clinical outcomes of endovascular treatment of patients with distal aneurysms of cerebellar arteries.

Materials and methods

Materials and methods. The outcomes of endovascular treatment of 6 patients with distal aneurysms of cerebellar arteries who underwent surgery at the Neurosurgical Division No. 3 of the Polenov Russian Research Institute of Neurosurgery between January 1 of 2017 and March 31 of 2023 were analyzed.

Results

Results. The following endovascular methods were used: occlusion of the aneurysm sac using only detachable coils (n = 2); occlusion using stent‑assisted coiling (n = 3); deconstructive intervention with occlusion of the main artery (n = 1).  In 1 of 2 cases of coil‑only aneurysm occlusion, additional stent‑assisted occlusion was performed due to recurrence. Among 6 aneurysms, 1 (16.65 %) aneurysm was radically excluded from the blood flow (class А); 4 (66.7 %) were excluded subtotally (class B); 1 (16.65 %) was excluded partially (class С). Control angiography at least 6 months after showed radical exclusion of the aneurysm from the blood flow (class A) in 5 (83.3 %) patients, subtotal exclusion (class В) in 1 (16.7 %) patient. Clinical outcome was excellent in 5 (83.3 %) patients (0 points per the modified Rankin scale); in 1 patient after deconstructive surgery, augmentation of neurological symptoms with following partial regression was observed (2 points per the modified Rankin scale). Complications during deconstructive surgery were observed in 1 (16.7 %) patient.

Conclusion

Conclusion. Deconstructive surgery of the distal aneurysms of cerebellar arteries can be associated with high risk of postoperative ischemic complications with development of persisting neurological deficit. Surgical interventions with preservation of the artery lumen (including reconstructive surgeries) should be the method of choice in endovascular treatment of distal aneurysms of cerebellar arteries due to minimal risk of ischemic complications and improved clinical outcomes of surgical treatment.

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