neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2015-0-2-24-33neurosurgery-161Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTИНТРАОПЕРАЦИОННЫЙ АРТЕРИАЛЬНЫЙ ТРОМБОЗ В ХИРУРГИИ БОЛЬШИХ И ГИГАНТСКИХ ЧАСТИЧНО ТРОМБИРОВАННЫХ АНЕВРИЗМ СРЕДНИХ МОЗГОВЫХ АРТЕРИЙThe intraoperative arterial thrombosis in the surgery of partially thrombosed large and giant aneurysms of middle cerebral arteryЭлиаваШалва ШалвовичEliavaSh. Sh.noemail@neicon.ruПилипенкоЮрий ВикторовичPilipenkoYu. V.ypilipenko@nsi.ruШехтманОлег ДмитриевичShekhtmanO. D.noemail@neicon.ruЛукшинВасилий АндреевичLukshinV. A.noemail@neicon.ruКоноваловАнтон НиколаевичKonovalovAn. N.noemail@neicon.ruНИИ нейрохирургии им. акад. Н.Н. БурденкоRussian Federation201505102017022433Copyright © Элиава Ш.Ш., Пилипенко Ю.В., Шехтман О.Д., Лукшин В.А., Коновалов А.Н., 20172017Элиава Ш.Ш., Пилипенко Ю.В., Шехтман О.Д., Лукшин В.А., Коновалов А.Н.Eliava S.S., Pilipenko Y.V., Shekhtman O.D., Lukshin V.A., Konovalov A.N.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/161

Цель работы: Изучить частоту интраоперационного тромбоза артерий (ИТА) при микрохирургическом лечении больших и гигантских частично тромбированных аневризм средней мозговой артерии (СМА) и оценить методы лечения данного осложнения. Материал. В исследуемую группу включены 53 пациента, оперированные по поводу частично тромбированных аневризм СМА в НИИ нейрохирургии им. Н. Н. Бурденко за период с января 2005 г. по сентябрь 2014 г. Пациентов с большими аневризмами (15-25 мм) было 32, с гигантскими (>25 мм) - 21. Функциональный исход пациентов оценивали на основании модифицированной шкалы Ренкина (МШР). Результаты. Клипирование аневризм выполнено у 47 пациентов, треппинг - у 3 и укрепление стенок - у 3. ИТА наблюдался у 10 (18,9%) пациентов. Из 7 пациентов, которым проводили пункционное введение в тромбированную артерию модифицированной рекомбинантной проурокиназы (mr-proUK), без изменений в неврологическом статусе выписаны 5 (71,4%), с умеренным ухудшением (МШР2) - один (14,3%) и с выраженным ухудшением (МШР 4) - один (14,3%). Среди 3 пациентов с ИТА, у которых не применяли пункционное введение mr-proUK, у двух отмечалось выраженное ухудшение (МШР 3 и 4) и у одного - умеренное (МШР2). Заключение. Основной фактор риска тромбоза ветвей СМА - проведение тромбэктомии на фоне временного треппинга. Метод пункции тромбированной ветви СМА и инъекции в ее просвет фибринолитика является одним из возможных путей устранения ИТА с эффективностью 71,4%. При невозможности восстановления кровотока с помощью медикаментозного фибринолиза следует проводить реваскуляризацию дистальных отделов тромбированной артерии.

Objective. To study the frequency of intraoperative arterial thrombosis (IAT) during microsurgical treatment of large and giant partially thrombosed aneurysms of middle cerebral arteries (MCA) and to assess various options to treat this complication. Materials. The consecutive series of 53 patients operated on for partially thrombosed MCA aneurysms in Burdenko Neurosurgical Institute from January 2005 to September 2014 were analyzed. The large aneurysms (15-25 mm) were seen at 32 patients, giant (> 25 mm) aneurysms - at 21 patients. Results. The aneurysm clipping was performed at 47 patients, trapping - at 3, wrapping with surgical gauze - at 3. IAT was diagnosed at 10 (18.9%) patients. The injection of modified human recombinant prourokinase (mr-proUK) in the thrombosed artery was performed at 7 patients, among them 5 (71.4%) patients were discharged without any changes in the neurological status, one (14.3%) patient - with moderate deterioration (MRS 2) and one (14.3%) patient - with severe deterioration (MRS 4). Among patients without injection of mr-proUK (3 persons) two patients suffered from severe (MRS 3 and 4) and one - from moderate deterioration (MRS 2). Conclusion. The main risk factor for thrombosis of MCA branches is thrombectomy under condition of temporary trapping. The injection of fibrinolytic drugs in thrombosed MCA branch is an effective method to treat IAT. The revascularization operation (bypass) should be considered in the case of fibrinolytic agent fails to solve the problem.

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