neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.24412/2587-7569-2025-1-75-83neurosurgery-1649Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEСлучай рецидивной аневризмы средней мозговой артерии после реконструктивного клипирования (клиническое наблюдение и обзор литературы)The case of recurrent aneurysm of the middle cerebral artery after reconstructive clipping (clinical case and literature review)https://orcid.org/0000-0002-4831-1874ЛитвиненкоД. В.LitvinenkoD. V.

Литвиненко Дмитрий Викторович.

350086 Краснодар, ул. 1 Мая, 167

Dmitry V. Litvinenko.

167 1 Maya St., Krasnodar 350086

dlmalit73@gmail.comhttps://orcid.org/0009-0009-4355-6301ГерасютаА. Е.GerasyutaA. E.

350086 Краснодар, ул. 1 Мая, 167

167 1 Maya St., Krasnodar 350086

https://orcid.org/0000-0002-6845-5613ЗябловаЕ. И.ZyablovaE. I.

350086 Краснодар, ул. 1 Мая, 167; 350063 Краснодар, ул. М. Седина, 4

167 1 Maya St., Krasnodar 350086; 4 M. Sedina St., Krasnodar 350063

https://orcid.org/0000-0002-5600-329XТкачевВ. В.TkachevV. V.

350086 Краснодар, ул. 1 Мая, 167; 350063 Краснодар, ул. М. Седина, 4

167 1 Maya St., Krasnodar 350086; 4 M. Sedina St., Krasnodar 350063

https://orcid.org/0000-0001-9401-4099ПорхановВ. А.PorkhanovV. A.

350086 Краснодар, ул. 1 Мая, 167; 350063 Краснодар, ул. М. Седина, 4

167 1 Maya St., Krasnodar 350086; 4 M. Sedina St., Krasnodar 350063

ГБУЗ «Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского» Минздрава Краснодарского краяРоссияResearch Institute – Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky, Ministry of Health of Krasnodar RegionRussian FederationГБУЗ «Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского» Минздрава Краснодарского края; ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РоссииРоссияResearch Institute – Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky, Ministry of Health of Krasnodar Region; Kuban State Medical University, Ministry of Health of RussiaRussian Federation2025190420252717583Copyright © Литвиненко Д.В., Герасюта А.Е., Зяблова Е.И., Ткачев В.В., Порханов В.А., 20252025Литвиненко Д.В., Герасюта А.Е., Зяблова Е.И., Ткачев В.В., Порханов В.А.Litvinenko D.V., Gerasyuta A.E., Zyablova E.I., Tkachev V.V., Porkhanov V.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/1649

Благодаря совершенствованию методов неинвазивной лучевой диагностики, их широкой доступности для населения развитых стран стал неоспоримым тот факт, что возможно рецидивирующее течение аневризматической болезни головного мозга даже в случаях радикального оперативного лечения.

Основными причинами прогрессирования аневризматической болезни принято считать увеличение в размерах остаточных аневризм, рецидивирование и формирование аневризм de novo.

В статье описан случай успешного лечения пациентки 43 лет с рецидивной аневризмой развилки средней мозговой артерии, рассмотрены вопросы диспансерного наблюдения за пациентами с церебральными аневризмами и хирургическая тактика при прогрессирующем течении аневризматической болезни, которая до настоящего времени остается предметом научных дискуссий.

Пациентка поступила в тяжелом состоянии с разорвавшейся аневризмой средней мозговой артерии. Выполнено реконструктивное клипирование с использованием 5 клипсов. При контрольной ангиографии обнаружен рецидив в пришеечной части небольших размеров. Через 5 лет сохранения стабильной ангиографической картины выявлено увеличение пришеечной части аневризмы. Выполнено повторное оперативное лечение – клипирование рецидивной аневризмы средней мозговой артерии. По данным контрольной церебральной ангиографии аневризма не контрастируется.

Современная концепция лечения аневризматической болезни головного мозга предполагает максимально радикальное выключение разорвавшейся аневризмы и всех клинически значимых интактных аневризм. Хирургическая тактика при прогрессирующем течении аневризматической болезни остается спорной, носит субъективный характер, учитывает клинический тип течения заболевания, метод выключения аневризм и опыт хирурга. Повторные оперативные вмешательства показаны при прогрессировании аневризматической болезни, сопровождающейся кровоизлиянием, во всех случаях «истинного рецидивирования», выявления аневризм de novo.

Оптимальным методом выключения рецидивных и псевдорецидивных аневризм является внутрисосудистая эмболизация аневризмы микроспиралями, в том числе с использованием ассистирующих технологий или потокотклоняющих устройств. Открытые операции следует рассматривать лишь как альтернативный метод лечения в связи с высоким риском интраоперационных осложнений во время выделения и клипирования аневризм, ранее подвергавшихся оперативному лечению. Отсутствие четких данных о сроках рецидива и роста имеющихся аневризм требует разработки модальности и периодичности контрольных постоперационных ангиографических обследований.

The improvement of methods of noninvasive radiation diagnostics, their wide accessibility to the population of developed countries, has made it indisputable that a recurrent course of aneurysmal brain disease is possible, even in cases of radical surgical treatment. The main causes of the progression of aneurysmal disease are considered to be an increase in the size of residual aneurysms, recurrence and formation of de novo aneurysms.

The article describes the case of successful treatment of a 43-year-old female patient with a recurrent aneurysm of the fork of the middle cerebral artery. The issues of dispensary observation of patients with cerebral aneurysms and surgical tactics in cases of progressive course of aneurysmal disease, which remains the subject of scientific discussions to date, are discussed.

Female patient with a ruptured aneurysm of the middle cerebral artery was admitted in serious condition. Reconstructive clipping was performed using 5 clips. Control angiography revealed a recurrence in the cervical part of a small size. After 5 years of stable angiographic picture, an increase in the cervical part was revealed. Repeated surgical treatment was performed – clipping of a recurrent middle cerebral artery aneurysm. In control cerebral angiography, the aneurysm is not contrasted.

The modern concept of treatment of aneurysmal brain disease involves the most radical shutdown of a ruptured aneurysm and all clinically significant intact aneurysms. Surgical tactics in the progressive course of aneurysmal disease remains controversial, is subjective, takes into account the clinical type of the disease, the method of turning off aneurysms and the surgeon’s experience.

Repeated surgical interventions are indicated with the progression of aneurysmal disease accompanied by hemorrhage, in all cases of “true recurrence”, detection of de novo aneurysms.

The optimal method for disabling recurrent and pseudorecidive aneurysms is intravascular embolization of the aneurysm with microspirals, including using assistive technologies or flow-bending devices. Open surgeries should be considered only as an alternative treatment method, due to the high risk of intraoperative complications during the isolation and clipping of aneurysms previously undergoing surgical treatment. The lack of clear data on the timing of recurrence and growth of existing aneurysms requires the development of modality and frequency of control postoperative angiographic examinations.

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