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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">neurosurgery</journal-id><journal-title-group><journal-title xml:lang="ru">Нейрохирургия</journal-title><trans-title-group xml:lang="en"><trans-title>Russian journal of neurosurgery</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1683-3295</issn><issn pub-type="epub">2587-7569</issn><publisher><publisher-name>Издательский дом "МедИНК"</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.63769/1683-3295-2025-27-2-100-112</article-id><article-id custom-type="elpub" pub-id-type="custom">neurosurgery-1689</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>НАБЛЮДЕНИЕ ИЗ ПРАКТИКИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>FROM PRACTICE</subject></subj-group></article-categories><title-group><article-title>Альтернативное среднепоточное шунтирование сосудов головного мозга с использованием дистальных ветвей наружной сонной артерии у пациентов со сложными аневризмами (клиническое наблюдение и обзор литературы)</article-title><trans-title-group xml:lang="en"><trans-title>Alternative middle-flow extracranial-intracranial cerebral bypass using distal branches  of the external carotid artery in patients with complex cerebral aneurysms  (clinical cases and literature review)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4518-9874</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лукьянчиков</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Lukyanchikov</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p><p>129090 Москва, Большая Сухаревская пл., 3</p><p>117997 Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p><p>3 Bolshaya Sukharevskaya Sq., Moscow 129090</p><p>1 Ostrovityanova St., Moscow 117997</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2864-9675</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шатохин</surname><given-names>Т. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Shatokhin</surname><given-names>T. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p><p>129090 Москва, Большая Сухаревская пл., 3</p><p>117997 Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p><p>3 Bolshaya Sukharevskaya Sq., Moscow 129090</p><p>1 Ostrovityanova St., Moscow 117997</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1473-9901</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Григорьевский</surname><given-names>Е. Д.</given-names></name><name name-style="western" xml:lang="en"><surname>Grigorevskii</surname><given-names>E. D.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p><p>129090 Москва, Большая Сухаревская пл., 3</p></bio><bio xml:lang="en"><p>Evgenii Dmitrievich Grigorevskii</p><p>80 Volokolamskoe Hwy, Moscow 125367</p><p>3 Bolshaya Sukharevskaya Sq., Moscow 129090</p></bio><email xlink:type="simple">grigorevskiyed@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7341-797X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Староверов</surname><given-names>М. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Staroverov</surname><given-names>M. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>117997 Москва, ул. Островитянова, 1</p><p>117513 Москва, ул. Островитянова, 1, стр. 10</p></bio><bio xml:lang="en"><p>1 Ostrovityanova St., Moscow 117997</p><p>Bld. 10, 1 Ostrovityanova St., Moscow 117513</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8975-7875</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шетова</surname><given-names>И. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Shetova</surname><given-names>I. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0009-4955-0234</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кулов</surname><given-names>З. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kulov</surname><given-names>Z. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3956-6362</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Супонева</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Suponeva</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7682-6672</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Максимова</surname><given-names>М. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Maksimova</surname><given-names>M. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8576-9983</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рябинкина</surname><given-names>Ю. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Ryabinkina</surname><given-names>Yu. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2850-3999</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Полищук</surname><given-names>Р. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Polishchuk</surname><given-names>R. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3307-8472</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Головнева</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Golovneva</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p></bio><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7593-2353</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Косолапов</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Kosolapov</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>390039 Рязань, ул. Интернациональная, 3а</p></bio><bio xml:lang="en"><p>3а Internatsionalnaya St., Ryazan 390039</p></bio><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Стариков</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Starikov</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>390039 Рязань, ул. Интернациональная, 3а</p></bio><bio xml:lang="en"><p>3а Internatsionalnaya St., Ryazan 390039</p></bio><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7206-8926</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Крылов</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Krylov</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>125367 Москва, Волоколамское шоссе, 80</p><p>129090 Москва, Большая Сухаревская пл., 3</p><p>117997 Москва, ул. Островитянова, 1</p></bio><bio xml:lang="en"><p>80 Volokolamskoe Hwy, Moscow 125367</p><p>3 Bolshaya Sukharevskaya Sq., Moscow 129090</p><p>1 Ostrovityanova St., Moscow 117997</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Научный центр неврологии»; ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Center of Neurology; N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; The Russian National Research Medical University named after N. I. Pirogov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБНУ «Научный центр неврологии»; ГБУЗ «Научно-исследовательский институт скорой помощи им. Н. В. Склифосовского Департамента здравоохранения г. Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Center of Neurology; N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н. И. Пирогова» Минздрава России; ФГБУ «Федеральный центр мозга и нейротехнологий» Федерального медико-биологического агентства России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>The Russian National Research Medical University named after N. I. Pirogov; Federal Brain and Neurotechnology Center, Federal Medical and Biological Agency of Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-4"><aff xml:lang="ru"><institution>ФГБНУ «Научный центр неврологии»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Center of Neurology</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-5"><aff xml:lang="ru"><institution>ГБУ Рязанской области «Областная клиническая больница»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State budget institution of the Ryazan region Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2025</year></pub-date><pub-date pub-type="epub"><day>18</day><month>08</month><year>2025</year></pub-date><volume>27</volume><issue>2</issue><fpage>100</fpage><lpage>112</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Лукьянчиков В.А., Шатохин Т.А., Григорьевский Е.Д., Староверов М.С., Шетова И.М., Кулов З.А., Супонева Н.А., Максимова М.Ю., Рябинкина Ю.В., Полищук Р.В., Головнева Е.А., Косолапов А.А., Стариков Н.А., Крылов В.В., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Лукьянчиков В.А., Шатохин Т.А., Григорьевский Е.Д., Староверов М.С., Шетова И.М., Кулов З.А., Супонева Н.А., Максимова М.Ю., Рябинкина Ю.В., Полищук Р.В., Головнева Е.А., Косолапов А.А., Стариков Н.А., Крылов В.В.</copyright-holder><copyright-holder xml:lang="en">Lukyanchikov V.A., Shatokhin T.A., Grigorevskii E.D., Staroverov M.S., Shetova I.M., Kulov Z.A., Suponeva N.A., Maksimova M.Y., Ryabinkina Y.V., Polishchuk R.V., Golovneva E.A., Kosolapov A.A., Starikov N.A., Krylov V.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.therjn.com/jour/article/view/1689">https://www.therjn.com/jour/article/view/1689</self-uri><abstract><sec><title>Введение</title><p>Введение. Лечение сложных аневризм головного мозга представляет большие трудности. Имеется большой арсенал внутрисосудистых методик для выключения из кровотока сложных аневризм головного мозга: внутрисосудистая эмболизация микроспиралями, установка потокоперенаправляющих стентов, баллонная ангиопластика и стентирование экстра- и интракраниальных сегментов магистральных артерий головного мозга. При этом микрохирургическое лечение аневризм головного мозга не потеряло своей актуальности и остается наиболее радикальным способом лечения. Однако простое клипирование или реконструкция стенки сложной аневризмы не всегда возможны. В таких случаях применяют треппинг несущей аневризму артерии и реваскуляризацию необходимого бассейна.</p><p>Цель работы – представить клинические наблюдения двух пациентов со сложными интракраниальными аневризмами без возможности эндоваскулярного вмешательства, которым был выполнен треппинг несущей артерии и альтернативное среднепоточное обходное шунтирование; сделать обзор литературы по ключевым аспектам данной темы.</p></sec><sec><title>Клиническое наблюдение</title><p>Клиническое наблюдение. Представлены клинические наблюдения двух пациентов, оперированных по поводу сложных интракраниальных аневризм. У первого выявлена сложная фузиформно-мешотчатая аневризма левой средней мозговой артерии (СМА), с отходящим от фузиформного купола лобным М2-сегментом левой СМА; у второго – гигантская мешотчатая аневризма супраклиноидного сегмента левой внутренней сонной артерии и задняя полная трифуркация слева. Эндоваскулярное вмешательство не представлялось возможным. Выполнен треппинг несущей артерии и наложение среднепоточного обходного шунтирования с использованием дистальных ветвей наружной сонной артерии (НСА). Применялась интраоперационная безрамная нейронавигация.</p></sec><sec><title>Заключение</title><p>Заключение. Использование конечных ветвей НСА (верхнечелюстной артерии и проксимальной части поверхностной височной артерии) расширяет возможности при выполнении реваскуляризирующих вмешательств на головном мозге в тех случаях, когда требуется выполнение низко- или среднепоточного экстра-интракраниального шунтирования. Относительно редкое использование этих артерий в практике и немногочисленные публикации об этих видах шунтирования требуют тщательного отбора пациентов с предоперационной оценкой брахиоцефальных артерий и гемодинамических параметров.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Background</title><p>Background. The treatment of complex cerebral aneurysms is still remained the great challenge for neurosurgeons. There is a large choice of intravascular techniques for excluding the complex cerebral aneurysms from the blood flow: endovascular embolization with microcoils, usage of flow-diverting stents, balloon angioplasty and stenting of extra- and intracranial segments of the main cerebral arteries. At the same time, the microsurgical treatment of cerebral aneurysms has not lost its relevance and remains the most radical method of treatment. However, simple clipping or reconstruction of complex aneurysm wall is not always possible. In such cases, trapping of parent artery and revascularization of the required blood supply territory are used.</p></sec><sec><title>Aim</title><p>Aim. To present the two clinical cases of patients with complex intracranial aneurysms without the possibility of endovascular treatment, who underwent parent artery trapping and alternative middle flow extracranial-intracranial (EC–IC) bypass as well as to conduct the literature review concerning the key aspects of this topic.</p></sec><sec><title>Clinical cases</title><p>Clinical cases. This article presents two patients operated on for complex intracranial aneurysms. The first patient had a complex fusiformsaccular aneurysm of the left middle cerebral artery (MCA) with a frontal M2 segment of the left MCA extending from the fusiform dome; the second patient had a giant saccular aneurysm of the supraclinoid segment of the left internal carotid artery (ICA) and a complete posterior trifurcation on the left. Endovascular treatment was considered as impossible. The trapping of the parent artery and performing of middle-flow EC–IC bypass using the distal branches of the external carotid artery (ECA) were conducted. Intraoperative frameless neuronavigation was used. Conclusion. The use of terminal branches of the ECA (maxillary artery and proximal part of superficial temporal artery) expands the possibilities of cerebral revascularization performing in cases where low- or middle-flow EC–IC bypasses are required. The relatively rare use of these arteries in practice and few publications about these types of bypasses require careful selection of patients with preoperative assessment of the brachiocephalic arteries and hemodynamic parameters.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>сложные аневризмы</kwd><kwd>интракраниальные аневризмы</kwd><kwd>хирургическая реваскуляризация головного мозга</kwd><kwd>экстра- интракраниальное шунтирование</kwd><kwd>наружная сонная артерия</kwd><kwd>безрамная нейронавигация</kwd></kwd-group><kwd-group xml:lang="en"><kwd>complex aneurysms</kwd><kwd>intracranial aneurysms</kwd><kwd>surgical cerebral revascularization</kwd><kwd>extracranial-intracranial bypass</kwd><kwd>external carotid artery</kwd><kwd>frameless neuronavigation</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Mooney M.A., Simon E.D., Brigeman S. et al. 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