References

neurosurgery

Нейрохирургия

Russian journal of neurosurgery

1683-32952587-7569

Издательский дом "МедИНК"

10.63769/1683-3295-2015-0-4-81-98

neurosurgery-225

Research Article

ОБЗОРЫ ЛИТЕРАТУРЫ

LITERATURE REVIEW

Сложные артериальные аневризмы головного мозга. Современная стратегия лечения

Complex cerebral aneurysms. Current treatment strategy

Люнькова

Регина Николаевна

Lyun’Kova

R. N.

regina.lunkova@mail.ru

Крылов

Владимир Викторович

Krylov

V. V.

noemail@neicon.ru

МГМСУRussian FederationМГМСУ; НИИ скорой помощи им. Н.В. СклифосовскогоRussian Federation

2015

05102017

048198

2017

Люнькова Р.Н., Крылов В.В.

Lyun’Kova R.N., Krylov V.V.

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/225

Часть артериальных аневризм (АА) головного мозга (до 19,6%) относят к «сложным аневризмам» из-за ключевых показателей, таких как анатомия АА (широкая шейка, большие размеры, кальцинированные стенки, отхождения ветвей из тела и купола аневризмы, наличие тромбов в просвете аневризмы), труднодоступность АА при микрохирургической окклюзии, тяжесть состояния больного (Hunt & Hess > 3, наличие ангиоспазма на момент лечения). Сложная АА не может быть вылечена одним, каким либо методом, например, с применением только стандартных нейрохирургических доступов при клипировании АА или с использованием только эндоваскулярного лечения. Проведен анализ 87 источников литературы, посвященных данной тематике. Применение эндоваскулярного метода лечения сложных АА сопровождается большим процентом неполной окклюзии (25-62%), реканализации (8-60%) и повторного лечения (5-38%). Использование стандартного нейрохирургического доступа в хирургии сложных АА сопровождается инвалидизацей больного и летальностью. Одной из современных стратегий лечения сложных АА является комбинированное лечение - сочетание эндоваскулярной и микрохирургической окклюзии АА. При проведении микрохирургического выключения сложной АА (клипирование, этапное ремоделирование шейки аневризмы при комбинированном лечении, реваскуляризирующие операции с реконструкцией кровотока) выполняются только базальные доступы, обеспечивающие визуализацию шейки аневризмы и её клипирование.

Some number of cerebral aneurysms (CA) (up to 19,6%) are supposed to be «complex» aneurysms because of such key features as anatomy of CA (wide neck, large or giant size, calcinated walls, arising of arteries from aneurismal dome, thrombosis of aneurysm), difficult accessibility of CA for microsurgical treatment, severity of patient’s state (Hunt & Hess > 3, presence of cerebral angiospasm). Complex CA could not be treated using only one method (routine neurosurgical approaches for CA clipping or endovascular treatment). The analysis of 87 literature resources dedicating to this topic was conducted. The usage of endovascular method alone for complex CA treatment results in high level of incomplete aneurysm occlusion (25-62%), recanalisation (8-60%) and repeated treatment (5-38%). The usage of routine neurosurgical approaches for complex CA clipping is accompanied by patients’ invalidization and lethality. The one of current strategies for complex CA surgery includes combined treatment - the combination of endovascular and microsurgical occlusion of CA. The skull base approaches are used for microsurgical treatment of complex CA (clipping, step-by-step modeling of aneurismal neck during combined treatment, revascularization surgery) providing the satisfactory visibility of aneurismal neck for its clipping.

сложная артериальная аневризмаремоделирование шейки аневризмыбазальный доступкачество окклюзии артериальной аневризмы (шкала Raymond I-III)complex cerebral aneurysmremodeling of aneurismal neckskull base approachRaymond scaleaneurysm occlusion classification

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