neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2016-0-4-78-84neurosurgery-377Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEДИАГНОСТИКА И ТАКТИКА ЛЕЧЕНИЯ ИНТРАКРАНИАЛЬНЫХ АНЕВРИЗМ У ПАЦИЕНТОВ С АУТОСОМНО-ДОМИНАНТНЫМ ПОЛИКИСТОЗОМ ПОЧЕКDiagnostics and treatment strategy in patients with intracranial aneurysms suffered from autosomal dominant polycistosis kidney diseaseКолотвиновВладимир СергеевичKolotvinovV. S.kolotvinov@gkb40.ur.ruМарченкоОльга ВикторовнаMarchenkoO. V.noemail@neicon.ruРудникЕвгений НиколаевичRudnikE. N.noemail@neicon.ruНазаровАндрей ВладимировичNazarovA. V.noemail@neicon.ruШамовАлександр ЮрьевичShamovA. Yu.noemail@neicon.ruСтраховАндрей АлександровичStrakhovA. A.noemail@neicon.ruПолтавецАлександра ВладимировнаPoltavetsA. V.noemail@neicon.ruМАУ «Городская клиническая больница №40»Russian Federation201624112017047884Copyright © Колотвинов В.С., Марченко О.В., Рудник Е.Н., Назаров А.В., Шамов А.Ю., Страхов А.А., Полтавец А.В., 20172017Колотвинов В.С., Марченко О.В., Рудник Е.Н., Назаров А.В., Шамов А.Ю., Страхов А.А., Полтавец А.В.Kolotvinov V.S., Marchenko O.V., Rudnik E.N., Nazarov A.V., Shamov A.Y., Strakhov A.A., Poltavets A.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/377

Аутосомно-доминантный поликистоз почек (АДПП) - тяжелое наследственное заболевание, которое часто сопровождается формированием интракраниальных аневризм (ИА). Цель: определение частоты встречаемости аневризм у пациентов с АДПП, разработка алгоритма лечения подобных пациентов. Материалы и методы: проводится проспективное исследование, направленное на выявление аневризм у пациентов с АДПП с помощью методик нейровизуализации. В исследование включены пациенты, госпитализированные в клинику в остром периоде субарахноидального кровоизлияния (САК) с АДПП. Выбор метода лечения основывался на оценке анатомических особенностей аневризмы и несущих артерий. Результаты. В клинике обследовано 47 пациентов с АДПП, аневризмы верифицированы у 14. САК в анамнезе было у 7 пациентов, из них в остром периоде в клинику госпитализировано 3. Всего оперировано 9 человек. Заключение. Пациентам с АДПП, особенно при наличии семейного анамнеза по САК, показано проведение КТ/МР-ангиографии с целью выявления ИА на догеморрагическом этапе с последующим хирургическим лечением. В интраоперационный мониторинг больных с ХПН наряду с обязательным стандартным обеспечением следует включать методики контроля волемического статуса с непрерывной регистрацией ЦВД и использования PiCCO технологии. Предпочтительным является проведение операции в многопрофильных стационарах, где есть возможность проведения заместительной почечной терапии. Хирургическое лечение пациентов с ИА и АДПП не ведет к увеличению показателей летальности и плохих функциональных исходов.

The autosomal dominant polycistosis kidney disease (ADPK) is the severe hereditary disorder, which often combined with the formation of intracranial aneurysms (IA). Objective: to estimate the aneurysms frequency among the patients suffered from ADPK as well as the treatment strategy development for such patients. Material and methods: the prospective trial for revealing of IA among patients with ADPK using various neurovisualization methods is conducted. All patients with acute subarachnoid hemorrhage (SAH) suffered from ADPK who was admitted to our hospital were included in this study. The selection of treatment method was based on the evaluation of anatomical parameters of aneurysm and parent arteries. Results. We examined 47 patients with ADPK, IAs were revealed among 14 of them, 9 patients were operated on, among them 7 had history of SAH and 3 persons were operated on in acute period of SAH. Conclusion. The screening CT or MR-angiography is obligatory for patients with ADPK especially in the case of family history concerning SAH for revealing unruptured IAs for their future surgical treatment. The intraoperative monitoring in patient with chronic renal failure has to include the control of volemic status with uninterrupted registration of central venous pressure and usage of PiCCO method. It is preferred to conduct the surgical treatment of such patients under condition of multi-field hospital where the possibility for substitutive renal therapy is existed. The surgical treatment of patients suffered from IAs combined with ADPK does not lead to increase of lethality and bad treatment outcomes.

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