Surgery for multiple cerebral aneurysms: Literature review and case report
https://doi.org/10.17650/1683-3295-2021-23-4-72-81
Abstract
We report a case of simultaneous microsurgical clipping of 5 cerebral aneurysms in a patient with multiple aneurysms of the anterior brain.
We analyzed the existing treatment approaches to multiple cerebral aneurysms, including endovascular isolation, microsurgical clipping, as well as surgical tactics in case of subarachnoid hemorrhage. We covered the recommendations for screening, surgical risks, and approaches to aneurysm isolation (single-stage and multiple-stage).
Using our own experience (since no strict guidelines are currently available), we concluded that it is important to screen cerebral vessels of all close relatives of patients with multiple and familial cerebral aneurysms.
About the Authors
A. V. Prirodov
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; RUDN University
Russian Federation
Russian Federation
3 Bolshaya Sukharevskaya Sq., Moscow 129090
6 Miklukho-Maklaya St., Moscow 117198
E. Yu. Bakharev
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
Russian Federation
Evgeniy Yuryevich Bakharev
3 Bolshaya Sukharevskaya Sq., Moscow 129090
Z. B. Khadzhiev
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
Russian Federation
3 Bolshaya Sukharevskaya Sq., Moscow 129090
A. A. Grin
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department; A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia
Russian Federation
Russian Federation
3 Bolshaya Sukharevskaya Sq., Moscow 129090
Bld. 1, 20 Delegatskaya St., Moscow 127473
M. V. Sinkin
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
Russian Federation
3 Bolshaya Sukharevskaya Sq., Moscow 129090
I. I. Utkina
N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department
Russian Federation
Russian Federation
3 Bolshaya Sukharevskaya Sq., Moscow 129090
References
1. Хирургия аневризм головного мозга. Под ред. В.В. Крылова. М.: Т.А. Алексеева, 2011. Т. 1. 432 с. [Surgery for cerebral aneurysms. Ed. by V.V. Krylov. Moscow: T.A. Alekseeva, 2011. V. 1. 432 р. (In Russ.)].
2. Крылов В.В., Коновалов А.Н., Дашьян В.Г. и др. Состояние нейрохирургической службы Российской Федерации. Нейрохирургия 2016;3:3–44. [Krylov V.V., Konovalov A.N., Dashyan V.G. et al. Situation with neurosurgical care in the Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2016;3:3–44. (In Russ.)].
3. Крылов В.В., Дашьян В.Г., Шетова И.М. и др. Нейрохирургическая помощь больным с сосудистыми заболеваниями головного мозга в Российской Федерации. Нейрохирургия 2017;4:11–20. [Krylov V.V., Dashyan V.G., Shetova I.M. et al. Neurosurgical care for patients with cerebrovascular pathology in Russian Federation. Neyrokhirurgiya = Russian Journal of Neurosurgery 2017;4:11–20. (In Russ.)].
4. Inagawa T. Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir (Wien) 2009;151(12):1623–30. DOI: 10.1007/s00701-009-0479-y.
5. Navalitloha Y., Taechoran C., O’Chareon S. Multiple intracranial aneurysms: incidence and management outcome in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2000;83(12):1442–6.
6. Rinne J., Hernesniemi J., Puranen M., Saari T. Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 1994;35(5):803–8. DOI: 10.1227/00006123-199411000-00001.
7. Rinne J., Hernesniemi J., Niskanen M., Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery 1995;36(1):31–8. DOI: 10.1227/00006123-199501000-00003.
8. Лепшоков М.Х., Ткачёв В.В., Усачёв А.А. и др. Хирургическое лечение множественных аневризм супрасубтенториальной локализации. Кубанский научный медицинский вестник 2013;7(142):19–22. [Lepshokov M.K., Tkachev V.V., Usachev A.A. et al. Surgical treatment of multiple aneurysms suprasubtentorial localization. Kubanskii nauchnyi meditsinskii vestnik = Kuban Scientific Medical Bulletin 2013;7(142):19–22. (In Russ.)].
9. Крылов В.В., Элиава Ш.Ш., Яковлев С.Б. и др. Клинические рекомендации по лечению неразорвавшихся бессимптомных аневризм головного мозга. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко 2016;5: 124–135. [Krylov V.V., Eliava Sh.Sh., Yakovlev S.B. et al. Clinical guidelines for treatment of unruptured asymptomatic brain aneurysms. Zhurnal “Voprosy neyrokhirurgii” im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2016;5:124–135. (In Russ.)].
10. Greenberg M.S. Handbook of Neurosurgery. 8th edition. New York: Thieme, 2016. 1650 p.
11. Лебедева Е.Р., Сакович В.П., Колотвинов В.С., Медведева С.Ю. Системная дисплазия соединительной ткани как фактор риска развития интракраниальных аневризм. Уральский медицинский журнал 2012;5(97):13–24. [Lebedeva E.R., Sakovich V.P., Kolotvinov V.S., Medvedeva S.Yu. Systemic connective tissue dysplasia as a risk factor for the development of intracranial aneurysms. Uralskiy meditsinskiy zhurnal = Ural Medical Journal 2012;5(97):13–24. (In Russ.)].
12. Juvela S. Prevalence of and risk factors for intracranial aneurysms. Lancet Neurol 2011;10(7):595–7. DOI: 10.1016/s1474-4422(11)70125-9.
13. Pepin M., Schwarze U., Superti-Furga A., Byers P.H. Clinical and genetic features of Ehlers–Danlos syndrome type IV, the vascular type. N Engl J Med 2000;342(10):673–680. DOI: 10.1056/nejm200003093421001.
14. Schievink W.I. Genetics of intracranial aneurysms. Neurosurgery 1997;40(4): 651–2; discussion 662–3. DOI: 10.1097/00006123-199704000-00001.
15. Perrone R.D., Malek A.M., Watnick T. Vascular complications in autosomal dominant polycystic kidney disease. Nat Rev Nephrol 2015;11(10):589–98. DOI: 10.1038/nrneph.2015.128.
16. Lather H.D., Gornik H.L., Olin J.W. et al. Prevalence of intracranial aneurysm in women with fibromuscular dysplasia: a report from the US registry for fibromuscular dysplasia. JAMA Neurol 2017;74(9):1081–7. DOI: 10.1001/jamaneurol.2017.1333.
17. Kim S.T., Cloft H., Flemming K.D. et al. Increased prevalence of cerebrovascular disease in hospitalized patients with Ehlers–Danlos syndrome. J Stroke Cerebrovasc Dis 2017;26(8):1678–82. DOI 10.1016/j.jstrokecerebrovasd is.2017.03.025.
18. Kim S.T., Cloft H., Flemming K.D. et al. Increased prevalence of сerebrovascular disease in hospitalized patients with Marfan syndrome. J Stroke Cerebrovasc Dis 2018;27(2):296–300. DOI: 10.1016/j.jstrokecerebrovasd is.2017.08.036.
19. Alg V.S., Sofat R., Houlden H., Werring D.J. Genetic risk factors for intracranial aneurysms: a meta-analysis in more than 116,000 individuals. Neurology 2013;80(23):2154–65. DOI: 10.1212/WNL.0b013e318295d751.
20. Onda H., Kasuya H., Yoneyama T. et al. Genomewide-linkage and haplotypeassociation studies map intracranial aneurysm to chromosome 7q11. Am J Hum Genet 2001;69(4):804–19. DOI: 10.1086/323614.
21. Vlak M.H., Algra A., Brandenburg R., Rinkel G.J.E. Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: A systematic review and metaanalysis. Lancet Neurol 2011;10(7): 626–36. DOI: 10.1016/S1474-4422(11)70109-0.
22. Ronkainen A., Hernesniemi J., Puranen M. et al. Familial intracranial aneurysms. Lancet 1997;349(9049):380–4. DOI: 10.1016/S0140-6736(97)80009-8.
23. Czepko R., Rybak M., Potoczny P. et al. Surgical strategy and outcome in multiple cerebral aneurysms. Przegl Lek 2004;61(5):477–81. (In Pol.).
24. Foroud Т., Sauerbeck L., Brown R. et al. Genome screen to detect linkage to intracranial aneurysm susceptibility genes: The Familial Intracranial Aneurysm (FIA) study. Stroke 2008;39(5):1434–40. DOI: 10.1161/STROKEAHA.107.502930.
25. Lai Н.P., Cheng К.М., Yu S.С.H. et al. Size, location, and multiplicity of ruptured intracranial aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage. Hong Kong Med J 2009;15(4):262–6.
26. Vega-Basulto S.D., Silva-Adan S., Peñones-Montero R. Surgical treatment of múltiple intracraneal aneurysms. Neurocirugia (Astur) 2003;14(5):385–91. DOI: 10.1016/s1130-1473(03)70517-x. (In Span.).
27. Bor A.S.E., Rinkel G.J.E., Adami J. et al. Risk of subarachnoid haemorrhage according to number of affected relatives: a population based case-control study. Brain 2008;131(Pt 10):2662–5. DOI: 10.1093/brain/awn187.
28. Greving J.P., Wermer M.J.N., Brown R.O. Jr. et al. Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol 2014;13(1):59–66. DOI: 10.1016/S1474-4422(13)70263-1.
29. UCAS Japan Investigators; Morita A., Kirino T., Hashi K. et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 2012;366(26):2474–82. DOI: 10.1056/NEJMoa1113260.
30. Wiebers D.O., Whisnant J.P., Huston J. 3rd et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362(9378):103–10. DOI: 10.1016/s0140-6736(03)13860-3.
31. Ahmetspahić A., Burazerović E., Omerhodžić I. et al. Current management of mirror distal anterior cerebral artery aneurysms in association with multiple aneurysms: Case report with literature review. World Neurosurgery 2019;130:324– 34. DOI: 10.1016/j.wneu.2019.07.084.
32. Mizoi K., Suzuki J., Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien) 1989;96(1–2):8–14. DOI: 10.1007/BF01403489.
33. Tejus M.N., Singh D., Jagetia A. et al. Endovascular nuances in management of multiple intracranial aneurysms. Neurol India 2019;67(4):1062–5. DOI: 10.4103/0028-3886.266249.
34. Хирургия сложных аневризм головного мозга. Под ред. В.В. Крылова. М.: АБВ-Пресс, 2019. 308 с. [Surgery for complicated cerebral aneurysms. Ed. by V.V. Krylov. Moscow: АBV-press, 2019. 308 p. (In Russ.)].
35. Ландик С.А., Свистов Д.В., Кандыба Д.В., Савелло А.В. Сравнительный анализ исходов микрохирургического и внутрисосудистого лечения аневризм головного мозга. Нейрохирургия 2009;1:16–23. [Landik S.A., Svistov D.V., Kandyba D.V., Savello A.V. The comparative analysis of surgical outcomes after microsurgical and endovascular treatment of cerebral aneurysms. Neyrokhirurgiya = Russian Journal of Neurosurgery 2009;1:16–23. (In Russ.)].
36. Henkes H., Fischer S., Weber W. et al. Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 2004;54(2):268–80. DOI: 10.1227/01.neu.0000103221.16671.f0.
37. Medical Advisory Secretariat. Coil embolization for intracranial aneurysms: an evidence-based analysis. Ont Health Technol Assess Ser 2006;6(1):1–114.
38. Wang H.-Y., Song J., Gao F. et al. Outcomes of microsurgical clipping vs coil embolization for ruptured aneurysmal subarachnoid hemorrhage: A multicenter real-world analysis of 583 patients in China. Medicine (Baltimore) 2019;98(33):е16821. DOI: 10.1097/MD.0000000000016821.
39. Spetzler R.F., McDougall C.G., Zabramski J.M. et al. Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurgery 2019;132(3):771–6. DOI: 10.3171/2018.8.JNS181846.
40. Сенько И.В., Климов А.Б., Дашьян В.Г., Винокуров А.Г. Открытое хирургическое лечение больных после осложнений эндоваскулярной эмболизации аневризм головного мозга. Нейрохирургия 2012;3:64–9. [Senko I.V., Klimov A.B., Dashyan V.G., Vinokurov A.G. Open surgery for complications after endovascular embolization of cerebral aneurysms. Neyrokhirurgiya = Russian Journal of Neurosurgery 2012;3:64–9. (In Russ.)].
41. Raper D.M.S., Rutledge С., Winkler E.A., Abla A.A. Definitive treatment with microsurgical clipping after recurrence and rerupture of coiled anterior cerebral artery aneurysms. Oper Neurosurgery (Hagerstown) 2020;19(4):393–402. DOI: 10.1093/ons/opaa103.
42. Spetzler R.F., Zabramski J.M., McDougall C.G. et al. Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurgery 2018;128(1):120–5. DOI: 10.3171/2016.9.JNS161301.
43. Andrade-Barazarte H., Kivelev J., Goehre F. et al. Contralateral approach to bilateral middle cerebral artery aneurysms: Comparative study, angiographic analysis, and surgical results. Neurosurgery 2015;77(6):916–26; discussion 926. DOI: 10.1227/NEU.0000000000000930.
44. Clatterbuck R.E., Tamargo R.J. Contralateral approaches to multiple cerebral aneurysms. Neurosurgery 2005;57(l Suppl):160–3; discussion 160–3. DOI: 10.1227/01.neu.0000163601. 37465.6e.
45. Czirjak S., Nyary I., Futo J., Szeifert G.T. Bilateral supraorbital keyhole approach for multiple aneurysms via superciliary skin incisions. Surg Neurol 2002;57(5):314–23. DOI: 10.1016/s0090-3019(02)00698-5.
46. de Oliveira E., Tedeschi H., Siqueira M.G. et al. Anatomical and technical aspects of the contralateral approach for multiple aneurysms. Acta Neurochir (Wien) 1996;138(1):1–11; discussion 11. DOI: 10.1007/BF01411716.
47. Pereira R.S.S., Casulari L.A. Surgical treatment of bilateral multiple intracranial aneurysms. Review of a personal experience in 69 cases. J Neurosurgery Sci 2006;50(l):1–8.
48. Крылов В.В., Ткачев В.В., Добровольский Г.Ф. Контралатеральная хирургия аневризм головного мозга. М.: Mедицина, 2002. 192 c. [Krylov V.V., Tkachev V.V., Dobrovolskiy G.F. Contralateral brain aneurysm surgery. Moscow: Medicine, 2002. 192 p. (In Russ.)].
49. Andrade-Barazarte H., Kivelev J., Goehre F. et al. Contralateral approach to internal carotid artery ophthalmic segment aneurysms: Angiographic analysis and surgical results for 30 patients. Neurosurgery 2015;77(1):104–12. DOI: 10.1227/NEU.0000000000000742.
50. Nussbaum E.S., Kallmes K.M. Contralateral approach for the treatment of a distal supraclinoid aneurysm: A technical case report. Br J Neurosurgery 2019;31:1–4. DOI: 10.1080/02688697.2019.1648754.
51. Fries G., Perneczky A., van Lindert E., Bahadori-Mortasawi F. Contralateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysms. Neurosurgery 1997;41(2):333–42; discussion 342–3. DOI: 10.1097/00006123-199708000-00001.
52. Ulrich P., Perneczky A., Muacevic A. Surgical strategy in cases of multiple aneurysms. Zentralbl Neurochir 1997;58(4):163–70. (In Germ.).
53. Acik V., Cavus G., Bilgin E. et al. Surgical treatment of mirror middle cerebral artery aneurysms: bilateral and unilateral approach. World Neurosurgery 2017;108:774–82. DOI: 10.1016/j.wneu.2017.09.078.
54. Niknejad H.R., Stockx L., Wuyts J. Minimally invasive aneurysm clipping: The extent of the supraorbital approach. World Neurosurgery 2019;127:e1132–6. DOI: 10.1016/j.wneu.2019.04.068.
55. Rathore L., Yamada Y., Kawase T. et al. The keyhole approach in anterior circulation aneurysm – Current indication and limitation with review of literature. Asian J Neurosurgery 2020;15(2):278–84. DOI: 10.4103/ajns.AJNS_25_19.
56. Tang C., Sun J., Xue H. et al. Supraorbital keyhole approach for anterior circulation aneurysms. Turk Neurosurgery 2013;23(4):434–8. DOI: 10.5137/1019-5149.JTN.6160-12.1.
57. Kozyrev D.A., Jahromi B.R., Thiarawat P. et al. Three distal anterior cerebral artery aneurysms in the same branch associated with five additional intracranial aneurysms. Sur Neurol Int 2017;8:62. DOI: 10.4103/sni.sni_394_16.
58. Казанцев А.Н., Миронов А.В., Тарасов Р.С. и др. Случай открытого хирургического лечения множественных аневризм интракраниальных артерий головного мозга. Фундаментальная и клиническая медицина 2017;2(2):100–6. DOI: 10.23946/2500-0764-2017-2-2-100-106. [Kazantsev A.N., Mironov A.V., Tarasov R.S. et al. Оpen surgery for treating multiple aneurysms of intracranial cerebral arteries. Fundamental and Clinical Medicine 2017;2(2):100–6. DOI: 10.23946/2500-0764-2017-2-2-100-106. (In Russ.)].
59. Xu K., Hou K., Xu B. et al. Single-stage clipping of seven intracranial aneurysms in the anterior circulation via unilateral pterional approach: A case report and literature review. J Neurol Surg A Cent Eur Neurosurgery 2020;81(3):271–8. DOI: 10.1055/s-0039-1698381.
60. Белоусова О.Б. Обоснование дифференцированной тактики ведения больных с артериальными аневризмами в острой стадии кровоизлияния с учетом ближайших и отдаленных результатов хирургического лечения. Доступно по: https://viewer.rusneb.ru/ru/rsl01003466325?page=1&rotate=0&theme=white. [Belousova O.B. Rationale for a tailored management strategy in patients with arterial aneurysms in the acute stage of hemorrhage with due consideration for short-term and longterm surgical outcomes. Available at: https://viewer.rusneb.ru/ru/rsl01003466325?page=1&rotate=0&theme=white. (In Russ.)].
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For citations:
Prirodov A.V., Bakharev E.Yu., Khadzhiev Z.B., Grin A.A., Sinkin M.V., Utkina I.I. Surgery for multiple cerebral aneurysms: Literature review and case report. Russian journal of neurosurgery. 2021;23(4):72-81. (In Russ.) https://doi.org/10.17650/1683-3295-2021-23-4-72-81
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