The surgical treatment of multiple bilateral aneurysms of internal carotid artery

Introduction. The patients suffered from multiple aneurysms with at least one of large or giant size put together 19,6% among all patients admitted into Scientific Research Institute of Neurosurgery n.a. N.N. Burdenko requiring accurate preoperative estimation and individual treatment strategy. Material and methods. We conducted the analysis of treatment outcomes at 22 patients with multiple bilateral aneurysms of internal carotid artery (ICA), one of which had large or giant size/ All these patients underwent step-by-step or combined surgical treatment. The total amount of aneurysms located on various ICA segments was 61. The average patients’ age was 45,6±5,9 years old, men : women - 6 : 16. The mass effect of aneurysm was seen at 7 patients, 15 patients suffered from subarachnoid hemorrhage (among them 4 were operated on in acute period of hemorrhage). Results. The radicality of surgical treatment of intracranial ICA aneurysms was 89,1% (46 aneurysms). The single-step treatment was performed at 8 patients, two-step - at 12 patients, 3- and 4-step surgery - one and one clinical case. The good functional outcomes (GOS = 4 - 5) after step-by-step surgical treatment were achieved at 15 (68,2%) patients at discharge and at 14 (87,5%) patients with known follow-up. This article demonstrates the current possibilities of microsurgical and endovascular methods using clinical cases as well as discusses the treatment outcomes and choice of treatment strategy. Conclusion. The combination of microsurgical and endovascular treatment methods allows achieving favorable treatment outcomes at patients with multiple ICA aneurysms. The choice of treatment strategy should be based on clinical condition of patient as well as on anatomical features of aneurysms and treatment opportunities of certain hospital.

аневризмы головного мозга, хирургическое лечение аневризм, гигантские аневризмы, комбинированное лечение аневризм, cerebral aneurysms, surgical treatment of aneurysms, giant aneurysms, combined treatment of aneurysms

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