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Сложные артериальные аневризмы головного мозга. Современная стратегия лечения

https://doi.org/10.17650/1683-3295-2015-0-4-81-98

Полный текст:

Аннотация

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.

Об авторах

Регина Николаевна Люнькова
МГМСУ
Россия


Владимир Викторович Крылов
МГМСУ; НИИ скорой помощи им. Н.В. Склифосовского
Россия


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Для цитирования:


Люнькова Р.Н., Крылов В.В. Сложные артериальные аневризмы головного мозга. Современная стратегия лечения. Нейрохирургия. 2015;(4):81-98. https://doi.org/10.17650/1683-3295-2015-0-4-81-98

For citation:


Lyun’Kova R.N., Krylov V.V. Complex cerebral aneurysms. Current treatment strategy. Russian journal of neurosurgery. 2015;(4):81-98. (In Russ.) https://doi.org/10.17650/1683-3295-2015-0-4-81-98

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