Complex cerebral aneurysms. Current treatment strategy
https://doi.org/10.17650/1683-3295-2015-0-4-81-98
Abstract
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.
About the Authors
R. N. Lyun’Kova
МГМСУ
Russian Federation
Russian Federation
V. V. Krylov
МГМСУ; НИИ скорой помощи им. Н.В. Склифосовского
Russian Federation
Russian Federation
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For citations:
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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