Surgery of basilar aneurysms

Despite the progress of endovascular treatment of cerebral aneurysms (CA) (stent-assisted and balloon-assisted aneurysm coiling, usage of flow diverting stents, development of new microcatheters, types of coils and stenting techniques («jailed-catheter technique» and «trans-cell technique» for aneurismal wall reconstruction, «Y-stent&waffle-cone technique» and «X-stent technique» for stenting of bifurcation aneurysms)) and the usage of new technical endovascular development which allows remodeling the blood flow in aneurysm (WEB-device, PED - Pipeline Embolization Device), the outcomes of secure CA occlusion by endovascular methods according to Raymond-Roy scale remain unsatisfactory with the large amount of Raymond II (residual neck) and Raymond III (residual aneurysms) results as well as high aneurysm recanalization rates and repeated operations (CLARITY (2011), ATENA (2009), АНА (2015), ISAT (2009), CARAT (2008), BRAT (2012), BRAT-3 (2014)). Microsurgical treatment of CA provides more radical exclusion of CA from blood flow (Raymond I) comparing with endovascular treatment. However the usage of routine approaches to aneurysms of basilar artery (BA) is limited because of high mortality and disability of patients. Objective: to enlight the modern cranial base approaches for microsurgical treatment of aneurysms of basilar artery. This article presents the most popular skull base approaches to basilar bifurcation as described by their authors. Results. The accurate technique of skull base approach performance, manipulations on skull base in surgically allowed areas and the extension of routine surgically routes with combination of various traction methods of basal brain regions turn the skull base approaches into unreplaceable manipulations.. Conclusion. The described skull base approaches allowed safely and securely eliminating basilar aneurysms from blood flow with good and excellent treatment outcome estimated by Glasgow Outcome Scale and Rankin scale.

артериальная аневризма, базальный доступ, транскавернозный доступ, микрохирургическое клипирование в расширенном хирургическом промежутке, cerebral aneurysm, skull base approach, transcavernous approach, aneurysm clipping under conditions of extended surgical spaces

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