Objective — to determinate clinical and anatomical options of influence of strategy and tactics of microsurgical treatment cerebral arterial aneurysms (AA) to increase the effectiveness of clipping surgery. Materials and methods. A retrospective analysis of the results of a comprehensive clinical and instrumental examination of 437 adult patients who were operated by clipping cerebral AA, which were on screening and treatment in the department of «Institute of Neurosurgery named after acad. A.P. Romodanov NAMS of Ukraine» in the period from 2009 to 2018 (results of treat of AA distal part anterior cerebral artery (ACA) were analyzed for the period from 1998 to 2015). Men were 235 (53.8 %), women — 202 (46.2 %). In all age groups men dominated. All patients performed a comprehensive clinical and instrumental study in accordance with the supplement to the Order of the Ministry of Health of Ukraine No. 317 dated 13.06.2008. The code for ICD-10: І60.1. Survey results for unification were evaluated according to international scales and classifications. Results. Often, AA was affected by the complex anterior communicating artery (145 (33.2 %)), bifurcation of the M1–M2-segment of the middle cerebral artery (112 (25.6 %)), C5–C6-segments of the internal carotid artery (98 (22.4%)), A2–A5-segments of ACA (79 (18.1 %)). AA of the basilar bifurcation were only 3 (0.7 %) cases. Clinically, cerebral AA was found after ruptured in 382 (87.6 %). Most of AAs were «berry»-type of shape — 364 (83.3 %). Complex AA was detected in 73 (16.7 %) patients. Extended basal craniotomy was used in 46 (10.5 %) cases, pterional craniotomy — in 323 (73.9 %), and other accesses — in 68 (15.6 %). The technique of simple clinging of aneurysms was used in 273 (57.4 %) cases, multiple clipping with clip reconstruction — in 148 (39.0 %), other methods — in 16 (3.6 %). Temporary clip proximally before final dissection was performed in 319 (73.0 %) patients, «pilot» clipping — 76 (17.4%), without proximal control — 42 (9.6 %). Conclusions. When choosing the appropriate strategy and tactics of the microsurgical devascularization of cerebral AA should take into account clinical manifestations and features of the course of the disease. The choice of the optimal microsurgical corridor and AA clinging technique depends on the anatomic-topographic and hemodynamic parameters of AA and the affected arterial segment cerebral artery.

Мета роботи-оптимізувати хірургічний етап лікування менінгіом та артеріальних аневризм (АА) навколоселярної ділянки (НСД) за результатами аналізу індивідуальних топографо-анатомічних особливостей.

Objective ‒ to evaluate the influence of age, gender and localization on the clinical manifestation of cerebral bifurcational-hemodynamic arterial aneurysms (AA).Materials and methods. The retrospective study is based on the results of a comprehensive examination and surgical treatment of 547 (100 %) patients with bifurcational-hemodynamic cerebral AA in the Department of neurosurgical pathology of head and neck vessels of Romodanov Neurosurgery Institute during the period from 2011 till 2019. Recruiting of the patient to the clinical groups was done during the period between 2011‒2016 with their follow-up examination until 2019. It were enrolled 268 ((49.0 ± 4.2) %) men and 279 ((51.0 ± 4.2) %) women with bifurcational-hemodynamic aneurysms. The age of the patients was 18‒84 years (mean age ‒ 49,0±12,2 year).Results. Clinical manifestation of the cerebral bifurcational-hemodynamic AA was more often seen in patients during working age (16‒60 years) — 430 ((78.5 ± 3.4) %) patients, more often in men (p˂0.05). The peak frequency of clinical manifestation of AA ‒ 34.2 % (187 patients) was seen in the age interval 51‒60 years (the male/female ratio ‒ 51.3 % (96) and 48.7 % (91)). In patients with AA, a significant predominance of women was observed in age group older 61 years (χ2 = 21.68, p <0.001, φ = 0.20). There was no statistically significant relationship between the frequency of clinical manifestation of AA and the patient’s age. However, there is a statistically significant relationship between gender and age in some locations. The percentage of patients with AA complex of the anterior cerebral-anterior communicating artery among women is 62.5 ± 15.0 (25/40, after 60 years it’s in 1.7 times higher than among men 37.5 ± 15.0 (15/40). While before the age of 61, there is a 1.6-fold increase in men, 61.3 ± 7.5 (100/163). For the internal carotid artery segments, the percentage of patients who underwent AA among women is 81.6 ± 12.0 (31/38), after 60 years it is in 4.4 times higher than among men 18.4 ± 12.0 (7/38). For the middle cerebral artery, the percentage among women is 73.1 ± 17.4% (19/26), after 60 years it is in 2.7 times higher than in men 6.4 ± 17.7% (7/26). Until the age of 61, the gender difference in the internal carotid artery and the middle cerebral artery segments does not reach a statistically significant level (p> 0.05). At other localizations, gender-age dependence was not observed. Multiple cerebral aneurysmal lesions were associated with clinical manifestation at the age of 41‒50 years in males with 3 AA.Conclusions. A statistically significant influence of age, gender and the presence of multiple cerebral AA on the clinical manifestation of the disease was revealed. Localization of AA did not affect the timing of the clinical manifestation.

Отделение нейрохирургической патологии сосудов головы и шеи, Институт нейрохирургии им. акад.

Objective ‒ to analyze the effectiveness of intraoperative contact Doppler, repositioning the clip on the aneurysm and pilot clipping of the cervical aneurysm as the main methods of prevention of inadequate clipping of the cervical aneurysm in patients with intraoperative rupture of aneurysms. Materials and methods. Due to the use of intraoperative contact ultrasound Doppler control it was possible to avoid inadequate clipping of cerebral aneurysms in 16 cases, of which in 12 (75.00 %) cases ‒ incomplete clipping of cerebral aneurysms, in 3 (18.75 %) cases ‒ compression of the aneurysm’s artery-carrier, in 1 (6.25 %) case ‒ slipping of the clip with cerebral aneurysm. Perioperative examination of patients, in addition to intraoperative contact ultrasound Doppler control of radical clipping cerebral aneurysms, included clinical and neurological examination, computed tomography of the brain, cerebral angiography, ultrasound duplex scanning of the main vessels of the head and neck. In the analysis of observations of inadequate clipping of cerebral aneurysms (according to contact intraoperative Doppler), the following parameters were considered: size, location of cerebral aneurysm, timing of surgery after subarachnoid hemorrhage, anatomical forms of intracranial hemorrhage. Results. The purpose of the operations was to devascularize saccular aneurysm to prevent its re-rupture, to reduce the mass effect caused by intracerebral hematoma; reduction of intracranial pressure, rehabilitation of basal cisterns of the brain., But in the postoperative period there was a tendency to worsen the results of treatment, the appearance of focal neurological symptoms on the background of cerebral vasospasm with subsequent development of ischemic complications in patients with III‒V degree according to the Hunt‒Hess Scale on admission, in patients with prolonged temporary clipping of the cerebral aneurysm-artery and prolonged mechanical manipulation of the cerebral arteries and cerebral aneurysm. It should be noted that all patients in our sample, with complicated clipping of cerebral saccular aneurysms, had an intraoperative rupture of the MA, which complicated the process of clipping the saccular aneurysm and prolonged the time of surgery and was one of the inducers of postoperative aggravating consequences. There was a tendency to worsen the results of treatment in patients with III–IV degree according to the Hunt‒Hess Scale. Thus, patients with 1 point according to the Glasgow Outcome Scale, there were 2 patients who had II and III degrees according to Hunt–Hess Scale at hospitalization; among discharged patients with 3 point according to Glasgow Outcome Scale was dominated by patients from the second century according to Hunt‒Hess Scale at hospitalization, among patients with 5 point according to Glasgow Outcome Scale dominated patients who had I degree according to the Hunt‒Hess Scale at hospitalization. Conclusions. Inadequate clipping of the cervix cerebral aneurysm is the main type of non-hemorrhagic complications in the surgery of cerebral aneurysms. The Inadequate clipping of the cervix of the cerebral aneurysm includes the presence of residual blood flow in the cerebral aneurysm after its clipping, stenosis/compression of the main and perforating cerebral arteries with a clip, slipping of the clip from the aneurysm. Among the factors influencing the radical and adequate clipping of the cervix cerebral aneurysm are the size, location of the aneurysm, atherosclerotic lesions of the walls of the arteries and neck of the aneurysm and transferred subarachnoid hemorrhage. Reliable methods of prevention of inadequate clipping of saccular aneurysm are the use of intraoperative Doppler blood flow control, pilot clipping of complex aneurysms, optimization and individualization of surgical access. Aggravating factors that lead to unsatisfactory results of treatment of patients and negative clinical dynamics after the operation of clipping cerebral saccular aneurysm are: severe condition of the patient before surgery (III‒V gr. according to the Hunt‒Hess Scale), severe cerebral edema, intraoperative rupture of saccular aneurysm, long-term mechanical manipulations on cerebral arteries (long-term temporary clipping of saccular aneurysm, isolation of saccular aneurysm and «neighboring» cerebral arteries from arachnoid adhesions, frequent repositioning of the clip).