ConclusionEVD ensures effective monitoring and reduction of ICP. EVD is associated with a relatively low risk of infectious, liquorodynamic, and hemorrhagic complications and does not worsen outcomes when used in patients with aSAH. We propose that all patients in the acute stage of SAH with H-H severity of III-V should receive EVD immediately before surgery.

A pproximAtely 40% to 50% of large and giant cerebral aneurysms contain an intraluminal thrombus. 2,8,12 The risk of rupture of partially thrombosed aneurysms is comparable to the risk of rupture of nonthrombosed aneurysms; additionally, the probability of ischemic stroke due to distal thromboembolism is high. 2,8,22 In this regard, patients harboring aneurysms with an intraluminal thrombus are candidates for surgical treatment. 2,8,11,17 The Burdenko Neurosurgical Institute has extensive experience in the treatment of large and giant partially thrombosed aneurysms of the middle cerebral artery (MCA). At this institute, the vast majority of these aneurysms have been treated using microsurgical techniques. Thrombosis of the branches of the MCA is one of the most serious complications of microsurgery and can cause severe neurological deficits.The object of this study was to assess the frequency of intraoperative arterial thrombosis (IAT) during microsurgical treatment of large and giant partially thrombosed abbreviatioNs CTA = CT angiography; DSA = digital subtraction angiography; IAT = intraoperative arterial thrombosis; MCA = middle cerebral artery; mr-proUK = modified human recombinant prourokinase; mRS = modified Rankin Scale.

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