Implementation of a large number of surgeries enabled improvement of the technique and clarification of the prerequisites for preoperative examination, intraoperative control, and postoperative management of patients. A low mortalits rate suggests this technique for use in clinical practice. The surgery is indicated for the treatment of giant aneurysms of the petrous, cavernous, and clinoid segments of the ICA. In the case of giant supraclinoid aneurysms, the surgery may be combined with removal of thrombotic masses from the aneurysm sac for rapid decompression of the cranial nerves. Application of this surgery for treatment of giant aneurysms of the trunk and bifurcation of the basilar artery is promising but requires further investigation. The surgery is also recommended for improving cerebral perfusion in the setting of complex stenotic occlusive lesions of the BCA: prolonged BCA stenoses, tandem ICA stenoses located in both the extracranial and intracranial segments, nonspecific vasculitis and arteriitis, subcranial aneurysms, kinking etc.

The study objectiveis to evaluate the effectiveness of surgical treatment of intracranial aneurysms with the use of flow diverting stents (FDS).Materials and methods.In 2016, in the Federal Neurosurgical Center (Novosibirsk) 64 patients (11 men, 53 women, mean age – 50.1 ± 11.4 years) with intracranial aneurysms were operated on; 69 FDS were implanted. Total number of occluded aneurysms 64.Results.The digital subtraction angiography control after 6 months demonstrated, that the total occlusion rate with was in 71 % cases, subtotal – in 29 %. An excellent and good functional outcome (modified Rankin scale 0–2) was obtained in 60 (93.7 %) patients, poor (modified Rankin scale 3–5) – in 4 (6.3 %). Complications rate were 4.7 %, death rate – 0 %.Conclusion.The implantation of FDSs is an effective method for the treating of cerebral aneurysms, including cases, when using alternative endovascular techniques has a high risk of recanalization, and the microsurgical treatment has an increased operating risk.

The objective is to present the clinical experience of using the pConus stent-like device in the treatment of complex bifurcation aneurysms.Clinical cases. A 64-year-old patient was admitted with complaints of periodic headache without loss of consciousness and an increase in focal symptoms. Saccular aneurysms of the anterior communicating artery and the left superior cerebellar artery were found without signs of subarachnoid hemorrhage. For occlusion of the aneurysm of the left superior cerebellar artery (dimensions 7.4 х 5.3 mm, neck width 5.0 mm, facing left and up, body/neck ratio 1.48, the branch of the artery branched off from the neck), a pConus device (crown diameter 8 mm) was used with micro-coils.A 61-year-old patient was admitted with complaints of headache in the occipital region, accompanied by repeated vomiting and an increase in blood pressure to 200/110 mm Hg. Subarachnoid hemorrhage and a saccular aneurysm of the basilar artery bifurcation (facing up, anteriorly and somewhat to the left, measuring 4.9 x 3.4 mm, neck width 3.1 mm, dome/neck ratio 1.1) were revealed. A pConus device was used for micro-coils occlusion (4-25-6 mm).In the postoperative period, both patients did not experience an increase in focal neurological symptoms. Control angiography after 6 months confirmed stable occlusion, all major vessels were passable.Conclusion. In the described cases, there were no technical problems during the installation and implantation of the device. The use of the pConus device in the treatment of complex bifurcation aneurysms technically simplifies surgical intervention, since it does not require catheterization of the efferent vessels of the aneurysm.

Цель исследования -оценка эффективности различных эндоваскулярных методик в лечении пациентов с аневризмами верхней мозжечковой артерии (ВМА) (в зависимости от анатомо-топографических характеристик аневризм).