[Features of modeling a polymer implant for closing a defect after decompressive craniotomy]. / Osobennosti modelirovaniya, izgotovleniya i ustanovki polimernykh implantatov dlya zakrytiya defekta cherepa posle dekompressivnoi trepanatsii.

BACKGROUND: Individual polymer implants are widespread for bone reconstruction after decompressive craniectomy. Despite the availability of customized titanium products, various specialists and hospitals prefer polymer implants. OBJECTIVE: To compare the methods of modeling and manufacturing the polymethylmethacrylate implants and identify the features affecting the quality of reconstruction. MATERIAL AND METHODS: We analyzed 14 patients with extensive skull defects after installation of polymethyl methacrylate implants. Software used for modeling of individual implants by different specialists was compared. RESULTS: Satisfactory reconstruction result was obtained in all cases. There were no infectious complications. The authors outlined certain important aspects for modeling of individual polymer products: local use of anatomical thickness of the implant, leaving safe spaces, prevention of temporal retraction, template-based resection before reconstruction. CONCLUSION: To date, skull defect closure with polymeric materials remains relevant, and even has certain advantages over customized titanium products.

[Combination of pituitary adenomas and intracranial aneurysms]. / Sochetanie adenom gipofiza i intrakranial'nykh anevrizm.

The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.

[Principles of surgical treatment for patients with asymptomatic aneurysms and cerebral aneurysms in the cold period after spontaneous intracranial hemorrhages]. / Printsipy vybora metoda khirurgicheskogo lecheniia bol'nykh s bessimptomnymi anevrizmami i anevrizmami golovnogo mozga v kholodnom periode posle spontannykh vnutricherepnykh krovoizliianii.

Surgical treatment of patients with cerebral aneurysms still remains one of the most important issues of cerebrovascular neurosurgery, which is associated with both complexity of treatment and risks posed by the disease. The purpose of this publication is to discuss the recommendations and algorithms adopted at the Neurosurgical Institute for choosing surgical treatment of patients with single and multiple intracranial aneurysms based on the clinical course of disease and anatomical morphological classifications of aneurysms. The study was based on a large clinical material: we analyzed treatment outcomes in 1,621 patients (2009-2017); of these, 966 (59.5%) patients were operated on using microsurgical techniques, and 655 (40.4%) patients underwent endovascular surgery. Surgical treatment of patients with cerebral aneurysms has been performed in close cooperation between two vascular (microsurgical and endovasal) departments, using the latest technical innovations.

[Proximal clipping of a large fusiform aneurysm of the A2 segment of the left anterior cerebral artery with awakening of the patient (a case report and literature review)]. / Proksimal'noe klipirovanie bol'shoi fuziformnoi anevrizmy A2 segmenta levoi perednei mozgovoi arterii s probuzhdeniem bol'noi (sluchai iz praktiki i obzor literatury).

Arterial aneurysms of the A2 segment are very rare (<1%) peripheral aneurysms of the anterior cerebral artery (ACA) territory. Usually, these are saccular aneurysms; there are single reports of fusiform aneurysms of this location. Surgical treatment of these aneurysms involves both microsurgical and endovascular interventions. In the presented case, we used deconstructive surgery (proximal clipping of the aneurysm) with intraoperative awakening of the patient, which verified sufficient collateral blood flow. In the case of focal deficit development, we planned to simultaneously perform an interarterial anastomosis between the A3 segments of the right and left ACAs.

[Immediate outcomes of microsurgical treatment of cerebral arteriovenous malformations in non-hemorrhagic patients]. / Blizhaishie rezul'taty mikrokhirurgicheskogo lecheniia arterio-venoznykh mal'formatsii golovnogo mozga u patsientov bez krovoizliianiia.

Arteriovenous malformations (AVMs) are some of the most frequent congenital abnormalities of the cerebral vascular system and usually occur at a young age. Given the fact that AVMs can manifest, in addition to hemorrhages, as symptomatic epilepsy (17-40%) that occurs more often at a young age and may lead to significant disability, investigation of this pathology remains topical. Particular attention has recently been paid to the management of AVM patients without clinical signs of hemorrhage at the time of pathology diagnosis. OBJECTIVE: The objective of this study was to optimize the management of patients with unruptured AVMs based on analysis of the immediate outcomes of microsurgical treatment. MATERIAL AND METHODS: We retrospectively analyzed the immediate outcomes of microsurgical treatment of AVM patients hospitalized to the Burdenko Neurosurgical Institute in the period from 2009 to 2017. The patients included in the study met the following criteria: age over 18 years; microsurgical resection of AVM. The main exclusion criterion was a hemorrhage history confirmed by clinical data or verified by a neuroimaging study (MRI/CT). The study included 160 patients (58.1% males and 41.9% females) aged 18 to 67 years (mean, 33.5 years). According to the clinical course, patients with epileptic syndrome prevailed: 99 (61.9%) cases. Headaches occurred in 49 (30.6%) patients; 8 (5%) patients had asymptomatic AVMs; 4 (2.5%) patients had ischemic stroke. The surgical risk was assessed by using the Spetzler-Martin (S-M) scale: Grade I - 18 (11.3%) patients, Grade II - 71 (44.4%) patients, Grade III - 60 (37.5%) patients, and Grade IV - 11 (6.8%) patients. Direct surgery in patients with AVMs classified as S-M V was not planned. RESULTS: Postoperative analysis revealed that 33 patients included in the study group in accordance with the above criteria had silent AVM hemorrhage that was confirmed only based on the intraoperative picture. The best surgical treatment outcomes were observed in patients with S-M I and II AVMs. The outcome scored 4 and 5 on the Glasgow Outcome Scale (GOS) was in 100% of cases in the S-M I group, 98.6% in the S-M II group, 86.7% in the S-M III group, and 81.8% in the S-M IV group. The relatively good outcomes of S-M IV AVM resection are explained by careful selection of patients for surgery. In general, good postoperative outcomes (GOS score of 4 and 5) were in 93.2% of patients. The main newly developed postoperative symptoms were visual impairments - visual field defects (64.7% of all complications). Postoperative mortality was 1.3%. CONCLUSION: Surgical treatment is indicated for patients with unruptured AVMs and S-M I or II surgical risk, regardless of clinical manifestations. In other cases, the treatment approach depends on a number of risk factors.

[The history of surgery for brain and spinal cord vascular pathology at the Burdenko Neurosurgical Institute (to the 50th anniversary of foundation of the First Neurovascular Department)]. / Istoriya khirurgii sosudistoi patologii golovnogo i spinnogo mozga v Institute neirokhirurgii im. akad. N.N. Burdenko (k 50-letiyu osnovaniya pervogo neirososudistogo otdeleniya).

The Vascular Department of the Burdenko Neurosurgical Institute is one of the country's first dedicated departments engaged in treatment of patients with cerebrovascular diseases. The modern vascular service of the Institute is represented by several departments and groups: the Department of Microsurgical Treatment of Vascular Diseases, a group of Reconstructive Brachiocephalic Surgery, and the Department of Endovascular Surgery and Neurodiagnosis that is also engaged in intra-arterial chemotherapy and angiographic diagnosis. The neurovascular service of the Institute is a rightful leader of Russia in the number operations and their complexity: patients with the most serious and unusual pathologies are referred to the Institute from across the country. The achievements of the service are based on science and clinical practice that underlie progressive improvement in the diagnosis, surgical methodology, and recovery of neurovascular patients. On November 02, 2016, the Vascular Department of the Burdenko Neurosurgical Institute will celebrate the 50th anniversary of its foundation.

[The modern role of microsurgery in treatment of large and giant aneurysms of the internal carotid artery]. / Sovremennaya rol' mikrokhirurgii v lechenii krupnykh i gigantskikh anevrizm vnutrennei sonnoi arterii.

INTRODUCTION: Large (1.5-2.5 cm) and giant (>2.5 cm in diameter) aneurysms of the internal carotid artery (ICA) remain one of the complex neurosurgical pathologies in terms of microsurgery. In recent years, endovascular techniques for treatment of paraclinoid aneurysms, in particular ICA reconstruction using flow-diverting stents, have become a priority. However, surgery of flow stents has a number of limitations, therefore the choice of treatment in each case is individual. PURPOSE: To analyze the results of direct surgery in patients with large and giant aneurysms of the ICA and to determine the role and place of modern microsurgical techniques in the treatment of this vascular disease. MATERIAL AND METHODS: The study included 260 patients with large and giant ICA aneurysms who were operated on at the Institute using microsurgical techniques in the period between 2001 and 2015. The mean age of patients was 45.1 years. The male/female ratio was 1:2.5. One hundred sixty four (63.1%) patients were operated on after hemorrhages, of whom 15 (5.7%) patients were operated on in the acute period; 69 (26.5%) patients had a pseudotumoral course of the disease; 9 (3.5%) patients had a mixed course of the disease; aneurysms were incidentally found in 18 (6.9%) patients. The aneurysm localization was as follows: paraclinoid aneurisms in 158 (60.7%) patients, supraclinoid aneurisms in 77 (29.6%) patients, and ICA bifurcation aneurisms in 25 (9.6%) patients. Microsurgical clipping was performed in 228 (87.7%) patients, including 158 (60.7%) patients in whom an intravascular blood aspiration technique was used. Aneurysm trapping using a flowmetry probe was performed in 16 patients, with creating vascular anastomoses in 4 (1.5%) cases. In 16 (6.2%) patients, interventions were completed by gauze strengthening. We performed a comparative analysis of the results of endovascular treatment of paraclinoid aneurysms reported in recent publications and obtained in the present series. RESULTS: Treatment outcomes (Glasgow Outcome Scale) were favorable (Grade 4-5) in 224 (86.2%) patients and satisfactory in 29 (11.1%) patients. Two patients (0.7%) developed diencephalic (electrolyte) disturbances that were successfully corrected using replacement therapy. The mortality was 2.7% (7 patients); the treatment completeness was 94.3%. Comparison with the literature data demonstrated comparable results for both treatment techniques. CONCLUSION: Microsurgical techniques in treatment of large and giant ICA aneurysms are the methods of choice in complex non-standard cases where endovascular treatment is ineffective or contraindicated. Planning of microsurgical treatment should include the possibility of revascularization surgery. Treatment of these patients should be carried out at large dedicated centers having appropriate expertise and facilities.

[Amygdalohippocampectomy in treatment of epilepsy in patients with temporal lobe cavernomas].

BACKGROUND: In some cases, single-stage or delayed amygdalohippocampectomy (AHE) can be used for effective treatment of epileptic syndrome upon resection of temporal lobe cavernomas. The efficacy of AHE in treatment of temporal epilepsies is proved in general; however, the indications for surgery in patients with cavernomas are not developed. OBJECTIVE: The study objective was to evaluate the efficacy and safety AHE in the treatment of epilepsy in patients with temporal lobe cavernomas and to define the indications for surgery. MATERIAL AND METHODS: Of 14 patients with temporal lobe cavernomas, which manifested as epileptic seizures, 10 patients underwent selective AHE, and 4 patients underwent anteromedial temporal lobectomy. In 12 cases, AHE was performed simultaneously with cavernoma resection. Delayed AHE was carried out in 2 cases. All patients underwent preoperative MRI and EEG. Preoperative video-EEG monitoring was performed in 3 cases. The duration of postoperative follow-up was at least 1 year (mean follow-up was 3.3 years). RESULTS: Improvement in the epileptic syndrome was observed in all patients. In the postoperative period, 7 patients had no seizures (Engel class IA); of them, 3 patients discontinued anticonvulsants. The surgery outcome depended on the disease duration. Significant postoperative complications in the form of reversible hemiparesis were observed in 1 case. CONCLUSION: Amygdalohippocampectomy is highly efficient in treatment of severe forms of epilepsy in patients with temporal lobe cavernomas. In the case of long history of typical temporal seizures and pharmacoresistant epilepsy, AHE can be performed simultaneously with cavernoma resection.

[Improvement of visual functions after successful microsurgical exclusion of a giant aneurysm of the right internal carotid artery using revascularization techniques]. / Uluchshenie zritel'nykh funktsii posle uspeshnogo mikrokhirurgicheskogo vykliucheniia gigantskoi anevrizmy pravoi vnutrennei sonnoi arterii s primeneniem revaskuliariziruiushchikh metodik.

We describe a clinical case of successful treatment of a female patient with a giant paraclinoid aneurysm of the right ICA. The aneurysm had a pseudotumoral course and manifested as pronounced progressive visual impairments. The patient underwent microsurgery including trapping/clipping of the right ICA aneurysm after creation of an EICMA and a high-flow anastomosis between the ECA and the M2 segment of the MCA. The surgery enabled decompression of the optic nerves, avoiding their injury. Postoperatively, the patient underwent transcutaneous electrical stimulation of the optic nerves. The case feature was that the patient developed gradual restoration of the blind eye vision.

[Combined treatment of cerebral arteriovenous malformations. Experience of the Burdenko Neurosurgical Institute].

OBJECTIVE: Despite the achievements of recent years, cerebral AVMs continue to pose a challenge to treatment. The objective of this work was the development of recommendations for combined treatment of AVMs based on analysis of the available material and published data. MATERIAL AND METHODS: The study included 93 patients hospitalized at the Neurosurgical Institute for combined treatment of cerebral AVMs in 2010-2014. A group of combined surgery (removal of an AVM with preoperative embolization) consisted of 40 patients, and a group of combined radiotherapy (radiation after partial embolization or partial removal of an AVM) included 53 patients. 36 patients underwent radiosurgery, and 17 patients received stereotactic radiation therapy. Both groups were analyzed in terms of outcomes, complications, and follow-up results. RESULTS: In the group of combined surgery, according to the Glasgow outcome scale, good results (grade 4-5) were achieved in 35 (87.5%) patients at discharge and in 27 (90%) patients during follow-up. Treatment outcomes, surgery duration, and the amount of blood loss were not significantly different from those in the control group. Complete AVM obliteration was achieved in 29 (80.6%) patients 3 years after radiosurgery and in 8 (47%) patients after stereotactic radiotherapy. In discussion, these findings are compared to the published data, and recommendations for AVM treatment are suggested. CONCLUSION: The combined treatment of AVMs is effective management for patients with complex AVMs (Spetzler-Martin grade III-IV AVMs). Successful treatment of AVMs requires careful planning and teamwork of vascular and endovascular neurosurgeons, radiologists, and neurologists.

[Surgical treatment of cerebral vascular diseases].

Theoretical and practical aspects of the complex treatment of brain and spinal vascular diseases using microsurgical, endovascular and radiosurgical methods are considered. Authors present the data demonstrating that, due to the implementation of the program of development of vascular centers in the Russian Federation, considerable progress was made in the treatment of cerebral aneurisms and hemorrhagic stroke. In author's opinion, wide introduction of surgical methods in the treatment of occlusive lesions of the blood vessels supplying the brain is needed.

[Intraoperative indocyanine green fluorescence angiography in surgery of brain aneurysms. The first experience with using the technique and literature review].

Intraoperative blood flow assessment after aneurysm clipping has become a standard procedure in vascular neurosurgery worldwide. Intraoperative indacyanine green angiography (ICG) has recently been certified in Russia. Fifteen patients with aneurysms operated with ICG control in Burdenko NSI are described in present publication. ICG advantages and weaknesses are discussed along with alternative flow control techniques available now.

[Long-term results of treatment of patients with large or giant intracranial aneurysms of internal carotid artery].

At Burdenko Neurosurgical Institute annually arrives 50-60 patients with large and giant aneurysms of the brain, which is nearly 15% of all patients with aneurysms. About half of them--patients with paraclinoid aneurysms, which are successfully treated by cliping using techniques of intravascular blood aspiration (IVBA) or proximal control of blood flow in the neck. This paper analyzes the long-term outcomes of patients who were operated for large and giant aneurysms of the internal carotid artery in the last 15 years. Catamnesis was collected from 93 (71.5%) of 130 patient. Mean follow-up was 65.2 +/- 36.0 months. Mean age of patients at the time of surgery was 45.55 +/- 7.5 years and at the time of catamnesis evaluation 50.4 +/- 10.2 years. Men to women ratio was 18:75. Patients with multiple aneurysms was 22.6% (21 patients). In most cases--67 (72%) patients--aneurysms were treated by cliping of aneurysms using IVBA, in 14 (15%) cases--using proximal control of blood flow in the neck, in 5 (5.4%) cases--reinforced with gauze and glue, in 6 (6.5%) patient--by aneurysm trapping, in one case the aneurysm was not cliped. Radical surgery performed in 87 (93.5%) patients. Catamnesis analysis of survived patients showed that 55.8% of them are complaining of headaches, which they associate with the operation. 39 (43.3%) patients noted persistent elements of asthenia, 4 (4.6%) had sleep disorders, 5 (5.8%) suffered of epileptic seizures and 1 (1.10%) of depression. Korsakoff's syndrome, developed after surgery in 2 (2.3%) patients remains. Only 38.4% of patients after surgery continue to work. Favorable outcome on the Glasgow outcome scale (4-5) was obtained in 81 (87.1%) patients, poor (2-3) in 5 (5.4%) patients. Mortality rate was 7.5%. Severe oculomotor disturbances have a slight tendency to recovery over time.

[Simvastatin efficacy in vasospasm treatment in patients after aneurysm SAH].

Number of trials had previously demonstrated cerebroprotective effect of statin therapy in SAH patients. Aim of the current study was to assess effects of simvastatin on vasospasm in clinical practice. The study group comprised 35 patients admitted to Burdenko Neurosurgery Institute with aneurysmal SAH in 2007-2011. All patients were treated with surgery within 14 days post-SAH and received simvastatin 40 mg/day. Mean age was 46,5 (16-69) years, male: female ratio - 20:15, Hunt-Hess scale breakdown: I - 7 (20%), II - 12 (34.3%), III - 11 (31.4%), IV - 4 (11.4%), V - 1 (2.8%). In 31 (88.6%) patients aneurysm was clipped, in 4 (11.4%)--coiled. Outcomes at discharge and at follow-up (modified Rankin scale), vasospasm dynamics, delayed ischemic neurological deficit (DIND), duration of hospital stay and number of home discharged patients were evaluated and analyzed in comparison to control group (n = 30). Statin group did not demonstrated valid difference in immediate and late outcomes (mean 20,5 month), risk of DIND, length of hospital stay and percentage of discharged home patients. Statin group showed significantly lower rates of vasospam progression--42.9% vs. 76.7% in control (chi2-test, p = 0.01). Our evidence corresponds with outcomes of international trials of statin application in SAH patients. As follows from our results and existing randomized and clinical trials data there is no strong evidence nowadays to recommend statin prescription in SAH patients.

[Surgical treatment of patients with supratentorial cavernomas manifested with seizures].

UNLABELLED: Supratentorial compartment is the most frequent cavernomas location associated with seizures in 50-79% cases. Surgical removal of some cavernomas remains a delicate decision. To assess long-term epilepsy results in consecutive series of patients treated for supratentorial cavernomas. PATIENTS AND METHODS: Single-center retrospective study of 302 patients (2002-2010) with operated supratentorial cavernomas was performed. Male: female ratio= 139:163, age ranged 1 to 68 years, mean: 26.4. Multiple lesion were diagnosed in 27 (8.9%) patients, eloquent in 77 (24.9%) cases. Mean follow up was 55.2 months. Functional outcomes using modified Rankin scale and epilepsy outcomes using Engel scale were assessed. Data were statistically analyzed in respect to natural history, lesion type, location, size, extent of resection, use of anti-epileptic drugs, etc. Seizures suffered 74.8% of patients, generalized seizures--79.6% from those who have an epilepsy. In 34.5% of patients epileptic symptoms tended to worsen over time. Seizures improved in 78.2% patients post op, 62.3%--became seizure-free. Early surgery and less than 5 seizures in history were found a reliable predictors of better epilepsy outcome. Drug-resistant subgroup was associated with worse outcomes. Resection of gliosis and tailored ECoG-guided resection with respect to epilepsy outcome were not proved beneficial. Long-term disability was 9%, 3% in non-eloquent and 21% in eloquent and deep cavernomas group. One patient died (0.3%). Surgery remains an effective treatment for recurrent hemorrhage prevention and seizure control with acceptable morbidity. The benefits of surgery for eloquent and deep-seated cavernomas must be accurately weighted with higher risks. For symptomatic non-eloquent cavernomas surgical excision should be considered as soon as possible after disease onset.

[Microsurgical treatment of cerebral arteriovenous malformations in Burdenko Neurosurgical Institute (recent experience)].

Recently the number of AVM resections in Burdenko Neurosurgical Institute has been increased dramatically. Aim of this study was to assess the results of open surgery in our clinic in modern neurosurgical era. Consecutive series if 160 patients with AVM treated using microsurgical technique since 2009 till 2011 was analyzed. Spetzler-Martin score distribution was: grade I--29 (18.1%) cases, grade II--84 (52.5%), grade III--38 (23.8%), grade IV--9 (5.6%). Patients with grade V AVMs were not operated. Treatment options included: AVM resection in 143 (89.4%) cases, embolization followed by resection in 15 (9.3%) and clipping of afferents in 2 (1.3%). Glasgow outcome scale score distribution was the following: V (good recovery)--70 (43.7%), IV (moderate disability)--71 (44.4%), III (severe disability)--16 (10%), II (vegetative state)--1 (0.6%) and I (death)--2 (1.3%). Microsurgery remains the primary option for radical treatment of cerebral AVMs. Careful selection of patients and planning of surgery are crucial for good outcomes.

[The role of intraoperative flowmetry in surgery of cerebral aneurysms].

Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping.

[Arterial wide-section anastomoses: experimental study on animals].

A mechanical device for making arterial wide-section anastomoses was tested on a series of 15 laboratory rabbits. End-to-side anastomoses were made using a vein graft and they functioned in 93.1% of cases, as evidenced by intraoperative Doppler studies. When an anastomosis is made, the mean duration of temporary blood flow arrest in the rabbit aorta averaged 2 min. According to outcomes, the survived animals were divided into 3 groups: Group 1 comprised 2 (13.3%) rabbits that died within 10-12 hours after surgery and had significant symptoms of anastomotic dysfunction. Group 2 included 8 (53.3%) animals that died 2-3 days after surgery. They moved 5-6 hours following surgery without assistance, which was indicating of anastomotic functioning. Group 3 consisted of 3 (20%) rabbits that survived 2 weeks. Autoptic studies revealed no anastomic thrombosis in Group 2 animals. Group 3 animals were noted to have signs of allograft thrombosis and rejection. Thus, it is expedient to continue studies to make arterial wide-section anastomoses, by using the above device, in order to introduce this procedure into clinical practice.

[Intraoperative contact Doppler ultrasonography in the surgery of cerebral aneurysm].

Vascular occlusion leading to the development of an ischemic focus or incomplete aneurysm closure is one of the main causes that deteriorate the total results of surgical treatment in patients with cerebral aneurysms. The study covering 50 patients with 54 aneurysms who were evaluated for vascular patency by contact Doppler ultrasonography (CDUS) assessed the role and reliability of this technique. In the study group, the ratio of males to females was 30:24, their mean age was 44 years (23-67 years); the ratio of patients with acute subarachnoidal hemorrhage (SAH) to those without SAH was 24:30. The functional outcomes were assessed by a modified Rankin scale and compared with those in the control group. The clip site was inspected by the results of CDUS in 19 (31.7%) cases; clip reposition was made in 16 (26.7%) cases due to vascular stenosis; an additional clip was use to exclude the aneurysmal functioning part in 1 (1.7%) case. Vascular stenosis was detected in 2 (3.3%) cases; however, the position of clips remained unchanged since aneurysm was excluded under the conditions of its rupture. According to the modified Rankin scale, good results were slightly more in the study group of "acute" patients than in the control group: 96.7% versus 90%; the similar results were obtained in non-SAH patients: 66.7% versus 62.5%; lambda < 1.36). CDUS is a noninvasive, simple, reliable, and inexpensive technique for blood flow evaluation.