[Unruptured asymptomatic brain aneurysms: modern approaches to the choice of surgical method and treatment outcomes]. / Nerazorvavshiesya bessimptomnye anevrizmy arterial'nykh sosudov golovnogo mozga: sovremennye podkhody k vyboru khirurgicheskogo metoda i rezul'taty lecheniya patsientov.

BACKGROUND: In recent years, significant attention has been paid to preventive vascular neurosurgery. Treatment of unruptured asymptomatic brain aneurysms is one of the sections of this surgery. OBJECTIVE: To evaluate treatment outcomes in patients with unruptured asymptomatic brain aneurysms who underwent treatment chosen on the basis of criteria adopted at the Burdenko Neurosurgery Center. MATERIAL AND METHODS: There were 2814 unruptured asymptomatic brain aneurysms in 2334 patients for the period from 1995 to 2019. RESULTS: Microsurgical operations for unruptured asymptomatic brain aneurysms were performed in 64.9% of cases, endovascular procedures - in 35.1% of patients. Endovascular operations were usually performed for ICA aneurysms and posterior aneurysms of circle of Willis. Microsurgical operations were mainly performed in patients with aneurysms of anterior and middle cerebral arteries. Favorable outcomes (GOS grade V-IV) were obtained in most patients (98.3%). Incidence of severe complications was similar in both groups, mortality rate was 0.3% and 0.4%, respectively. CONCLUSION: Currently, there is a tendency towards annual increase in the number of surgeries for unruptured brain aneurysms. Anatomical and morphological characteristics of aneurysm should be considered to achieve favorable clinical results. At the same time, comprehensive analysis of each case and identification of individual risk factors will eliminate serious complications of surgical treatment.

[Surgical treatment of vertebral artery confluence aneurysms]. / Khirurgicheskoe lechenie anevrizm v oblasti sliyaniya pozvonochnykh arterii.

BACKGROUND: Aneurysms of vertebral artery confluence and proximal parts of basilar artery are extremely rare. They are usually combined with proximal fenestration of basilar artery. No timely surgical treatment of these aneurysms is associated with high risk of adverse outcomes, and their treatment is a challenge for neurosurgeons. MATERIAL AND METHODS: We analyzed postoperative outcomes in 17 patients with 21 aneurysms of vertebral artery confluence and proximal parts of basilar artery. RESULTS: Six patients with 10 aneurysms underwent microsurgical resection, 11 patients with 11 aneurysms - endovascular procedure. Persistent postoperative deterioration was observed in 5 (29.4%) patients: severe neurological symptoms (GOS grade 3) in 1 case (5.9%), minor bulbar disorders in 4 cases (23.53%). There were no lethal outcomes. CONCLUSION: According to our own and literature data, aneurysms of vertebral artery confluence are extremely rare. The risk of rupture of these aneurysms is extremely high. Endovascular approach is preferred in these patients. Microsurgical procedure is an acceptable alternative if endovascular surgery is impossible.

[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.

[Microsurgical treatment of aneurysms of vertebral and posterior-lower cerebellar arteries: surgical approaches, exclusion options, treatment results]. / Mikrokhirurgicheskoe lechenie anevrizm pozvonochnykh i zadnikh nizhnikh mozzhechkovykh arterii: khirurgicheskie dostupy, varianty vykliucheniia, rezul'taty lecheniia.

Aneurysms of vertebral (VA) and posterior inferior cerebellar arteries (PICA) are relatively rare pathologies and account for 3.4% of the total number of intracranial aneurysms. MATERIAL AND METHODS: The experience of microsurgical treatment of 67 patients with VA and PICA aneurysms in N.N. Burdenko National Medical Research Center for Neurosurgery of the RF Ministry of Health from 2012 to 2017 is presented. RESULTS: Most patients underwent reconstructive microsurgical interventions: clipping of the aneurysm neck in 42 (62.7%) patients and complex clipping with the formation of arterial opening - in 10 (14.9%). Exclusion of the aneurysm together with the carrier artery (trapping, proximal clipping) was performed on 10 (14.9%) patients. In 5 (7.5%) patients, deconstruction of the carrier artery of the aneurysm was performed after creating local anastomoses. The radical exclusion of aneurysms in the studied group was 95.5%. Postoperative dysfunction of the caudal group of cranial nerves was detected in 11 (16.4%) patients. There were no lethal outcomes, or cases with vegetative status outcomes. CONCLUSION: Microsurgical intervention is an effective way to treat VA and PICA aneurysms, subject to the principles of patient selection based on existing treatment algorithms as well as adherence to an interdisciplinary approach.

[Intracisternal administration of verapamil for the prevention and treatment of vasospasm in patients after microsurgical treatment of cerebral aneurysms in the acute period of hemorrhage]. / Intratsisternal'noe vvedenie verapamila dlia profilaktiki i lecheniia vazospazma u bol'nykh posle mikrokhirurgicheskogo lecheniia anevrizm sosudov golovnogo mozga v ostrom periode krovoizliianiia.

The first results of intracisternal administration of verapamil for the prevention and treatment of cerebral vasospasm (CVS) in patients in the acute period of subarachnoid hemorrhage (SAH) after microsurgical clipping of cerebral aneurysms are presented. OBJECTIVE: Safety assessment of the method of prolonged intracisternal infusion (PII) of verapamil. MATERIAL AND METHODS: Over the period from May 2017 to December 2018, 42 patients were included in the study, who underwent clipping of aneurysm of the anterior segments of the Willis circle. Most patients (78.6%) were operated during the first 6 days after SAH. For each patient, a thin silicone catheter was installed, through which verapamil was infused. A prerequisite was the installation of external ventricular drainage and opening of the lamina terminalis. The daily dosage of verapamil varied from 25 to 50 mg of the drug diluted in 200-400 ml of isotonic sodium chloride solution. The indication for the use of the PII method was the presence of one of the following factors: a score on the Hunt-Hess scale from III to V, 3 or 4 points on the Fisher scale, confirmed angiographically by the CVS before the operation. RESULTS: The PII procedure was performed from 2 to 5 days. The average dose of verapamil was 143.5±41.2 mg additionally, in the presence of an angiographically confirmed CVS accompanied by clinical manifestations, 14 (33.4%) patients received intra-arterial injection of verapamil in several stages, with individual selection of the drug dose. The formation of new cerebral ischemic foci of vasospastic genesis was observed in only 1 (2.4%) patient. No infectious intracranial complications were noted. The average follow-up period was 297.6±156.1 days. Long-term treatment outcomes, assessed by a modified Rankin scale from 0 to 2 points, were observed in 83.3% of patients. There were no outcomes such as vegetative status and no deaths. The frequency of liquorodynamic disorders, as well as epileptic syndrome did not exceed that among patients with SAH according to the literature. CONCLUSION: The study has confirmed the safety of prolonged PII. The efficacy of the method, compared with other methods for CVS treatment requires further investigation. The first results look quite promising: the observation shows a low percentage of new foci of cerebral ischemia and the absence of deaths associated with it. In patients with severe CVS, the efficacy of the PII method is increased when combined with intra-arterial administration of verapamil.

[Combination of infraoptic anterior cerebral artery with an aneurysm of the ACA-AcomA complex. Case study and literature review]. / Sochetanie infraopticheskoi perednei mozgovoi arterii s anevrizmoi kompleksa PMA-PSA. Sluchai iz praktiki i obzor literatury.

The infraoptic anterior cerebral artery (ACA) is an abnormal vessel that usually is a bifurcation of the intradural part of the internal carotid artery (ICA) or near the site of discharge of the ophthalmic artery, which passes under the ipsilateral optic nerve and penetrates between the optic nerves into the prechiasm cistern, reaching the ACA-AcomA complex. The infra-optic ACA is an extremely rare anomaly, but it may be of great clinical significance in surgery of the arteries of the anterior sections of the Willis circle. The article describes the case of a combination of infra-optical ACA with an aneurysm of the ACA-AcomA complex. This observation is of interest both from the viewpoint of the rarity of the considered pathology and the associated increased risk of the formation of intracranial aneurysms.

[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.

[Rupture of a giant aneurysm of the accessory middle cerebral artery: a case report and a literature review]. / Razryv gigantskoi chastichno trombirovannoi anevrizmy dobavochnoi srednei mozgovoi arterii: sluchai iz praktiki i obzor literatury.

The accessory middle cerebral artery is a rare congenital vascular abnormality. The international literature has reported cases of accessory MCA aneurysms. In this article, we describe a case of rupture of a giant partially thrombosed aneurysm of the accessory MCA. This case is of great interest due to rarity of the pathology and associated diagnostic errors.

[Tactics of surgical treatment of patients with unruptured asymptomatic cerebral aneurysms]. / Taktika khirurgicheskogo lecheniya bol'nykh s nerazorvavshimisya bessimptomnymi anevrizmami tserebral'nykh sosudov.

AIM: To clarify the indications for surgical treatment and the principles for choosing a surgical technique for patients with unruptured asymptomatic aneurysms (UAAs) based on the results of direct and endovasal operations performed at the Burdenko Neurosurgical Institute and on the literature data. MATERIAL AND METHODS: The study included 694 UAA patients (481 females (69.3%) and 213 males (30.7%)) operated on at the Burdenko Neurosurgical Institute from 1997 to 2013. The patients' age ranged from 1 to 74 years (mean age, 48.3 years). Multiple aneurysms were in 126 (18.2%) patients. Anterior circle of Willis aneurysms were in 92.8% of cases. Among these, internal carotid artery (ICA) aneurysms (46.3%) and middle cerebral artery (MCA) aneurysms (30.8%) were predominant. Microsurgical and endovascular interventions on aneurysms were performed in 665 patients (95.8%). RESULTS: Complete aneurysm exclusion was achieved in 94.8% of cases. A pronounced neurological deficit developed in 8 (1.2%) patients, and a moderate neurological deficit developed in 62 (9.3%) patients. Postoperative mortality was 0.5%. CONCLUSION: Surgical treatment of UAAs is associated with low disability and mortality rates. All UAAs need to be operated on, especially in young and middle age patients, if surgery is technically possible, and there are no concomitant diseases contraindicating the intervention. The choice of an UAA exclusion technique is made based on the general principles of surgical treatment of cerebral aneurysms. At present, the method of choice is endovascular surgery for most cases of vertebrobasilar basin and ICA aneurysms and a microsurgical intervention for anterior cerebral artery and MCA aneurysms.

[The principles for choosing a surgical technique for patients with acute cerebral aneurysm rupture]. / Printsipy vybora metoda khirurgicheskogo lecheniya bol'nykh v ostrom periode razryva tserebral'nykh anevrizm.

The article describes the principles for choosing a surgical technique for patients with cerebral aneurysms in acute subarachnoid hemorrhage. The principles were developed based on the experience gained at the Burdenko Neurosurgical Institute. Microsurgical and endovascular treatment options are considered.

[Unruptured cerebral aneurysms]. / Nerazorvavshiesia tserebral'nye anevrizmy.

The problem of high disability and mortality due to subarachnoid hemorrhage (SAH) from cerebral aneurysms has led to the fact that surgical treatment of unruptured aneurysms has been considered in Western Europe, Japan, and the United States as a method for prevention of subarachnoid hemorrhage for many years. The introduction of the so-called surgical SAH prophylaxis in Russia is a challenge that requires defining the principles of patient selection and choosing a treatment technique for unruptured cerebral aneurysms. The article highlights the modern approaches to treatment of asymptomatic unruptured cerebral aneurysms based on the concepts of aneurysm epidemiology and natural progression.

[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.