Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)172210.18786/2072-0505-2023-51-005ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИResearch ArticleThe results of surgery for giant aneurysms of the middle cerebral arteries: a retrospective studyРезультаты хирургического лечения гигантских аневризм средних мозговых артерий: ретроспективное исследованиеhttps://orcid.org/0000-0003-4001-3212565689079005961-6210PilipenkoYuri V.ПилипенкоЮрий Викторович
Russian Federation

MD, PhD, Neurosurgeon, Senior Research Fellow, 3rd Vascular Department

канд. мед. наук, врач-нейрохирург, ст. науч. сотр. 3-го сосудистого отделения

3664656@mail.ruhttps://orcid.org/0000-0001-6103-93296602494062EliavaShalva S.ЭлиаваШалва Шалвович
Russian Federation

MD, PhD, Professor, Corr. Member of Russ. Acad. Sci., Neurosurgeon, Head of 3rd Vascular Department

д-р мед. наук, профессор, чл-корр. РАН, врач-нейрохирург, заведующий 3-м сосудистым отделением

Eliava@nsi.ruhttps://orcid.org/0000-0002-0932-4752572030443986614-6204KonovalovAnton N.КоноваловАнтон Николаевич
Russian Federation

MD, PhD, Neurosurgeon, Research Fellow, 3rd Vascular Department

канд. мед. наук, врач-нейрохирург, науч. сотр. 3-го сосудистого отделения

ANKonovalov@nsi.ruhttps://orcid.org/0000-0003-2622-780457216816277AHB-5634-20224708-7670GrebenevFyodor V.ГребеневФёдор Вячеславович
Russian Federation

Neurosurgeon, Postgraduate Student, 3rd Vascular Department

врач-нейрохирург, аспирант 3-го сосудистого отделения

grebenevf@gmail.comBarchunovBoris V.БарчуновБорис Владимирович
Russian Federation

PhD (in Phys. And Math.), Research Fellow

канд. физ.-мат. наук, ст. науч. сотр.

neurosrgn@yahoo.comNational Medical Research Center for Neurosurgery named after Academician N.N. BurdenkoФГАУ «Национальный медицинский исследовательский центр нейрохирургии имени академика Н.Н. Бурденко» Минздрава РоссииCenter for Physical Instrumentation of Prokhorov General Physics InstituteЦентр физического приборостроения ФГБУН ФИЦ «Институт общей физики им. А.М. Прохорова Российской академии наук»190420231005202351132442008202205042023Copyright ©; 2023, Pilipenko Y.V., Eliava S.S., Konovalov A.N., Grebenev F.V., Barchunov B.V.Copyright ©; 2023, Пилипенко Ю.В., Элиава Ш.Ш., Коновалов А.Н., Гребенев Ф.В., Барчунов Б.В.2023Pilipenko Y.V., Eliava S.S., Konovalov A.N., Grebenev F.V., Barchunov B.V.Пилипенко Ю.В., Элиава Ш.Ш., Коновалов А.Н., Гребенев Ф.В., Барчунов Б.В.https://creativecommons.org/licenses/by-nc/4.0https://almclinmed.ru/jour/article/view/1722

Background: Surgical treatment of middle cerebral artery (MCA) giant aneurysms is a challenging task. The information on its current principles is rather limited, with the publications based on isolated case reports and small series.

Aim: To identify the types of procedures and evaluate the results of surgery in patients with giant MCA aneurysms.

Materials and methods: We retrospectively analyzed the data on 55 patients who had undergone surgery for MCA giant aneurysms in the Burdenko Neurosurgery Center from 2010 to 2021. Thereafter 52 patients were followed up for 6 to 120 months (for 53.1 ± 33.7 months on average).

Results: The giant MCA aneurysms were located at the M1 segment bifurcation in 33 (60%) patients, within the M1 segment, in 11 (20%), M2 in 7 (12.7%), and M3 and M4 in 4 (7.3%) patients. There were 32 (58.2%) saccular and 23 (41.8%) fusiform aneurysms. Surgical interventions for MCA giant aneurysms included their neck clipping (50.9%, n = 28), clipping with formation of the arterial lumen (3.6%, n = 2), bypass procedures (34.5%, n = 19), wrapping (3.6%, n = 2), and endovascular procedures (7.3%, n = 4). Perioperative worsening of the neurologic status (The Modified Rankin Scale, mRS) was observed in 50.9% (n = 28) of the patients, and the death rate was 1.8% (n = 1). The complete closure of giant aneurysms was achieved in 78.2% (n = 43) of the cases. The long-term outcome was favorable in 76.9% of the patients (40 from 52 available for the follow up).

Conclusion: Microsurgical clipping and bypass types of surgery were the most common surgical procedures for the treatment of MCA giant aneurysms. These procedures are technically complex and are associated with a relatively high number of complications. The main directions of future studies could be in the search for new and more precise diagnostic assessment of the collateral circulation in the cortical MCA branches, improvement of the algorithm for the bypass selection, as well as an investigation of the long-term results of endovascular and combined treatments. A thorough long-term postoperative patient follow-up and the possibility of high quality control angiography are of major importance.

Актуальность. Хирургическое лечение гигантских аневризм средней мозговой артерии (СМА) представляет собой сложную задачу. При этом информация о современных его принципах весьма ограничена: публикации основываются на отдельных случаях и небольших сериях.

Цель – определить виды операций и оценить результаты хирургического лечения пациентов с гигантскими аневризмами СМА.

Материал и методы. Ретроспективно проанализированы данные 55 пациентов, прооперированных по поводу гигантских аневризм СМА в ФГАУ «НМИЦ нейрохирургии им. ак. Н.Н. Бурденко» Минздрава России в период с 2010 по 2021 г. Катамнез прослежен у 52 пациентов и составил от 6 до 120 месяцев (в среднем 53,1 ± 33,7 месяца).

Результаты. Гигантские аневризмы СМА в 33 (60%) случаях находились в области бифуркации М1-сегмента, в 11 (20%) – на М1-сегменте, в 7 (12,7%) – на М2, в 4 (7,3%) – на М3- и М4-сегментах. В 32 (58,2%) случаях аневризмы имели мешотчатую форму, в 23 (41,8%) были фузиформными. Хирургическое лечение гигантских аневризм СМА включало в себя клипирование шейки (50,9%, n = 28), клипирование с формированием просвета артерии (3,6%, n = 2), создание анастомозов (34,5%, n = 19), укрепление хирургической марлей (3,6%, n = 2) и эндоваскулярные операции (7,3%, n = 4). Ухудшение неврологического статуса в периоперационном периоде отмечено у 50,9% (n = 28) пациентов, летальность составила 1,8% (n = 1). Тотальное выключение гигантских аневризм было достигнуто в 78,2% (n = 43). В отдаленном периоде удовлетворительные результаты наблюдались у 76,9% пациентов (у 40 из 52 доступных в катамнезе).

Заключение. Микрохирургическое клипирование и создание анастомозов были наиболее часто выполняемым хирургическим пособием при лечении гигантских аневризм СМА. Подобные операции технически сложны и сопровождаются достаточно высоким числом осложнений. Основными направлениями будущих исследований видятся поиск новых, более точных методов диагностики коллатерального кровообращения в бассейне корковых ветвей СМА, совершенствование алгоритма выбора типа анастомоза, а также изучение долгосрочных результатов после эндоваскулярного и комбинированного методов лечения. Особенно важным считаем тщательное динамическое наблюдение за пациентами в отдаленном периоде после операции, а также обеспечение их возможностью качественных контрольных ангиографических исследований.

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