Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms

The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an e...

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Main Authors: V.V. Moroz, O.Yu. Harmatina, I.I. Skorokhoda, N.A. Shakhin, R.B. Ghanem, U.I. Maliar
Format: Article
Language:English
Published: NAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of Ukraine 2022-12-01
Series:Українська Інтервенційна Нейрорадіологія та Хірургія
Subjects:
Online Access:https://enj.org.ua/index.php/journal/article/view/210
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author V.V. Moroz
O.Yu. Harmatina
I.I. Skorokhoda
N.A. Shakhin
R.B. Ghanem
U.I. Maliar
author_facet V.V. Moroz
O.Yu. Harmatina
I.I. Skorokhoda
N.A. Shakhin
R.B. Ghanem
U.I. Maliar
author_sort V.V. Moroz
collection DOAJ
description The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms. Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery). Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm. Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned. Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.
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spelling doaj.art-4c812ff03f4f4f6f81a47b27005d79212022-12-22T04:41:53ZengNAMS of Ukraine, State Organization "Scientific-Practical Center of Endovascular Neuroradiology, Non-Governmental Organization “All Ukrainian Association of Endovascular Neuroradiology, Shupyk National Healthcare University of UkraineУкраїнська Інтервенційна Нейрорадіологія та Хірургія2786-48552786-48632022-12-01402557110.26683/2786-4855-2022-2(40)-55-71210Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysmsV.V. Moroz0O.Yu. Harmatina1I.I. Skorokhoda2N.A. Shakhin3R.B. Ghanem4U.I. Maliar5The State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe State Institution «Romodanov Neurosurgery Institute NAMS of Ukraine», Kyiv, UkraineThe aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms. Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery). Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm. Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned. Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.https://enj.org.ua/index.php/journal/article/view/210complicated cerebral aneurysm; microanastomosis; surgical treatment; results of surgical treatment.
spellingShingle V.V. Moroz
O.Yu. Harmatina
I.I. Skorokhoda
N.A. Shakhin
R.B. Ghanem
U.I. Maliar
Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
Українська Інтервенційна Нейрорадіологія та Хірургія
complicated cerebral aneurysm; microanastomosis; surgical treatment; results of surgical treatment.
title Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
title_full Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
title_fullStr Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
title_full_unstemmed Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
title_short Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms
title_sort surgical revascularization bypass surgery in the treatment of complicated cerebral aneurysms
topic complicated cerebral aneurysm; microanastomosis; surgical treatment; results of surgical treatment.
url https://enj.org.ua/index.php/journal/article/view/210
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