Individualization of microsurgical tactics during clipping cerebral arterial aneurysms

Abstract

Objective — to determinate clinical and anatomical options of influence of strategy and tactics of microsurgical treatment cerebral arterial aneurysms (AA) to increase the effectiveness of clipping surgery. Materials and methods. A retrospective analysis of the results of a comprehensive clinical and instrumental examination of 437 adult patients who were operated by clipping cerebral AA, which were on screening and treatment in the department of «Institute of Neurosurgery named after acad. A.P. Romodanov NAMS of Ukraine» in the period from 2009 to 2018 (results of treat of AA distal part anterior cerebral artery (ACA) were analyzed for the period from 1998 to 2015). Men were 235 (53.8 %), women — 202 (46.2 %). In all age groups men dominated. All patients performed a comprehensive clinical and instrumental study in accordance with the supplement to the Order of the Ministry of Health of Ukraine No. 317 dated 13.06.2008. The code for ICD-10: І60.1. Survey results for unification were evaluated according to international scales and classifications. Results. Often, AA was affected by the complex anterior communicating artery (145 (33.2 %)), bifurcation of the M1–M2-segment of the middle cerebral artery (112 (25.6 %)), C5–C6-segments of the internal carotid artery (98 (22.4%)), A2–A5-segments of ACA (79 (18.1 %)). AA of the basilar bifurcation were only 3 (0.7 %) cases. Clinically, cerebral AA was found after ruptured in 382 (87.6 %). Most of AAs were «berry»-type of shape — 364 (83.3 %). Complex AA was detected in 73 (16.7 %) patients. Extended basal craniotomy was used in 46 (10.5 %) cases, pterional craniotomy — in 323 (73.9 %), and other accesses — in 68 (15.6 %). The technique of simple clinging of aneurysms was used in 273 (57.4 %) cases, multiple clipping with clip reconstruction — in 148 (39.0 %), other methods — in 16 (3.6 %). Temporary clip proximally before final dissection was performed in 319 (73.0 %) patients, «pilot» clipping — 76 (17.4%), without proximal control — 42 (9.6 %). Conclusions. When choosing the appropriate strategy and tactics of the microsurgical devascularization of cerebral AA should take into account clinical manifestations and features of the course of the disease. The choice of the optimal microsurgical corridor and AA clinging technique depends on the anatomic-topographic and hemodynamic parameters of AA and the affected arterial segment cerebral artery.