Russian journal of neurosurgery最新文献

{"title":"Surgical treatment of gliomas in motor zone under control of neurophysiological monitoring","authors":"A. V. Dimertsev, A. Zuev, M. Podgurskaya","doi":"10.17650/1683-3295-2023-25-1-10-20","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-10-20","url":null,"abstract":"Background. Primary tumors of central nervous system account for about 2 % of all human tumors. Generally, the tumor removal is a necessary treatment step. The main goal of the intracerebral tumors surgical treatment is the formation removal in the most radical physiologically possible way, because this directly affects the patients’ life length and its quality.Aim. To assess the results of surgical treatment of motor zone tumors and identify predictors of development of irreversible motor disorders.Materials and methods. A retrospective analysis of results of surgical treatment from 105 patients with tumors that affect corticospinal tract and primary motor cortex of the brain or localized in close proximity to those areas (up to 10 mm). All patients were treated in the neurosurgical department of N.I. Pirogov National Medical and Surgical Center, Ministry of Health of Russia (Moscow) in the period from 2014 to 2020. There were 48 (46 %) men, 57 (54 %) women aged from 22 to 79 (mean age 47.6 ± 14.5) years. Tumors volume before surgery ranged from 5.16 to 283.3 (mean volume 80.9 ± 55.1) cm3. The tumors’ size and their relationship with the surrounding structures were assessed by pre‑surgery magnetic resonance imaging and magnetic resonance tractography. For the intraoperative assessment of motor zone state dynamics, the transcranial electrical stimulation (n = 105, 100 %) and direct transcortical stimulation (with the eight‑contact electrode stripe) (n = 68, 64.8 %) of the primary motor cortex were used. To assess the proximity of the motor zones, a straight cortical and subcortical bi‑ or monopolar electrical stimulation was used (n = 105, 100 %).Results. Sixty‑seven tumors (63.8 %) were removed completely, close to total removal was in 22 (20.9 %) tumors, 11 (10.5 %) tumors removal was subtotal and 5 (4.8 %) tumors were removed partially. Tumor volume after surgery ranged from 0 to 84.4 (mean volume – 3.54 ± 5.01) cm3, Development of novel motor deficiency or increase in pre‑surgery motor deficiency was observed in 46 (43.8 %) patients 24 hours after surgery and in 32 (30.5 %) of them 7 days after the treatment. However, during course of conservative therapy, the majority of patients showed regress of motor deficit and it remained only in 12 (11.4 %) patients on examination that was performed 6 months after surgery. Assessment of factors affecting development of persistent motor deficiency revealed its statistically significant association with intraoperative response decrease according to transcranial stimulation (p < 0.001) and transcortical stimulation (p < 0.001) data. There were no significant changes in the functional status of patients during postoperative period depending on strength of the direct stimulation when the resection was stopped (р = 0.9) or depending on radicality of tumor removal (p = 0.393).Conclusion.Removal of tumors of motor cortex and corticospinal tract using the multimodal neurophysiological mapping allows to achieve ","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123406343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping of cortical speech zones and arcuate tract in patients with gliomas of temporal lobe of left hemisphere (analysis of a series of 27 observations)","authors":"V. Zhukov, S. A. Goryainov, S. Buklina, R. Afandiev, Y. Vologdina, S. Maryashev, A. Ogurtsova, G. Kobyakov","doi":"10.17650/1683-3295-2023-25-1-53-61","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-53-61","url":null,"abstract":"Introduction. Craniotomy in conscious patients is a possible tool for optimizing of tumor resection degree (Extent of Resection) while maintaining the quality of life. Traditionally, the main focus during these operations is on the cortical speech areas. At the same time, there is a shortage of studies on mapping of long associative tracts during the removal of gliomas of dominant speech hemisphere.Aim. To analyze the data of intraoperative mapping and the postoperative state of speech function in patients with temporal lobe gliomas of left hemisphere (including those involving arcuate bundle) operated by the use of method of craniotomy in consciousness.Materials and methods. Gliomas of temporal lobe of left hemisphere were removed in 27 patients aged 14 to 67 years (median age 43 years). In 10 patients, the tumor was localized in middle parts of temporal lobe (at the level of middle and upper temporal gyri), in 9 patients – in posterior parts of temporal lobe and exited into the supramarginal zone, in 8 it spread partially from temporal lobe to insular area. Gliomas of high degree of malignancy were detected in 21 patients, 6 had tumors of low degree of malignancy. Surgical intervention was performed with intraoperative “awakening”. All patients underwent cortical electrophysiological stimulation in order to control localization of cortical speech zones, subcortical stimulation was performed in 21 cases to identify terminals of arcuate bundle. Speech disorders before and after surgery (on day 4–6) were evaluated by neuropsychologist using the method proposed by A. R. Luria, an automated test with the naming of pictures was additionally used intraoperatively. The average current strength of direct electrical stimulation was 3 (1.9–6.5) mA. In 12 cases, magnetic resonance (MR) tractography with construction of arcuate tract was performed before and after the surgery.Results. Cortical temporal speech zones during intraoperative electrical stimulation were detected in 20 (74 %) of 27 patients. In 10 patients, the arcuate tract was mapped in form of appearance of mixed speech disorders in the depth of surgical wound. In 23 (85.2 %) of 27 patients in early postoperative period, an increase in speech disorders was noted of which 13 people had disorders of temporal type only and 10 people (surgery on deep posterior parts of temporal lobe) had a combination of temporal and frontal types of speech disorders (conduction aphasia). Postoperative MR‑tractography (performed in 12 patients) revealed direct intraoperative tract lesion in 5 cases and ischemia of the tract area passage in 2 cases. These 7 patients had combined speech disorders after surgery. Gross sensory aphasia after surgery was manifested in 4 patients, in 2 of them ischemia was revealed according to postoperative magnetic resonance imaging, and 2 more had hemorrhagic impregnation in the removed tumor bed.Conclusion. When removing tumors of temporal lobe in “awakening” conditions it is necessar","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125277027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative neurophysiological monitoring in surgery of lumbar spinal stenosis","authors":"A. V. Krasilnikov, A. V. Trifonov, A. V. Safronov","doi":"10.17650/1683-3295-2023-25-1-47-52","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-47-52","url":null,"abstract":"Background. Lumbar spinal stenosis is a pathological constriction of the central spinal canal, lateral pocket or intervertebral foramen. The complication rate of lumbar spinal stenosis surgery ranges from 10 to 24 %. In order to reduce the number of intraoperative and early postoperative complications accompanied by the development of neurological deficit, various techniques of intraoperative neurophysiological monitoring are used.Aim. Study of informativity of the use of intraoperative neurophysiological monitoring during surgical treatment of degenerative lumbar spinal stenosis based on the experience of the neurosurgical department of the Republican Clinical Hospital (Yoshkar‑Ola, Mari El Republic).Materials and methods. Thus, 69 decompressive‑stabilizing surgical interventions for degenerative lumbar spinal stenosis at the L3–L5 level, performed with intraoperative neurophysiological monitoring (free‑run electromyography, transcranial motor evoked potentials, somatosensory evoked potentials, triggered electromyography were included in the retrospective study).Results. During intraoperative neurophysiological monitoring transcranial motor evoked potentials from the legs was registered in all cases. Normal somatosensory evoked potentials were recorded in most cases, in 12 cases (17.4 %) baseline somatosensory evoked potentials were not registered due to preoperative neurological deficits and the presence of concomitant somatic pathology. 308 inserted pedicular screws were examined using the triggered electromyography. Muscle responses were registered in 31 (45 %) operations, 45 (14 %) screws. True negatives were registered with 29 (64.4 %), true positives were registered with 12 (26.7 %), and false positives were registered with 4 (8.9 %) screws. In the postoperative period no increase in motor and sensory neurological deficits was observed in all patients; no neurological signs of screw malpositioning were revealed.Conclusion. The use of multimodal intraoperative neurophysiological monitoring during surgical treatment of lumbar spinal stenosis reduces the risk of postoperative neurological complications.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"92 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131235488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic endonasal approach for craniopharyngiomas in children","authors":"E. Gormolysova, V. A. Lepilin, B. Pashaev, A. Kalinovsky","doi":"10.17650/1683-3295-2023-25-1-28-35","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-28-35","url":null,"abstract":"Background. The incidence of craniopharyngiomas is up to 15 % of intracranial tumors in children. The endoscopic endonasal approach (EEA) is widely spread nowadays and especially for the craniopharyngiomas removal in adults. Nevertheless, this approach is still not so common in pediatric patients. The endoscopic technique significantly improves the visualization of the structures located around the tumor.Aim. To determine the possibilities and limitations for the use of EEA in the treatment of pediatric patients with cranio pharyngiomas.Materials and methods. A total five pediatric patients with craniopharyngiomas were operated via EEA Federal Center of Neurosurgery of Ministry of Health of Russia (Novosibirsk): the age of patients ranged from 4 to 17 years, including 3 boys and 2 girls. All patients at the preoperative stage already had endocrine disorders in one volume or another. Postoperative evaluation of the visual functions showed the improvement in one patient, three patients remained unchanged and one patient developed worthening. In addition, the volume of the sphenoid sinus was studied, the degree of pneumatization of which determines the anatomical accessibility of the tumor.Results. Our experience of the EEA for the craniopharyngiomas in pediatric patients has shown a positive result regarding to the tumor’s gross‑total removal and no data of the tumor recurrence at the follow‑up. According to our results it can be judged that endonasal endoscopic approach for the craniopharyngiomas in pediatric patients could be a method of choice based on the anatomical accessibility of the tumor and its relationships with the critical neurovascular structures.Conclusions. Endoscopic endonasal removal of craniopharyngiomas in pediatric patients can be successfully used when the tumor is anatomically accessible. The experience of using EED in surgery for craniopharyngiomas in children has shown positive results, including a high radical removal of the tumor and the absence of relapses during further follow‑up of patients.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124657113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral autoregulation and blood flow distribution in the precerebral arteries for determining indications of extra-intracranial bypass in patients with carotid artery occlusion","authors":"V. Semenyutin, A. Nikiforova, A. Vesnina, K. Samochernykh","doi":"10.17650/1683-3295-2023-25-1-21-27","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-21-27","url":null,"abstract":"Background. Prevention of ischemic stroke in patients with carotid artery occlusion is conventionally associated with performing cerebral revascularization. However, determining the indications for it is still an actual problem. The informative value of noninvasive assessment of cerebral autoregulation and blood flow distribution in the precerebral arteries in patients with carotid artery stenosis is shown. At the same time, in patients with carotid artery occlusion, these indicators have been studied to a lesser extent.Aim. To evaluate the informative value of cerebral autoregulation and blood flow distribution in the precerebral arte ries for determination the indications of extra‑intracranial bypass in patients with carotid occlusion.Materials and methods. 54 patients (aged from 41 to 83 y. o.) with carotid artery occlusion were studied. Blood flow velocity in intracranial arteries was determined with transcranial Doppler (system Multi‑Dop X), whereas flow velocity index in precerebral arteries – with duplex scanning (system Vivid Е). Cerebral autoregulation was assessed based on phase shift between spontaneous oscillations of blood flow velocity in basal cerebral arteries and systemic blood pressure within the range of Mayer’s waves (80–120 mHz).Results. The state of cerebral autoregulation was imparied on both sides in 90 % patients with the symptomatic carotid occlusion (0.3 ± 0.3 rad ipsilateral, 0.7 ± 0.6 rad contralateral). The state of cerebral autoregulation was not impaired in 79 % patients with asymptomatic carotid occlusion (1.0 ± 0.3 rad ipsilateral, 1.1 ± 0.4 rad contralateral). The flow velocity index in the contralateral internal carotid artery (306 ± 109 ml / min) and the ipsilateral vertebral (139 ± 69 ml / min) and external carotid (175 ± 72 ml / min) arteries was increased.Conclusions. Noninvasive preoperative assessment of cerebral autoregulation and blood flow distribution in the precerebral arteries makes to evaluate the state of the cerebrovascular reserve to quantify and can be used to determining indications for cerebral revascularization in patients with carotid occlusion.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124460432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency ablation of epileptogenic periventricular heterotopia","authors":"A. S. Guzeeva, N. Denisova, A. Dmitriev, A. A. Khalepa, N. A. Zubok, F. A. Efremov","doi":"10.17650/1683-3295-2023-25-1-62-69","DOIUrl":"https://doi.org/10.17650/1683-3295-2023-25-1-62-69","url":null,"abstract":"Background. Periventricular heterotopia is one of the causes of the intractable epilepsy. Different treatments of this pathology show variable efficacy.Aim. To present the result of radiofrequency ablation of periventricular heterotopia in a patient with drug‑resistant epilepsy.Materials and methods. 33‑year‑old female patient has been suffering from epilepsy since the age of 19 with frequent focal seizures (up to 70–80 times a month) and bilateral tonic‑clonic seizures (up to 4–6 times a year). In 2018 the patient underwent resection of the right temporal lobe with its medial structures and partial resection of the periventricular heterotopia located in the right lateral ventricle. The frequency of focal seizures after 1st surgical treatment increased till 150 per month, bilateral seizures – up to 3–4 per month. After additional examination stereotaxic radiofrequency ablation of periventricular heterotopia on the right side was performed in 2019 in the Department of Functional Neurosurgery of the Federal Neurosurgical Center (Novosibirsk). In total 5 ablation spots were made in the periventricular heterotopia. Follow‑up period was 14 months. Right after the operation a transient left‑sided hemiparesis has developed (up to 4 score of MRC scale) which regressed by the time of discharge. During 14 months of the follow‑up period the patient had 3 bilateral tonic‑clonic seizures, however, after 2nd surgical treatment focal seizures did not appear.Conclusion. This clinical case demonstrates sufficient efficacy and relative safety of radiofrequency ablation of periventricular heterotopia in drug‑resistant epilepsy.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115433467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: Surgical treatment of combined dural arteriovenous fistula and angiographically occult arteriovenous malformation complicated by intracerebral hemorrhage","authors":"A. Prirodov, E. Y. Bakharev, R. M. Kozlova, M. Y. Sinkin, A. Grin","doi":"10.17650/1683-3295-2022-24-4-85-94","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-4-85-94","url":null,"abstract":"Background. Cerebral arteriovenous malformations and dural arteriovenous fistulas are relatively rare pathologies with frequency of 1–1.5 and 0.1–0.2 cases per 100 000 people per year, respectively. Probability of a combination of these pathologies in a single patient is extremely low. The authors were not able to find publications describing a combination of these pathologies of the cerebral vasculature.Aim. To present a clinical case of successful surgical treatment of combined cerebral pathology – dural arteriovenous fistula and angiographically occult arteriovenous malformation – in a patient with intracranial hemorrhage.Materials and methods. Analysis of the results of treatment of patient with dural arteriovenous fistula with hemorrhagic disease course at the N.V. Sklifosovsky Research Institute of Emergency Medicine (Moscow) was performed. The patient underwent osteoplastic cranial trepanation, resection of the dural arteriovenous fistula. Intraoperatively an angiographically occult arteriovenous malformation was detected which caused the hemorrhage.Results. Surgical treatment allowed to achieve a satisfactory outcome. Intraoperatively diagnosed angiographically occult arteriovenous malformation was confirmed histologically.Conclusions. The presented clinical observation shows the necessity of careful revision of hematoma cavity in the presence of isolated intraparenchymal hemorrhage from dural arteriovenous fistula.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131303639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intramedullary spinal cord metastases: current state of the problem","authors":"V. Ovchinnikov, A. Zuev","doi":"10.17650/1683-3295-2022-24-4-118-123","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-4-118-123","url":null,"abstract":"Intramedullary metastases are a rather rare manifestation of the underlying cancer. Their presence indicates an unfavorable prognosis and leads to a noticeable decrease in the quality of life. The absence of pathognomonic symptoms prevents the rapid and accurate identification of this pathology, which leads to a late diagnosis. The main methods of treating spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy. Refining diagnostic algorithms and optimizing protocols for managing patients with intramedullary metastases can help play a role in improving overall prognosis and patient survival. The review covers the epidemiology, the mechanisms of metastasis, the clinical picture, modern methods of diagnosis and treatment of intramedullary metastases, as well as the outcomes of this pathology. The main methods of treatment of spinal metastases include surgical treatment; radiation and chemotherapy; steroid therapy.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127381772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissection of basal cisterns for treatment of severe traumatic brain injury","authors":"A. Stanishevskiy, K. Babichev, S. Gizatullin, D. V. Svistov, I. Onnitsev, D. Davydov","doi":"10.17650/1683-3295-2022-24-4-111-117","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-4-111-117","url":null,"abstract":"Background. According to WHO, severe traumatic brain injury is among the top ten leading causes of death worldwide. Despite the centuries‑old history of development of the treatment methods to patients with traumatic brain injury their results according to large randomized studies remain unsatisfactory – mortality and severe disability are observed in more than 50 % of patients. Some experimental studies indicate that decompressive craniectomy can aggravate the severity of cerebral edema by creating conditions for traction of nerve fibers and can lead to hemorrhagic transformation of injury foci and ischemia. During the last decade, experimental studies and technological progress have significantly expanded the understanding of brain normal and pathological physiology and made it possible to develop new methods of surgical interventions. In particular, a number of publications have shown significant advantages of dissection of arachnoid spaces of brain base in case of severe traumatic brain injury as compared with classical decompressive craniectomy.Aim. To analyze the literature data on pathophysiological justification, surgery technique and results of dissection of arachnoid spaces of the brain base in case of severe traumatic brain injury as well as the advantages and disadvantages of the method as compared with standard treatment methods of such patients.Materials and methods. Literature search through in the main databases was carried out. The methods of opening of basal subarachnoid spaces in case of severe traumatic brain injury, pathophysiological justification and surgery techniques as well as results of clinical studies of the techniques employed are analyzed.Results. Information on pathogenesis of cerebral edema and pathophysiological justification of effectiveness of opening of brain base cisterns for treatment of traumatic brain injury, data on cisternostomy surgery technique and results were revealed, systematized and analyzed. Publications of individual clinical cases and series of observations indicate acceptable results of cisternostomy in comparison with decompressive craniectomy for treatment of traumatic brain injury.Conclusions. Dissection of arachnoid spaces of the brain base with perforation of the terminal plate and the Liliequist membrane is a promising method of surgical treatment of severe traumatic brain injury.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127806632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysm of the primitive trigeminal artery: a clinical case and a literature review","authors":"S. Goroshchenko, L. Rozhchenko, V. Bobinov, E. G. Kolomin, A. Petrov","doi":"10.17650/1683-3295-2022-24-4-95-100","DOIUrl":"https://doi.org/10.17650/1683-3295-2022-24-4-95-100","url":null,"abstract":"Background. The primitive trigeminal artery is a fetal anastomosis connecting carotid and vertebrobasilar basins during embryonic period of development. After birth, this artery in the child is obliterated and reduced in most cases. Sometimes the obliteration does not occur and as a result the aneurysms may be formed on this artery (due to change in ordinary hemodynamics in carotid basin), as a consequence, it produces a risk of subarachnoid hemorrhage that sharply worsens prognosis of the disease outcome. The usual microsurgical treatment methods of aneurysms of such localization are of little use and are highly traumatic due to the very “low” location of the neck, because the surgery may need extended basal accesses requiring resection of skull base bones. Also, an “open” surgery produces risks of perforating arteries injury that often extend from trigeminal artery and feed the brain stem, the injury will immediately result in brain ischemic damage. That is why the preferred method for treatment of that kind of pathology may include endovascular intervention both of non‑reconstructive type employing microcoils only and those of reconstructive requiring implantation of assisting or flow‑redirecting stents.Aim. To demonstrate a case of successful treatment of patient with a primitive trigeminal artery aneurysm.Materials and methods. A woman, who was admitted to clinic with complaints of convergent strabismus, undergone surgery for large aneurysm located on primitive trigeminal artery. CT brain angiography revealed large aneurysm of primitive trigeminal artery on the right, the result was later confirmed by data of selective cerebral subtraction angiography. Taking into account oculomotor disorders in the patient, it was decided to refrain from microcoils use due to risk of the mass‑effect preservation. Under double disaggregant therapy (ticagrelor 90 mg twice daily + acetylsalicylic acid 100 mg once daily in the evening) and monitoring the functional activity of platelets, a flow‑deflecting stent was implanted into the right internal carotid artery.Results. The patient was discharged from hospital on the 1st day after the surgery and returned to work. A control angiography performed 3 years later revealed a total shutdown of the aneurysm from bloodstream as well as a partial regression of oculomotor disorders. Intravascular treatment in this situation served as an effective method of choice and made it possible to reliably turn off the aneurysm from bloodstream without impairing the functional outcome of patient’s treatment.Conclusions. It can be assumed that intravascular intervention in case of such aneurysms serves as an effective method of choice as minimally invasive and low‑traumatic surgery in the treatment of patients with that type of pathology.","PeriodicalId":197162,"journal":{"name":"Russian journal of neurosurgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129743951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}