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УДК: 616.8–08 DOI:10.33920/med-01-2412-12

Микрохирургическое лечение церебральных аневризм после эндоваскулярного лечения (систематический обзор литературы). Часть 2

Джинджихадзе Реваз Семенович доктор медицинских наук, доцент, руководитель отделения нейрохирургии, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», г. Москва, ORCID https://orcid.org/0000-0003-3283-9524, e-mail: brainsurg77@gmail.com
Гаджиагаев Вадим Султанбекович врач-нейрохирург, научный сотрудник отделения нейрохирургии, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», г. Москва, ORCID https://orcid.org/0000-0001-7661-4402, e-mail: vgadzhiagaev@yandex.ru
Поляков Андрей Викторович кандидат медицинских наук, заведующий отделением нейрохирургии, старший научный сотрудник, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», г. Москва, ORCID https://orcid.org/0000-0001-7413-1968, e-mail: ap.neurosurg@mail.ru
Зайцев Андрей Дмитриевич врач-нейрохирург, младший научный сотрудник отделения нейрохирургии, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», г. Москва, ORCID https://orcid.org/0000-0002-0987-3436, e-mail: Andrew.zay97@gmail.com
Султанов Руслан Айратович кандидат медицинских наук, врач-нейрохирург, научный сотрудник отделения нейрохирургии, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», ул. Щепкина, 61/2, 129110, Москва, Россия, ORCID https://orcid.org/0000-0003-1363-7564, e-mail: rus4455@yandex.ru
Салямова Эльвира Игоревна врач-нейрохирург отделения нейрохирургии, ГБУЗ МО «МОНИКИ им. М. Ф. Владимирского», г. Москва, ORCID https://orcid.org/0000-0001-6449-7114, e-mail: salyamova.neuro@mail.ru

Статья является продолжением обзора литературы, опубликованного в номере 11, в котором авторы провели систематический обзор литературы, посвященной микрохирургическому лечению рекуррентных и резидуальных аневризм после неуспешного эндоваскулярного лечения, определить особенностей хирургической техники в зависимости от причины рецидива аневризмы, локализации, размера, формы аневризмы, а также проанализировать результаты лечения — радикальность выключения, частоту осложнений, клинические исходы. Несмотря на технические сложности, микрохирургическое лечение резидуальных и рекуррентных аневризм является безопасным и эффективным методом в большинстве случаев, при этом лишь у небольшой части пациентов требуется применение нестандартных методик: удаление спиралей, тромбэктомия, деконструктивное вмешательство в комбинации с реваскуляризацией. Агрессивное лечение рекомендуется во всех случаях, когда при долгосрочном ангиографическом наблюдении отмечается увеличивающийся остаток или же рецидив аневризмы.

Литература:

1. Guglielmi G. et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. // J. Neurosurg. United States, 1992. Vol. 77, № 4. P. 515–524.

2. Pierot L. et al. Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device. // J. Neurointerv. Surg. England, 2019. Vol. 11, № 8. P. 807–811.

3. Mbabuike N. et al. Microsurgical Management of Intracranial Aneurysms After Failed Flow Diversion // World Neurosurg. Elsevier Inc., 2020. Vol. 134. P. e16 — e28.

4. Makoui A.S. et al. Early aneurysm recurrence after technically satisfactory Guglielmi detachable coil therapy: is early surveillance needed? Case report. // J. Neurosurg. United States, 2000. Vol. 92, № 2. P. 355–358.

5. Zhang Y.J. et al. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. // Neurosurgery. United States, 2003. Vol. 52, № 2. P. 283–285.

6. Nomura M. et al. Aneurysm clipping after partial endovascular embolization for ruptured cerebral aneurysms. // Interv. Neuroradiol. 2000. Vol. 6 Suppl 1. P. 49–58.

7. Thornton J. et al. Surgery following endovascular coiling of intracranial aneurysms. // Surg. Neurol. United States, 2000. Vol. 54, № 5. P. 352–360.

8. Asgari S. et al. Complementary management of partially occluded aneurysms by using surgical or endovascular therapy // J. Neurosurg. 2002. Vol. 97, № 4. P. 843–850.

9. Conrad M.D. et al. Regrowth of residual ruptured aneurysms treated by Guglielmi’s Detachable Coils which demanded further treatment by surgical clipping: Report of 7 cases and review of the literature // Acta Neurochir. (Wien). 2002. Vol. 144, № 5. P. 419–426.

10. Deinsberger W. et al. Surgical management of previously coiled intracranial aneurysms. // Br.J. Neurosurg. England, 2003. Vol. 17, № 2. P. 149–154.

11. Zhang Y.J. et al. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy // Neurosurgery. 2003. Vol. 52, № 2. P. 283–295.

12. Veznedaroglu E. et al. Surgically Treated Aneurysms Previously Coiled: Lessons Learned // Neurosurgery. 2004. Vol. 54, № 2. P. 300–305.

13. Minh T. et al. Neurosurgical management of intracranial aneurysms following unsuccessful or incomplete endovascular therapy. // Br.J. Neurosurg. England, 2006. Vol. 20, № 5. P. 306–311.

14. König R.W. et al. Neurosurgical management of previously coiled recurrent intracranial aneurysms. // Zentralbl. Neurochir. Germany, 2007. Vol. 68, № 1. P. 8–13.

15. Raftopoulos C. et al. Neurosurgical management of inadequately embolized intracranial aneurysms: a series of 17 consecutive cases. // Acta Neurochir. (Wien). Austria, 2007. Vol. 149, № 1. P. 11–19.

16. Tirakotai W. et al. Surgery of intracranial aneurysms previously treated endovascularly // Clin. Neurol. Neurosurg. 2007. Vol. 109, № 9. P. 744–752.

17. Klein O. et al. Aneurysm clipping after endovascular treatment with coils: A report of 13 cases // Neurosurg. Rev. 2008. Vol. 31, № 4. P. 403–411.

18. Lejeune J.P. et al. Neurosurgical treatment for aneurysm remnants or recurrences after coil occlusion // Neurosurgery. 2008. Vol. 63, № 4. P. 684–691.

19. Waldron J. S., Halbach V. V, Lawton M.T. Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion. // Neurosurgery. United States, 2009. Vol. 64, № 5 Suppl 2. P. 301–307.

20. Chung J. et al. Early and late microsurgical clipping for initially coiled intracranial aneurysms. // Neuroradiology. Germany, 2010. Vol. 52, № 12. P. 1143–1151.

21. Kumar R. et al. Surgical management of intracranial aneurysms previously treated with endovascular therapy. // Neurol. India. India, 2010. Vol. 58, № 2. P. 292–297.

22. Ramanathan D. et al. Treatment of coil embolization failed recurrent giant basilar tip aneurysms with bypass and surgical occlusion. // J. Neurointerv. Surg. England, 2010. Vol. 2, № 3. P. 237–241.

23. Yu J.-L. et al. Microsurgical Clipping of Intracranial Aneurysms Following Unsuccessful Endovascular Treatment: Analysis of Ten cases. // Interv. Neuroradiol. 2010. Vol. 16, № 1. P. 23–30.

24. Deshaies E.M. Extruded Platinum Coils from Recurrent Previously Coiled Intracranial Aneurysms Discovered at the Time of Microsurgical Clip Ligation: A Report of three Cases. // Interv. Neuroradiol. 2011. Vol. 17, № 1. P. 59–63.

25. Romani R. et al. Microsurgery for previously coiled aneurysms: Experience with 81 patients // Neurosurgery. 2011. Vol. 68, № 1. P. 140–153.

26. Dorfer C. et al. Management of residual and recurrent aneurysms after initial endovascular treatment. // Neurosurgery. United States, 2012. Vol. 70, № 3. P. 534–537.

27. Nakamura M. et al. Microsurgical clipping of previously coiled intracranial aneurysms. // Clin. Neurol. Neurosurg. Netherlands, 2013. Vol. 115, № 8. P. 1343–1349.

28. Izumo T. et al. Microsurgical Clipping for Recurrent Aneurysms after Initial Endovascular Coil Embolization // World Neurosurg. Elsevier Inc, 2015. Vol. 83, № 2. P. 211–218.

29. Owen C.M., Montemurro N., Lawton M.T. Microsurgical Management of Residual and Recurrent Aneurysms After Coiling and Clipping: An Experience With 97 Patients. // Neurosurgery. United States, 2015. Vol. 62 Suppl 1. P. 92–102.

30. Daou B. et al. Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients. // J. Neurosurg. United States, 2016. Vol. 125, № 6. P. 1337–1343.

31. Nisson P. L. et al. Surgical Clipping of Previously Ruptured, Coiled Aneurysms: Outcome Assessment in 53 Patients // World Neurosurg. Elsevier Inc, 2018. Vol. 120. P. e203 — e211.

32. Shtaya A. et al. Outcomes of Microsurgical Clipping of Recurrent Aneurysms After Endovascular Coiling // World Neurosurg. Elsevier Inc, 2018. Vol. 112. P. e540 — e547.

33. Toyota S. et al. Clipping of recurrent cerebral aneurysms after coil embolization // Acta Neurochir. Suppl. 2018. Vol. 129. P. 53–59.

34. Kutty R.K. et al. Management of Recurrent Aneurysms after Endovascular Coiling: A Fujita Experience. // Asian J. Neurosurg. 2019. Vol. 14, № 4. P. 1151–1156.

35. Liu J.J. et al. Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients // World Neurosurg. Elsevier Inc, 2019. Vol. 124. P. e649 — e658.

36. Roy A.K. et al. Microsurgical Treatment of Cerebral Aneurysms After Previous Endovascular Therapy: Single-Center Series and Systematic Review. // World Neurosurg. United States, 2019. Vol. 123. P. e103 — e115.

37. Wu J. et al. Microsurgical ligation for incompletely coiled or recurrent intracranial aneurysms: A 17-year single-center experience // Chinese Neurosurg. J. Chinese Neurosurgical Journal, 2019. Vol. 5, № 1. P. 1–14.

38. Lee J. et al. Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization. // J. Cerebrovasc. Endovasc. Neurosurg. Korea (South), 2020. Vol. 22, № 3. P. 165–175.

39. Raper D.M. S. et al. Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms. // Oper. Neurosurg. (Hagerstown, Md.). United States, 2020. Vol. 19, № 4. P. 393–402.

40. Pirayesh A. et al. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization — a quest for the ultimate therapy // Neurosurg. Rev. Neurosurgical Review, 2021. Vol. 44, № 2. P. 1031–1051.

41. Rotim K. et al. MICROSURGICAL MANAGEMENT OF RECURRENT INTRACRANIAL ANEURYSMS FOLLOWING ENDOVASCULAR TREATMENT: A SINGLE INSTITUTION ILLUSTRATIVE CASE SERIES AND LITERATURE REVIEW. // Acta Clin. Croat. 2021. Vol. 60, № 4. P. 695–702.

42. Zheng Y. et al. Surgical Clipping of Previously Coiled Recurrent Intracranial Aneurysms: A Single-Center Experience // Front. Neurol. 2021. Vol. 12, № September.

43. Srinivasan V.M. et al. Retreatment of Residual and Recurrent Aneurysms After Embolization With the Woven EndoBridge Device: Multicenter Case Series // Neurosurgery. 2022. Vol. 90, № 5. P. 569–580.

44. Inci S., Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. // World Neurosurg. United States, 2023. Vol. 171. P. e336 — e348.

45. Kranawetter B. et al. Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono — institutional case series World Federation of Neurosurgical Societies // Acta Neurochir. (Wien). Springer Vienna, 2023. P. 1881–1889.

46. Johnston S.C. et al. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. // Stroke. United States, 2008. Vol. 39, № 1. P. 120–125.

47. Li H. et al. Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization. // J. Neurol. Surg.A. Cent. Eur. Neurosurg. Germany, 2020. Vol. 81, № 3. P. 207–212.

48. Dornbos D. 3rd et al. Pipeline embolization device for recurrence of previously treated aneurysms. // Neurosurg. Focus. United States, 2017. Vol. 42, № 6. P. E8.

49. Benaissa A. et al. Endovascular treatment with flow diverters of recanalized and multitreated aneurysms initially treated by endovascular approach. // J. Neurointerv. Surg. England, 2015. Vol. 7, № 1. P. 44–49.

50. Dai D. et al. Characterizing patterns of endothelialization following coil embolization: a whole-mount, dual immunostaining approach. // J. Neurointerv. Surg. England, 2016. Vol. 8, № 4. P. 402–406.

51. Bell R. S. et al. Can a self-expanding aneurysm stent be clipped? Emergency proximal control options for the vascular neurosurgeon. // Neurosurgery. United States, 2011. Vol. 68, № 4. P. 1056–1062.

52. Wang H.W. et al. Surgical management of recurrent aneurysms after coiling treatment // Br.J. Neurosurg. Informa UK Limited, trading as Taylor 8 Francis Group, 2017. Vol. 31, № 1. P. 96–100.

1. Guglielmi G. et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. // J. Neurosurg. United States, 1992. Vol. 77, № 4. P. 515–524.

2. Pierot L. et al. Clipping of recanalized intracerebral aneurysms initially treated by the Woven EndoBridge device. // J. Neurointerv. Surg. England, 2019. Vol. 11, № 8. P. 807–811.

3. Mbabuike N. et al. Microsurgical Management of Intracranial Aneurysms After Failed Flow Diversion // World Neurosurg. Elsevier Inc., 2020. Vol. 134. P. e16 — e28.

4. Makoui A. S. et al. Early aneurysm recurrence after technically satisfactory Guglielmi detachable coil therapy: is early surveillance needed? Case report. // J. Neurosurg. United States, 2000. Vol. 92, № 2. P. 355–358.

5. Zhang Y.J. et al. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy. // Neurosurgery. United States, 2003. Vol. 52, № 2. P. 283–285.

6. Nomura M. et al. Aneurysm clipping after partial endovascular embolization for ruptured cerebral aneurysms. // Interv. Neuroradiol. 2000. Vol. 6 Suppl 1. P. 49–58.

7. Thornton J. et al. Surgery following endovascular coiling of intracranial aneurysms. // Surg. Neurol. United States, 2000. Vol. 54, № 5. P. 352–360.

8. Asgari S. et al. Complementary management of partially occluded aneurysms by using surgical or endovascular therapy // J. Neurosurg. 2002. Vol. 97, № 4. P. 843–850.

9. Conrad M.D. et al. Regrowth of residual ruptured aneurysms treated by Guglielmi’s Detachable Coils which demanded further treatment by surgical clipping: Report of 7 cases and review of the literature // Acta Neurochir. (Wien). 2002. Vol. 144, № 5. P. 419–426.

10. Deinsberger W. et al. Surgical management of previously coiled intracranial aneurysms. // Br.J. Neurosurg. England, 2003. Vol. 17, № 2. P. 149–154.

11. Zhang Y.J. et al. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy // Neurosurgery. 2003. Vol. 52, № 2. P. 283–295.

12. Veznedaroglu E. et al. Surgically Treated Aneurysms Previously Coiled: Lessons Learned // Neurosurgery. 2004. Vol. 54, № 2. P. 300–305.

13. Minh T. et al. Neurosurgical management of intracranial aneurysms following unsuccessful or incomplete endovascular therapy. // Br.J. Neurosurg. England, 2006. Vol. 20, № 5. P. 306–311.

14. König R.W. et al. Neurosurgical management of previously coiled recurrent intracranial aneurysms. // Zentralbl. Neurochir. Germany, 2007. Vol. 68, № 1. P. 8–13.

15. Raftopoulos C. et al. Neurosurgical management of inadequately embolized intracranial aneurysms: a series of 17 consecutive cases. // Acta Neurochir. (Wien). Austria, 2007. Vol. 149, № 1. P. 11–19.

16. Tirakotai W. et al. Surgery of intracranial aneurysms previously treated endovascularly // Clin. Neurol. Neurosurg. 2007. Vol. 109, № 9. P. 744–752.

17. Klein O. et al. Aneurysm clipping after endovascular treatment with coils: A report of 13 cases // Neurosurg. Rev. 2008. Vol. 31, № 4. P. 403–411.

18. Lejeune J.P. et al. Neurosurgical treatment for aneurysm remnants or recurrences after coil occlusion // Neurosurgery. 2008. Vol. 63, № 4. P. 684–691.

19. Waldron J. S., Halbach V. V, Lawton M.T. Microsurgical management of incompletely coiled and recurrent aneurysms: trends, techniques, and observations on coil extrusion. // Neurosurgery. United States, 2009. Vol. 64, № 5 Suppl 2. P. 301–307.

20. Chung J. et al. Early and late microsurgical clipping for initially coiled intracranial aneurysms. // Neuroradiology. Germany, 2010. Vol. 52, № 12. P. 1143–1151.

21. Kumar R. et al. Surgical management of intracranial aneurysms previously treated with endovascular therapy. // Neurol. India. India, 2010. Vol. 58, № 2. P. 292–297.

22. Ramanathan D. et al. Treatment of coil embolization failed recurrent giant basilar tip aneurysms with bypass and surgical occlusion. // J. Neurointerv. Surg. England, 2010. Vol. 2, № 3. P. 237–241.

23. Yu J.-L. et al. Microsurgical Clipping of Intracranial Aneurysms Following Unsuccessful Endovascular Treatment: Analysis of Ten cases. // Interv. Neuroradiol. 2010. Vol. 16, № 1. P. 23–30.

24. Deshaies E.M. Extruded Platinum Coils from Recurrent Previously Coiled Intracranial Aneurysms Discovered at the Time of Microsurgical Clip Ligation: A Report of three Cases. // Interv. Neuroradiol. 2011. Vol. 17, № 1. P. 59–63.

25. Romani R. et al. Microsurgery for previously coiled aneurysms: Experience with 81 patients // Neurosurgery. 2011. Vol. 68, № 1. P. 140–153.

26. Dorfer C. et al. Management of residual and recurrent aneurysms after initial endovascular treatment. // Neurosurgery. United States, 2012. Vol. 70, № 3. P. 534–537.

27. Nakamura M. et al. Microsurgical clipping of previously coiled intracranial aneurysms. // Clin. Neurol. Neurosurg. Netherlands, 2013. Vol. 115, № 8. P. 1343–1349.

28. Izumo T. et al. Microsurgical Clipping for Recurrent Aneurysms after Initial Endovascular Coil Embolization // World Neurosurg. Elsevier Inc, 2015. Vol. 83, № 2. P. 211–218.

29. Owen C.M., Montemurro N., Lawton M.T. Microsurgical Management of Residual and Recurrent Aneurysms After Coiling and Clipping: An Experience With 97 Patients. // Neurosurgery. United States, 2015. Vol. 62 Suppl 1. P. 92–102.

30. Daou B. et al. Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients. // J. Neurosurg. United States, 2016. Vol. 125, № 6. P. 1337–1343.

31. Nisson P. L. et al. Surgical Clipping of Previously Ruptured, Coiled Aneurysms: Outcome Assessment in 53 Patients // World Neurosurg. Elsevier Inc, 2018. Vol. 120. P. e203 — e211.

32. Shtaya A. et al. Outcomes of Microsurgical Clipping of Recurrent Aneurysms After Endovascular Coiling // World Neurosurg. Elsevier Inc, 2018. Vol. 112. P. e540 — e547.

33. Toyota S. et al. Clipping of recurrent cerebral aneurysms after coil embolization // Acta Neurochir. Suppl. 2018. Vol. 129. P. 53–59.

34. Kutty R.K. et al. Management of Recurrent Aneurysms after Endovascular Coiling: A Fujita Experience. // Asian J. Neurosurg. 2019. Vol. 14, № 4. P. 1151–1156.

35. Liu J.J. et al. Surgical Treatment of Recurrent Previously Coiled and/or Stent-Coiled Intracerebral Aneurysms: A Single-Center Experience in a Series of 75 Patients // World Neurosurg. Elsevier Inc, 2019. Vol. 124. P. e649 — e658.

36. Roy A.K. et al. Microsurgical Treatment of Cerebral Aneurysms After Previous Endovascular Therapy: Single-Center Series and Systematic Review. // World Neurosurg. United States, 2019. Vol. 123. P. e103 — e115.

37. Wu J. et al. Microsurgical ligation for incompletely coiled or recurrent intracranial aneurysms: A 17-year single-center experience // Chinese Neurosurg. J. Chinese Neurosurgical Journal, 2019. Vol. 5, № 1. P. 1–14.

38. Lee J. et al. Microsurgical treatment for the recurrent cerebral aneurysm initially treated using coil embolization. // J. Cerebrovasc. Endovasc. Neurosurg. Korea (South), 2020. Vol. 22, № 3. P. 165–175.

39. Raper D.M. S. et al. Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms. // Oper. Neurosurg. (Hagerstown, Md.). United States, 2020. Vol. 19, № 4. P. 393–402.

40. Pirayesh A. et al. Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization — a quest for the ultimate therapy // Neurosurg. Rev. Neurosurgical Review, 2021. Vol. 44, № 2. P. 1031–1051.

41. Rotim K. et al. MICROSURGICAL MANAGEMENT OF RECURRENT INTRACRANIAL ANEURYSMS FOLLOWING ENDOVASCULAR TREATMENT: A SINGLE INSTITUTION ILLUSTRATIVE CASE SERIES AND LITERATURE REVIEW. // Acta Clin. Croat. 2021. Vol. 60, № 4. P. 695–702.

42. Zheng Y. et al. Surgical Clipping of Previously Coiled Recurrent Intracranial Aneurysms: A Single-Center Experience // Front. Neurol. 2021. Vol. 12, № September.

43. Srinivasan V.M. et al. Retreatment of Residual and Recurrent Aneurysms After Embolization With the Woven EndoBridge Device: Multicenter Case Series // Neurosurgery. 2022. Vol. 90, № 5. P. 569–580.

44. Inci S., Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. // World Neurosurg. United States, 2023. Vol. 171. P. e336 — e348.

45. Kranawetter B. et al. Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono — institutional case series World Federation of Neurosurgical Societies // Acta Neurochir. (Wien). Springer Vienna, 2023. P. 1881–1889.

46. Johnston S.C. et al. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. // Stroke. United States, 2008. Vol. 39, № 1. P. 120–125.

47. Li H. et al. Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization. // J. Neurol. Surg.A. Cent. Eur. Neurosurg. Germany, 2020. Vol. 81, № 3. P. 207–212.

48. Dornbos D. 3rd et al. Pipeline embolization device for recurrence of previously treated aneurysms. // Neurosurg. Focus. United States, 2017. Vol. 42, № 6. P. E8.

49. Benaissa A. et al. Endovascular treatment with flow diverters of recanalized and multitreated aneurysms initially treated by endovascular approach. // J. Neurointerv. Surg. England, 2015. Vol. 7, № 1. P. 44–49.

50. Dai D. et al. Characterizing patterns of endothelialization following coil embolization: a whole-mount, dual immunostaining approach. // J. Neurointerv. Surg. England, 2016. Vol. 8, № 4. P. 402–406.

51. Bell R. S. et al. Can a self-expanding aneurysm stent be clipped? Emergency proximal control options for the vascular neurosurgeon. // Neurosurgery. United States, 2011. Vol. 68, № 4. P. 1056–1062.

52. Wang H.W. et al. Surgical management of recurrent aneurysms after coiling treatment // Br.J. Neurosurg. Informa UK Limited, trading as Taylor 8 Francis Group, 2017. Vol. 31, № 1. P. 96–100.

Среди всех послеоперационных осложнений наиболее часто встречались ишемические осложнения. В среднем они наблюдались у 6.4 % пациентов в сериях (СО ±6,0 %, 95 % ДИ 3,9 %–8,8 %). В некоторых статьях проводилась попытка определения влияния на риск развития ишемических осложнений различных факторов (локализация, размер, форма аневризмы, вид эндоваскулярного вмешательства). В большинстве случаев статистически значимой связи определить не удалось. Единственным доказанным фактором увеличения риска осложнений являлось применение стент-ассистенции при эмболизации аневризмы. Также тенденция к статистической значимости определялась для локализации аневризмы — риск был немного выше при аневризмах вертебро-базилярного бассейна.

Геморрагических осложнений, связанных с неполным выключением аневризмы, в исследованиях не наблюдалось. У небольшого числа пациентов (2,6 %–4,1 %) встречались геморрагические осложнения, связанные с этапами микрохирургической операции (эпи- и субдуральные, а также подкожные гематомы). Инфекционные осложнения (менингит, пневмония) встречались в 2,6 %–4,8 % случаев, дисфункции черепных нервов — 6,0 %. Средняя летальность в сериях составила 1.8 % (СО ±3,5, 95 % ДИ 0.3 %–3,3 %).

В литературе приводится только одна серия наблюдений микрохирургического лечения пациентов после неуспешного лечения при помощи поток-перенаправляющих стентов [3] flow diversion (FD. В серию вошли 13 пациентов. У восьми из них были внутричерепные аневризмы каротидного бассейна без разрыва, у двух пациентов — крупная фузиформная аневризма вертебробазилярного бассейна и у одного — гигантская аневризма ствола базилярной артерии. У одного пациента после предыдущего лечения при помощи поток-перенаправляющего стента возникла аневризма бифуркации ВСА с отсроченным разрывом. У одного пациента была ранее разорвавшаяся аневризма супраклиноидного сегмента ВСА, первоначально выключенная при помощи ППС. Несмотря на проведение повторной процедуры установки ППС у пациента отмечалось прогрессирующее увеличение аневризмы.

Для Цитирования:
Джинджихадзе Реваз Семенович, Гаджиагаев Вадим Султанбекович, Поляков Андрей Викторович, Зайцев Андрей Дмитриевич, Султанов Руслан Айратович, Салямова Эльвира Игоревна, Микрохирургическое лечение церебральных аневризм после эндоваскулярного лечения (систематический обзор литературы). Часть 2. Вестник неврологии, психиатрии и нейрохирургии. 2024;12.
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