Revaz Semenovich Dzhindzhikhadze PhD in Medicine, associate professor, head of the Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russian Federation, ORCID https://orcid.org/0000-0003-3283-9524, e-mail: brainsurg77@gmail.com
Vadim Sultanbekovich Gadzhiagaev neurosurgeon, researcher of the Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russian Federation, ORCID https:// orcid.org/0000-0001-7661-4402, e-mail: vgadzhiagaev@yandex.ru
Andrey Viktorovich Polyakov PhD Candidate in Medicine, head of the Department of Neurosurgery, senior researcher, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russian Federation, ORCID https://orcid.org/0000-0001-7413-1968, e-mail: ap.neurosurg@mail.ru
Andrey Dmitrievich Zaytsev neurosurgeon, junior researcher of the Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russian Federation, ORCID https:// orcid.org/0000-0002-0987-3436, e-mail: Andrew.zay97@gmail.com
Ruslan Airatovich Sultanov PhD Candidate in Medicine, neurosurgeon, researcher of the Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russia, ORCID https://orcid.org/0000-0003-1363-7564, e-mail: rus4455@yandex.ru
Elvira Igorevna Salyamova neurosurgeon of the Department of Neurosurgery, Moscow Regional Clinical Research Institute named after M. F. Vladimirsky, 61/2, Shchepkina str., Moscow, 129110, Russian Federation, ORCID https://orcid.org/0000-0001-6449-7114, e-mail: salyamova.neuro@mail.ru
Currently, the indications for the use of endovascular techniques for intracranial aneurysm exclusion have significantly expanded. However, despite the introduction of new methods and devices, endovascular treatment of cerebral aneurysms has a significant drawback: lower radical exclusion. The long-term risk of aneurysm recurrence after endovascular embolization is significantly higher and can reach 15-34%, while the recurrence rate after clipping is about 1-3%. Objective. To conduct a systematic review of the literature on microsurgical treatment of recurrent and residual aneurysms after unsuccessful endovascular treatment, determine the surgical technique features depending on the cause of aneurysm recurrence, localization, size, and shape of the aneurysm, and analyze treatment outcomes, including radical exclusion, complication rates, and clinical outcomes. Materials and methods. A systematic review was conducted according to PRISMA guidelines. Literature searches were performed in PubMed and Web of Science databases. Patient data were extracted from the articles, along with morphological parameters of aneurysms: localization, aneurysm size, neck size, and shape of the aneurysm. Aneurysm occlusion rate was assessed using the modified Raymond-Roy scale. Clinical outcomes were evaluated using the modified Rankin scale. Results. After reviewing the full text of the articles, 42 studies were selected for final analysis. Most commonly, ICA aneurysms were encountered in the described series (40.6%), with the supraclinoid segment of the ICA being the most common location (31.8%). The average size was 9.81 mm (SD 7.57 mm, 95% CI 8.87-10.70 mm). Radical exclusion of aneurysms during microsurgical operations in patients after unsuccessful endovascular embolization was observed on average in 94.4% ± 8.4% (95% CI 90.0%-98.0%). Among all postoperative complications, ischemic complications were the most common, occurring on average in 6.4% of patients in the series (SD ±6.0%, 95% CI 3.9%-8.8%). The only proven factor increasing the risk of complications was the use of stent assistance during aneurysm embolization. There was also a tendency towards statistical significance for aneurysm localization, with the risk being slightly higher for vertebrobasilar aneurysms. Conclusion. Despite technical difficulties, microsurgical treatment of residual and recurrent aneurysms is a safe and effective method in most cases, with only a small number of patients requiring unconventional techniques such as coil removal, thrombectomy, or deconstructive procedures combined with revascularization. Aggressive treatment is recommended in all cases where longterm angiographic follow-up shows an increasing residual or recurrent aneurysm.
