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Kheireddin AS, Pronin IN, Yakovlev SB, Belousova OB, Kaftanov AN, Vinogradov EV. [Pathological tortuosity of intracranial arteries (pure arterial malformation) - diagnosis and management tactics]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:14-22. [PMID: 38549406 DOI: 10.17116/neiro20248802114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Tortuosity of intracranial arteries is rare and usually mistaken for arteriovenous malformations. In the world literature, the term «pure arterial malformations» is used to refer to this disease. OBJECTIVE To summarize the experience of the Burdenko Neurosurgery Center on diagnosis of intracranial artery tortuosity, management and treatment of these patients, as well as to review appropriate literature data. MATERIAL AND METHODS Tortuosity of intracranial arteries was detected in 11 patients (8 women and 3 men) aged 7-48 years who underwent outpatient or inpatient examination and treatment at the Burdenko Neurosurgery Center between 2009 and 2022. We analyzed angiographic, clinical and follow-up data of these patients, as well as appropriate literature data. RESULTS According to angiography data, all patients had moderate dilatation, elongation and tortuosity of intracranial arteries without signs of arteriovenous shunting. The most common finding was tortuosity of several segments of internal carotid artery (5 cases). Lesion of PCA, PComA, MCA and ACA was less common. In 7 cases, the walls of the deformed vessels had calcified zones. In two cases, there were saccular aneurysms in the walls of the tortuous vessels. In one case, tortuosity was combined with kinking of the left subclavian artery, in another one - tortuosity of C1 segment of the right ICA. No patient had specific clinical manifestations. The follow-up period was 1-10 years in 7 patients. There were no changes in structure of tortuosity or appearance of new aneurysms. CONCLUSION Tortuosity of intracranial arteries is an extremely rare disease with the highest incidence in young women. This abnormality has no specific clinical manifestations and does not require surgical or conservative treatment. Tortuosity of intracranial arteries should be differentiated from arterial dolichoectasia, fusiform aneurysms and AVMs.
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Affiliation(s)
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Buklina SB, Kaftanov AN, Melikyan AG, Kopachev DN, Batalov AI. [Crossed aphasia in neurosurgical practice: case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2022; 86:103-111. [PMID: 35170283 DOI: 10.17116/neiro202286011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Crossed aphasia in dexstral (CAD) is an extremely rare disorder. To date, about 200 cases have been described in the literature. MATERIAL AND METHODS The authors report 4 cases of CAD. Luria's neuropsychological examination was carried out. Functional asymmetry in the arm was analyzed using the Annett questionnaire. MRI and intraoperative findings confirmed localization of lesion in the right hemisphere in all patients. RESULTS A 59-year-old right-handed man developed frontotemporal aphasia after previous resection of right-sided glioblastoma of fronto-insular-temporal region. In a 31-year-old right-handed man, crossed aphasia occurred after extensive hemorrhage from arteriovenous malformation into the right frontotemporoparietal region. A 39-year-old right-handed man developed severe combined aphasia after resection of diffuse glioma of the right insular-temporal region. A 10-year-old right-handed boy developed aphasia with word forgetting after resection of a large tumor of the right temporal lobe. All patients had impaired dynamic praxis. Other cognitive functions were intact. CONCLUSION The authors discuss possible combinations of functions in one hemisphere for both right-handers and left-handers and emphasize diverse types of functional asymmetries described in the literature. Different localizations of functions in right-handers and left-handers indicate that local zones with different methods of information processing (successive or simultaneous) can coexist in one hemisphere. Therefore, the functions requiring different processing of information (for example, speech with praxis or spatial functions) can develop in one hemisphere. Cognitive impairment depends not only on the type of functional asymmetry, but also on localization of lesion. Crossed aphasia in right-handers indicates the rarest normal type of functional brain asymmetry with localization of speech functions in the right hemisphere. Possible aphasia in right-handers following damage to homologues of speech zones in the right hemisphere can require additional examination of these patients.
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Affiliation(s)
- S B Buklina
- Burdenko Neurosurgical Center, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | | | | | - A I Batalov
- Burdenko Neurosurgical Center, Moscow, Russia
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3
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Kheyreddin AS, Kaftanov AN, Yakovlev SB, Eliava SS, Arustamyan SR, Mikeladze KG. [Surgical treatment of vertebral artery confluence aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:45-52. [PMID: 34156206 DOI: 10.17116/neiro20218503145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aneurysms of vertebral artery confluence and proximal parts of basilar artery are extremely rare. They are usually combined with proximal fenestration of basilar artery. No timely surgical treatment of these aneurysms is associated with high risk of adverse outcomes, and their treatment is a challenge for neurosurgeons. MATERIAL AND METHODS We analyzed postoperative outcomes in 17 patients with 21 aneurysms of vertebral artery confluence and proximal parts of basilar artery. RESULTS Six patients with 10 aneurysms underwent microsurgical resection, 11 patients with 11 aneurysms - endovascular procedure. Persistent postoperative deterioration was observed in 5 (29.4%) patients: severe neurological symptoms (GOS grade 3) in 1 case (5.9%), minor bulbar disorders in 4 cases (23.53%). There were no lethal outcomes. CONCLUSION According to our own and literature data, aneurysms of vertebral artery confluence are extremely rare. The risk of rupture of these aneurysms is extremely high. Endovascular approach is preferred in these patients. Microsurgical procedure is an acceptable alternative if endovascular surgery is impossible.
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Affiliation(s)
- A S Kheyreddin
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - A N Kaftanov
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - S B Yakovlev
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Sh Sh Eliava
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - S R Arustamyan
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - K G Mikeladze
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
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4
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Pilipenko YV, Gorozhanin VA, Eliava SS, Varyukhina MD, Kaftanov AN. [Microsurgical resection of multiple unruptured cerebral AVMs. Case report and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2020; 84:69-75. [PMID: 32759929 DOI: 10.17116/neiro20208404169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple brain arteriovenous malformations (AVMs) are extremely rare. We report a 26-year-old patient with paroxysmal symptoms. This was the first case in our center over 10 years (0.15% of all patients with brain AVM in this period). Microsurgical resection of AVM of the left temporal lobe was carried out at the first stage (Spetzler-Martin grade I). A month later, resection of AVM of the left parietal lobe (Spetzler-Martin grade III) after preliminary endovascular embolization was carried out. Early postoperative visual and mental disorders occurred after the second surgery and completely regressed within 1 month. Control angiography after the second operation confirmed total resection of both AVMs. Thus, staged microsurgical resection of two cerebral AVMs combined with preliminary endovascular embolization of more complex AVM was effective and ensured favorable clinical result. We analyzed the features of our clinical case and compared our findings with literature data.
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5
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Kheyreddin AS, Kaftanov AN, Sazonov IA. [Combination of infraoptic anterior cerebral artery with an aneurysm of the ACA-AcomA complex. Case study and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2019; 83:82-89. [PMID: 31577273 DOI: 10.17116/neiro20198304182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The infraoptic anterior cerebral artery (ACA) is an abnormal vessel that usually is a bifurcation of the intradural part of the internal carotid artery (ICA) or near the site of discharge of the ophthalmic artery, which passes under the ipsilateral optic nerve and penetrates between the optic nerves into the prechiasm cistern, reaching the ACA-AcomA complex. The infra-optic ACA is an extremely rare anomaly, but it may be of great clinical significance in surgery of the arteries of the anterior sections of the Willis circle. The article describes the case of a combination of infra-optical ACA with an aneurysm of the ACA-AcomA complex. This observation is of interest both from the viewpoint of the rarity of the considered pathology and the associated increased risk of the formation of intracranial aneurysms.
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Affiliation(s)
| | | | - I A Sazonov
- Burdenko Neurosurgical Center, Moscow, Russia
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6
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Kheyreddin AS, Filatov YM, Kaftanov AN, Sazonov IA, Bukharin EY, Dmitriev AV. [Rupture of a giant aneurysm of the accessory middle cerebral artery: a case report and a literature review]. Zh Vopr Neirokhir Im N N Burdenko 2018; 81:103-107. [PMID: 29393293 DOI: 10.17116/neiro2017816103-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The accessory middle cerebral artery is a rare congenital vascular abnormality. The international literature has reported cases of accessory MCA aneurysms. In this article, we describe a case of rupture of a giant partially thrombosed aneurysm of the accessory MCA. This case is of great interest due to rarity of the pathology and associated diagnostic errors.
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Affiliation(s)
- A S Kheyreddin
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
| | - Yu M Filatov
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
| | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
| | - I A Sazonov
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
| | - E Yu Bukharin
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
| | - A V Dmitriev
- Burdenko Neurosurgical Institute, Moscow, Russia, 125047
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7
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Kheireddin AS, Lubnin AY, Kaftanov AN, Akhvlediani KN, Belousova OB, Dmitriev AV, Kuchina OB. [Surgical treatment of a pregnant female with AVM hemorrhage]. Zh Vopr Neirokhir Im N N Burdenko 2017; 81:88-94. [PMID: 28291219 DOI: 10.17116/neiro201780788-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hemorrhages from arteriovenous malformations (AVMs) in pregnant females are rare, but they are known to lead to high maternal and infant mortality. There are no standards for AVM treatment in pregnant females. Many authors believe that AVM resection before delivery improves the prognosis for life and health of the mother and fetus. In this paper, we present a case of successful surgical treatment of a female patient with AVM hemorrhage at 20 weeks and address management issues of these patients.
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Affiliation(s)
- A S Kheireddin
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - K N Akhvlediani
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - O B Belousova
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - A V Dmitriev
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
| | - O B Kuchina
- Burdenko Neurosurgical Institute, Moscow, Russia, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia
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8
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Arustamyan SR, Yakovlev SB, Shakhnovich AR, Krasnoperov IV, Sazonova OB, Bocharov AV, Bukharin EY, Belousova OB, Kaftanov AN. [Results of deconstructive endovascular surgery in treatment of large and giant intracranial aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2016; 80:22-31. [PMID: 27801396 DOI: 10.17116/neiro201680522-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To clarify the indications for deconstructive endovascular surgery in patients with large and giant intracranial aneurysms and to evaluate short-term and long-term postoperative outcomes. MATERIAL AND METHODS The study was based on a retrospective analysis of the treatment results in 50 patients with large (15-25 mm) and giant (more than 25 mm) intracranial aneurysms, aged from 18 to 75 years, who were treated at the Burdenko Neurosurgical Institute in 2002-2014. The patients underwent a balloon occlusion test (BOT) in various modifications before stationary occlusion of the carrier artery. For vascular occlusion, we used detachable latex balloon catheters (33 cases) and microcoils (17 cases). The condition of patients in the pre- and postoperative period was assessed by using the modified Rankin Scale. RESULTS There were no deaths due to occlusion of the internal carotid artery (37 patients). Postoperative complications occurred in 5 patients. On the basis of BOT, revascularization surgery involving placement of an extra-intracranial microanastomosis (EICMA) was performed in 6 cases. In more 4 cases, EICMA was placed in the early postoperative period due to developing signs of ischemia. Two of 7 patients underwent occlusion of both vertebral arteries (VAs) in the vertebrobasilar basin, which led to fatal outcomes. One more patient died of aggravation of brainstem compression after VA occlusion. There was no worsening of neurological symptoms among survivors. There were no deaths and persistent neurological disorders upon occlusion of branches of the main cerebral arteries, starting with the first order arteries (6 patients). Thirty one patients (66%) were followed-up in the period from 1 to 104 months. There were no deaths associated with artery occlusion. Two patients experienced delayed ischemic disorders. CONCLUSION Occlusion of the carrier artery should be performed in a carefully selected group of BOT-negative patients. This surgery can be indicated for aneurysms with a complicated configuration, the topographic and anatomical features of which exclude reconstructive surgery.
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Affiliation(s)
| | - S B Yakovlev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - O B Sazonova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A V Bocharov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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9
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Kheyreddin AS, Eliava SS, Yakovlev SB, Filatov YM, Kaftanov AN, Belousova OB, Sazonov IA, Arustamyan SR, Mikeladze KG, Bukharin EY, Dorokhov PS. [Tactics of surgical treatment of patients with unruptured asymptomatic cerebral aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2016; 80:32-43. [PMID: 27801397 DOI: 10.17116/neiro201680532-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To clarify the indications for surgical treatment and the principles for choosing a surgical technique for patients with unruptured asymptomatic aneurysms (UAAs) based on the results of direct and endovasal operations performed at the Burdenko Neurosurgical Institute and on the literature data. MATERIAL AND METHODS The study included 694 UAA patients (481 females (69.3%) and 213 males (30.7%)) operated on at the Burdenko Neurosurgical Institute from 1997 to 2013. The patients' age ranged from 1 to 74 years (mean age, 48.3 years). Multiple aneurysms were in 126 (18.2%) patients. Anterior circle of Willis aneurysms were in 92.8% of cases. Among these, internal carotid artery (ICA) aneurysms (46.3%) and middle cerebral artery (MCA) aneurysms (30.8%) were predominant. Microsurgical and endovascular interventions on aneurysms were performed in 665 patients (95.8%). RESULTS Complete aneurysm exclusion was achieved in 94.8% of cases. A pronounced neurological deficit developed in 8 (1.2%) patients, and a moderate neurological deficit developed in 62 (9.3%) patients. Postoperative mortality was 0.5%. CONCLUSION Surgical treatment of UAAs is associated with low disability and mortality rates. All UAAs need to be operated on, especially in young and middle age patients, if surgery is technically possible, and there are no concomitant diseases contraindicating the intervention. The choice of an UAA exclusion technique is made based on the general principles of surgical treatment of cerebral aneurysms. At present, the method of choice is endovascular surgery for most cases of vertebrobasilar basin and ICA aneurysms and a microsurgical intervention for anterior cerebral artery and MCA aneurysms.
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Affiliation(s)
| | - Sh Sh Eliava
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - S B Yakovlev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - Yu M Filatov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - I A Sazonov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | | | - P S Dorokhov
- Burdenko Neurosurgical Institute, Moscow, Russia
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10
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Shekhtman OD, Maryashev SA, Eliava SS, Yakovlev SB, Golanov AV, Shishkina LV, Pilipenko YV, Okishev DN, Bocharov AV, Bukharin EY, Mikeladze KG, Kisar'ev SA, Vinogradov EV, Kaftanov AN, Konovalov AN. [Combined treatment of cerebral arteriovenous malformations. Experience of the Burdenko Neurosurgical Institute]. Zh Vopr Neirokhir Im N N Burdenko 2015; 79:4-18. [PMID: 26529618 DOI: 10.17116/neiro20157944-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite the achievements of recent years, cerebral AVMs continue to pose a challenge to treatment. The objective of this work was the development of recommendations for combined treatment of AVMs based on analysis of the available material and published data. MATERIAL AND METHODS The study included 93 patients hospitalized at the Neurosurgical Institute for combined treatment of cerebral AVMs in 2010-2014. A group of combined surgery (removal of an AVM with preoperative embolization) consisted of 40 patients, and a group of combined radiotherapy (radiation after partial embolization or partial removal of an AVM) included 53 patients. 36 patients underwent radiosurgery, and 17 patients received stereotactic radiation therapy. Both groups were analyzed in terms of outcomes, complications, and follow-up results. RESULTS In the group of combined surgery, according to the Glasgow outcome scale, good results (grade 4-5) were achieved in 35 (87.5%) patients at discharge and in 27 (90%) patients during follow-up. Treatment outcomes, surgery duration, and the amount of blood loss were not significantly different from those in the control group. Complete AVM obliteration was achieved in 29 (80.6%) patients 3 years after radiosurgery and in 8 (47%) patients after stereotactic radiotherapy. In discussion, these findings are compared to the published data, and recommendations for AVM treatment are suggested. CONCLUSION The combined treatment of AVMs is effective management for patients with complex AVMs (Spetzler-Martin grade III-IV AVMs). Successful treatment of AVMs requires careful planning and teamwork of vascular and endovascular neurosurgeons, radiologists, and neurologists.
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Affiliation(s)
| | | | - Sh Sh Eliava
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - S B Yakovlev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A V Golanov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - D N Okishev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A V Bocharov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - S A Kisar'ev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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11
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Kheireddin AS, Filatov YM, Belousova OB, Eliava SS, Sazonov IA, Kaftanov AN, Maryashev SA. [De novo cerebral aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2015; 79:75-81. [PMID: 26146046 DOI: 10.17116/neiro201579275-81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To substantiate the reasonability and duration of angiographic follow-up of patients operated on for cerebral aneurysms to rule out de novo aneurysm formation. MATERIAL AND METHODS The results of angiographic examination (cerebral angiography and SCT angiography) of 43 patients with cerebral aneurysms operated on at the Burdenko Neurosurgical Institute in 1995-2012 are analyzed. The follow-up duration varied from 1 to 14 years after surgery (mean duration, 5 years). Patients' age ranged from 14 to 56 years. RESULTS Control angiographic examination showed that de novo aneurysms were formed in 7 (16.2%) patients. A total of 8 de novo aneurysms were detected (in one case there were two aneurysms formed). All aneurysms, both the previously operated and the de novo ones, were located in the anterior part of the circle of Willis. De novo aneurysms were clipped in 5 cases; the cavity of the de novo aneurysm was occluded with spirals in one case. One patient with a small aneurysm of the middle cerebral artery refused surgery. Neither lethal nor unfavorable outcomes were recorded. CONCLUSIONS The patient groups with the high risk of de novo aneurysm formation are as follows: 1) young smokers with hypertension; 2) patients who developed clinical signs of the disease when being young; 3) patients subjected to proximal exclusion of the main artery; and 4) patients with multiple and familial forms of the pathology. Dynamic angiographic follow-up (SCT angiography or magnetic resonance angiography) for 1-3 years is recommended for these patients.
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Affiliation(s)
| | - Yu M Filatov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - Sh Sh Eliava
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - I A Sazonov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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12
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Eliava SS, Shekhtman OD, Pilipenko YV, Okishev DN, Kheireddin AS, Kisar'ev SA, Kaftanov AN. [Intraoperative indocyanine green fluorescence angiography in surgery of brain aneurysms. The first experience with using the technique and literature review]. Zh Vopr Neirokhir Im N N Burdenko 2015; 79:33-41. [PMID: 25909743 DOI: 10.17116/neiro201579133-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraoperative blood flow assessment after aneurysm clipping has become a standard procedure in vascular neurosurgery worldwide. Intraoperative indacyanine green angiography (ICG) has recently been certified in Russia. Fifteen patients with aneurysms operated with ICG control in Burdenko NSI are described in present publication. ICG advantages and weaknesses are discussed along with alternative flow control techniques available now.
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Affiliation(s)
- Sh Sh Eliava
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - D N Okishev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - S A Kisar'ev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A N Kaftanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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13
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Kheĭreddin AS, Filatov IM, Belousova OB, Eliava SS, Iakovlev SB, Sazonov IA, Pilipenko IV, Mikeladze KG, Kaftanov AN, Vinogradov EV. [Substantiation of differentiated management of patients with multiple cerebral aneurysms]. Zh Vopr Neirokhir Im N N Burdenko 2012; 76:45-53. [PMID: 22856123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The study was performed to substantiate optimal tactics of management of patients with multiple cerebral aneurysms based on analysis of surgical results. This study included 233 (20%) patients with multiple cerebral aneurysms who were treated in Burdenko Neurosurgical Institute since 1995 till 2007. We analyzed results of single-stage (microsurgical technique) and multistage (microsurgical technique and step-by-step application of endovascular and microsurgical techniques) approaches. The following factors were investigated: severity of subarachnoid hemorrhage (Hunt-Hess scale), localization of aneurysms in different arterial systems, quantity and size of aneurysms.. Postoperative mortality was 4.7%. Poor outcomes were observed in 37 (16%) patients. In multi-stage surgical treatment the number of totally occluded aneurysms was significantly higher (92% vs. 79%, p < 0.05) as the number of palliative operations and untreated aneurysms was lower (5.8% vs. 16%, p < 0.05). The best technical and clinical results were obtained in the group of patients who were treated using step-by-step application of endovascular and microsurgical techniques. Despite coexistence of aneurysms of both carotid systems with vertebrobasilar aneurysms in 15% of this group, poor outcomes were not observed and total occlusion of aneurysms was performed in 91.4% of cases. Obtained technical and clinical results of treatment of multiple aneurysms prove that multi-stage surgical management is the therapy of choice in surgery of multiple aneurysms. Our data demonstrate high effectiveness of multimodal approach with integration of endovascular and microsurgical methods. Combination of both techniques is preferential in coexistence of aneurysms of carotid and vertebrobasilar systems.
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14
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Eliava SS, Filatov IM, Pilipenko IV, Shekhtman OD, Belousova OB, Okishev DN, Kheĭreddin AS, Iakovlev SB, Tseĭtlin AM, Kaftanov AN, Mariashev SA, Nepomniashchiĭ VP. [Microsurgical treatment of cerebral arteriovenous malformations in Burdenko Neurosurgical Institute (recent experience)]. Zh Vopr Neirokhir Im N N Burdenko 2012; 76:34-44. [PMID: 22856122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recently the number of AVM resections in Burdenko Neurosurgical Institute has been increased dramatically. Aim of this study was to assess the results of open surgery in our clinic in modern neurosurgical era. Consecutive series if 160 patients with AVM treated using microsurgical technique since 2009 till 2011 was analyzed. Spetzler-Martin score distribution was: grade I--29 (18.1%) cases, grade II--84 (52.5%), grade III--38 (23.8%), grade IV--9 (5.6%). Patients with grade V AVMs were not operated. Treatment options included: AVM resection in 143 (89.4%) cases, embolization followed by resection in 15 (9.3%) and clipping of afferents in 2 (1.3%). Glasgow outcome scale score distribution was the following: V (good recovery)--70 (43.7%), IV (moderate disability)--71 (44.4%), III (severe disability)--16 (10%), II (vegetative state)--1 (0.6%) and I (death)--2 (1.3%). Microsurgery remains the primary option for radical treatment of cerebral AVMs. Careful selection of patients and planning of surgery are crucial for good outcomes.
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