Author:
LITVINENKO D.V., ,ZYABLOVA E.I.,TKACHYOV V.V.,MUZLAEV G.G., , ,
Abstract
About 40% of patients with multiple intracranial aneurysms (MIAs) are admitted with poor-grade subarachnoid haemorrhage (Hunt & Hess Grades IVV). Therefore, an approach to identify the most appropriate strategy for an individual patient should be applied to obtain the best functional outcomes. However, there is still no consensus on selecting proper MIAs treatment in patients with acute subarachnoid haemorrhage with localization of all aneurysms in the surgical intervention area. The article presents a case of a 43-year-old patient with MIAs: a ruptured aneurysm of the anterior communicating artery (ACA) and intact right pericallosal and right middle cerebral arteries (MCA). The first stage included clipping the ruptured ACA aneurysm and decompressive craniectomy. After stabilization of the patient's condition, the second stage of treatment was performed: clipping the aneurysms of the right pericallosal and right MCA and autologous cranioplasty. The patient was discharged from the hospital in satisfactory condition. The presented case demonstrates the need for a flexible individual approach to treating patients with MIAs and acute subarachnoid bleeding. Staged surgical treatment and performing as the second stage clipping of intact aneurysms with simultaneous early cranioplasty after compensating the patient's condition allowed for good treatment outcomes. Keywords: Multiple intracranial aneurysms, aneurysm clipping, decompressive craniectomy, staged surgical treatment, cerebral aneurysm rupture.
Publisher
Avicenna Tajik State Medical University
Subject
Psychiatry and Mental health
Reference19 articles.
1. 1. Jabbarli R, Dinger TF, Darkwah Oppong M, Pierscianek D, Dammann P, Wrede KH, et al. Risk factors for and clinical consequences of multiple intracranial aneurysms: A systematic review and meta-analysis. Stroke. 2018;49(4):848-55. https://doi.org/10.1161/STROKEAHA.117.020342
2. Factors influencing management of unruptured intracranial aneurysms: An analysis of 424 consecutive patients;Guan;J Neurosurg,2017
3. 3. Yrysov K, Tursunov D, Reyer JA, Yamamoto E, Yrysova M, Hamajima N. Multiple ruptured cerebral aneurysms at the National Hospital of the Kyrgyz Republic between 2008 and 2014: A departmental summary. Nagoya J Med Sci. 2019;81(3):511-8. https://doi.org/10.18999/nagjms.81.3.511
4. 4. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G; European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93-112. https://doi.org/10.1159/000346087
5. 5. Konovalov AN, Krylov VV, Filatov VV, Eliava ShSh, Belousova OB, Tkachyov VV, i dr. Rekomendatel'nyy protokol vedeniya bol'nykh s subarakhnoidal'nym krovoizliyaniem vsledstvie razryva anevrizm sosudov golovnogo mozga [Advisable management protocol for patients with subarachnoidal hemorrhage resulting from cerebral vascular aneurysmal rupture]. Voprosy neyrokhirurgii im. N.N. Burdenko. 2006;3:3-10.