Endovascular treatment of fusiform aneurisms of brain vessels
Objective – to determine the effectiveness of endovascular treatment of fusiform arterial aneurysms of cerebral vessels.
Materials and metods. The results of endovascular treatment of 25 patients with fusiform cerebral aneurysms who were treated at the Center in the period from 2011 to 2018 were analyzed. There were 12 men (48 %), women – 13 (52 %). The average age of patients is 48 years. In 17 (68 %) cases were vertebrobasilar aneurysms, in 2 (8 %) cases – aneurysms of the anterior cerebral artery, in 3 (12 %) cases – aneurysms of the middle cerebral artery, in 3 (12 %) cases – aneurysms of internal carotid arteries. For the treatment of patients we used various stents: flow diversion (FRED (Microvention, USA), Pipeline (ev3, USA)), Derivo (Acandis, Germany)) and protection stents (Leo (Balt, France), Solitaire (Medtronic, USA)), in deconstructive interventions – detachable coils.
Results. It were performed 25 surgical interventions: in 23 (92 %) cases – reconstructive shutdown, in 2 (8 %) – deconstructive shutdown. There were no technical problems during surgical interventions. Complications were noted in two cases with VBB aneurysms in the early postoperative period stem disorders appeared due to the increasing mass effect. Both patients were dead. Control examination in a period from 6 months to 3 years 13 (52 %) patients were performed. The results of excluding aneurysms were evaluated on a Raymond–Roy scale. The type 1 was detected in 7 (53.8 %) patients, the type 2 – 1 (7.7 %), the type 3 – 5 (38.5 %). In 2 (15.4 %) patients bearing artery thrombosis was detected.
Conclusions. Extrasacular endovascular methods of treating fusiform arterial aneurysms of cerebral vessels are effective and relatively safe. They can expand the indications for endovascular treatment of these aneurysms, however compared with the treatment of saccular aneurysms hemodynamic changes and secondary aneurysm thrombosis are unpredictable and require further study.
Park SH, Yim MB, Lee CY et al. Intracranial fusiform aneurysms: it’s pathogenesis, clinical characteristics and managements. J Korean Neurosurg Soc. 2008;44:116-23. doi:10.3340/jkns.2008.44.3.116 pmid:19096660.
Findlay JM, Hao C, Emery D. Non-atherosclerotic fusiform cerebral aneurysms. Can J Neurol Sci 2002;29:41-8. doi:10.1017/S0317167100001700 pmid:11858533.
Drake CG, Peerless SJ. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg. 1997;87:141-62. doi:10.3171/jns.1997.87.2.0141pmid:9254076.
Fiorella D, Woo HH, Albuquerque FC et al. Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the Pipeline embolization device. Neurosurgery. 2008;62:1115-20; discussion 1120-21. doi:10.1227/01.neu.0000325873.44881.6epmid:18580809.
Fiorella D, Albuquerque F, Gonzalez F et al. Reconstruction of the right anterior circulation with the Pipeline embolization device to achieve treatment of a progressively symptomatic, large carotid aneurysm. J Neurointerv Surg. 2010;2:31-7. doi:10.1136/jnis.2009.000554 pmid:21990555.
Fiorella D, Hsu D, Woo HH et al. Very late thrombosis of a Pipeline embolization device construct: case report. Neurosurgery. 2010;67(3 suppl):E313-14; discussion E314. doi:10.1227/01.NEU.0000383875.08681.23 pmid:20679914.
Schnell S, Ansari SA, Vakil P et al. Three-dimensional hemodynamics in intracranial aneurysms: Influence of size and morphology. J Magn Reson Imaging. 2014;39:120-31.
Yang P, Zhao K, Zhou Y et al. Stent-assisted coil placement for the treatment of 211 acutely ruptured wide-necked intracranial aneurysms: a single-center 11-year experience. Radiology. 2015;276:619. doi:10.1148/radiol. 2015154025 pmid:26203716
Cantón G, Levy DI, Lasheras JC et al. Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms. J Neurosurg. 2005; 103:891-902. doi:10.3171/jns.2005.103.5.0891 pmid:16304994
Abstract views: 95 PDF Downloads: 40