Microsurgical management of clipping cerebral aneurysms of complex anatomical form, large and giant sizes

  • S O. Lytvak SI «Romodanov Neurosurgery Institute NAMSC of Ukraine»
Keywords: arterial aneurysm, brain, microsurgical treatment


Objective – to improve the results of surgical treatment of cerebral arterial aneurysms (AA) of complex anatomical form, large and giant sizes by developing a rational microsurgical strategy.

Materials and methods. A retrospective analysis of results of surgical treatment of AA in the period from 2011 to 2016 in 70 patients (38 women, 32 men, mean age – 48 years), were treated in Institute of Neurosurgery named after acad. A.P. Romodanov of NAMS of Ukraine is made. A set of diagnostic procedures included neurovisualization (computed tomography, computed tomography angiogram, magnetic resonance imaging, cerebral angiography) and functional methods of diagnostics (Doppler ultrasound of vessels of head and neck, electroencephalography). All surgical interventions were carried out with the use of intraoperative Doppler ultrasound control.

Results. Acute violation of cerebral circulation in hemorrhagic type at the onset of disease – 64 cases, other manifestations – 6. Localization of AA: the complex of the anterior cerebral – anterior communicating artery – 34 cases, 32 of them in the group of stroke, the middle cerebral artery – 18, the internal carotid artery – 16, the main artery – 2. Using of such technique of clipping AA: simple clipping – 26, the remodeling of the affected arterial segment with devascularization AA – 44. According to the modified Rankin scale (MRS) the results were: good recovery (from 0 to 2 points) – 38 (54.3 %) cases, moderate impairment (from 3 to 4 points) – 18 (25.7 %), severe impairment of functioning (5 points) – 12 (17.1 %). Two (2.9 %) death are fixed.

Conclusions. The best results were obtained with AA of ophthalmic segment of the internal carotid artery with a pseudo-tumor clinical manifestations in which the applied technique of remodeling clips without the temporary blocking of AA proximal to the arterial segment. In cases of multiple AA were surgically clipped of a ruptured AA and AA asymptomic diagnosed during the same operation was performed in 16 (22.9 %) cases followed good and satisfactory recovery that gives you the opportunity to make assumptions about the security and feasibility of this surgical approach in cases of multiple AA in accounting for the individual patient.


Download data is not yet available.


Medvedev JuA. Ot anevrizmy k anevrizmaticheskoj bolezni. Ocherki po patologii nervnoj sistemy (Rus.). St. Petersburg, 1996: 95-109.

Medvedev JuA, Bersnev VP, Zabrodskaja JuM. O segmentarnom stroenii arterialnogo kruga bolsho- go mozga, sochlenenijah v nem i ranee neizvestnoj bolezni jetih sochlenenij (Rus.). Nejrohirurgija (Rus.). 1998;2:9-17.

Medvedev JuA, Macko DE. Patologicheskaja anatomi- ja anevrizm arterij golovnogo mozga v svete hirur- gicheskogo lechenija (Rus.). Arhiv patologii (Rus.). 1983;1:81-90.

Al-Hussain SМ, Shoter AM, Bataina ZM. Circle of Willis in adults. Saudi Med J. 2001;22(10):895-8.

Bor AS, Velthuis BK, Majoie СB et al. Configuration of intracranial arteries and development of aneurysms: a follow-up study. Neurol. 2008;70(9):700-5.

Yiemeng Hoi, Hui Meng, Woodward S. et al. Effects of arterial geometry on aneurysm growth: three dimensional computational fluid dynamics study. J. Neurosurg. 2004;101:676-81.

Steiner T, Juvela S, Unterberg A et al. European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35,2:93-112. doi: 10.1159/000346087. Epub 2013 Feb 7. Review. PubMed PMID: 23406828.

McCormic WF, Nofzinger JD. Saccular intracranial aneurysms: an autopsy study. J. Neurosurg. 1965;22: 155-9.

Wang MC, Rubinstein D, Kindt GW et al. Prevalence of intracranial aneurysms in first-degree relatives of patients with aneurysms. Neurosurg Focus. 2002;13(3):e2.

Weir B. Unruptured intracranial aneurysms: a review. J. Neurosurg. 2002;96:3-42.

How to Cite
Lytvak, S. O. (2017). Microsurgical management of clipping cerebral aneurysms of complex anatomical form, large and giant sizes. Ukrainian Interventional Neuroradiology and Surgery, 20(2), 90-102. Retrieved from https://enj.org.ua/index.php/journal/article/view/38