Endovascular combined and multistep surgical treatment of complicated intracranial aneurysmal hemorrhage
Objective — to search for optimal combinations of surgical methods of treatment of complicated intracranial aneurysmal hemorrhage.
Materials and methods. The results of surgical treatment of complicated intracranial aneurysmal hemorrhage were analyzed. In the study group there were 32 women and 21 men. Patients of the young (20 (37.7 %)) and middle (24 (45.3 %)) age prevailed. Nine (17.0 %) patients were elderly. For occlusion of ruptured cerebral aneurysms, in all cases endovascular embolization was used with detachable coils. There have been written endovascular combined intervention: endovascular embolization of cerebral aneurysms and one-time ICA stenting (5.7 %), endovascular embolization of cerebral aneurysms and angiospasm-stage balloon angioplasty (3.8 %), endovascular embolization of cerebral aneurysms and intraarterial farmanhioplasty with nimodipine (28.3 %). Multistep surgical treatment was performed: removal of a parenchymal hematoma within 24–48 hours after endovascular embolization of cerebral aneurysm (5.7 %), ventriculostomy of the lateral ventricles within 4–24 hours after endovascular embolization of cerebral aneurysm (9.4%), in 4 cases, supplemented with ventricular fibrinolysis, decompression craniectomy (5.7 %) and balloon angioplasty (3.8 %).
Results. According to the severity of subarachnoid hemorrhage on the Hunt–Hess scale, the distribution before treatment was as follows: 1–2 grade — 56.6 %, 3 grade — 20.7 %, 4 grade — 15.1 %, 5 grade — 7.5 %. After treatment, a favorable result (1st and 2nd degree on the Rankin scale) was obtained in 34 cases, an unfavorable result (3–5th degree) — in 9. In 10 (18.9 %) cases, a lethal result occurred. Among all the observations of endovascular occlusion of cerebral aneurysms in the hemorrhagic period, mortality was 12.9 %.
Conclusions. The effectiveness of the u
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