Federal State Autonomous Institution N. N. Burdenko, National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (N.N. Burdenko NMRCN), Moscow, Russia.
Federal State Autonomous Institution N. N. Burdenko, National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation (N.N. Burdenko NMRCN), Moscow, Russia.
World Neurosurg. 2021 Nov;155:e727-e737. doi: 10.1016/j.wneu.2021.08.128. Epub 2021 Sep 4.
The treatment of middle cerebral artery (MCA) giant aneurysms (GAs) represents a challenging task.
The data for 55 patients treated for MCA GA (≥25 mm) at the N.N. Burdenko NMRCN between 2010 and 2019 were analyZed.
The GAs were located in the M1 segment in 11 (20%) patients, MCA bifurcation in 33 (60%), M2 in 7 (12.7%), and M3 in 4 (7.3%). There were 32 (58.2%) saccular and 23 (41.8%) fusiform GAs. MCA GAs were treated with neck clipping (50.9%), clipping with the artery lumen formation (3.6%), bypass surgeries (34.5%), wrapping (3.6%), and endovascular surgery (7.3%). A worsening of the neurologic state in the perioperative period was observed in 50.9% of patients. The complete closure of GA was achieved in 78.2%. Surgery-related mortality was 1.8%. The long-term outcome was favorable in 76.9% of patients. Surgery-related and disease-related plus treatment failures-related mortality was 9.6%.
Microsurgical clipping and bypass surgery are the main operative interventions for MCA GA treatment. These operations are technically complex and are followed by a relatively high percentage of complications. The main tasks that require further investigations are the introduction of new precise diagnostic methods for the collateral circulation assessment in the cortical MCA branches, the perfection of the algorithm for the bypass selection, and investigation of the long-term results of the endovascular and combined treatments. It is of major importance to thoroughly observe the patients long-term after the surgery and ensure the possibility for further angiographic studies.
大脑中动脉（MCA）巨大动脉瘤（GA）的治疗是一项具有挑战性的任务。
分析了 2010 年至 2019 年期间在 N.N. Burdenko NMRCN 接受 MCA GA（≥25mm）治疗的 55 例患者的数据。
GA 位于 M1 段 11 例（20%），MCA 分叉处 33 例（60%），M2 段 7 例（12.7%），M3 段 4 例（7.3%）。有 32 例（58.2%）囊状和 23 例（41.8%）梭形 GA。MCA GA 采用颈夹闭（50.9%）、动脉管腔成形夹闭（3.6%）、旁路手术（34.5%）、包裹（3.6%）和血管内手术（7.3%）治疗。围手术期神经状态恶化的发生率为 50.9%。完全闭塞 GA 达 78.2%。手术相关死亡率为 1.8%。长期预后良好的患者占 76.9%。手术相关、疾病相关和治疗失败相关的死亡率为 9.6%。
显微手术夹闭和旁路手术是治疗 MCA GA 的主要手术干预措施。这些手术技术复杂，并发症发生率相对较高。需要进一步研究的主要任务是引入新的精确诊断方法评估皮质 MCA 分支的侧支循环，完善旁路选择的算法，并研究血管内和联合治疗的长期结果。术后对患者进行长期彻底观察并确保进一步血管造影研究的可能性至关重要。
