Випадок комбінованого хірургічного лікування нерозірваної гігантської мішкоподібної аневризми супракліноїдного відділу правої внутрішньої сонної артерії

Abstract

We tried to determine the optimal tactics of endovascular occlusion of a giant saccular aneurysm supraclinoid part of the right internal carotid artery, which moves right middle cerebral artery on the background of hypoplasia and stenosis of the right internal carotid artery (ICA) in petrous segment in conjunction with stenosis in the M1-segment of right middle cerebral artery (MCA) and deconstruction clinoid part of the right ICA using coils with maintaining adequate perfusion in right MCA. We analyzed the results of surgical treatment endovascular embolization of giant intracranial unruptured aneurysms, on the background of concomitant stenosis of the ICA (2 similar cases in my own practice). In all cases, regardless of the degree of ICA stenosis performed a stand-alone coiling of aneurysms occlusion. Stenting of the stenotic part of the ICA was not performed. The results of the combined 3-stage of surgical treatment (bypass, endovascular coiling-aneurysm occlusion of the ICA, deconstruction ICA) patient with a giant saccular aneurysm supraclinoid part of right ICA, from which departs right MCA, against the background of hypoplasia and stenosis of right ICA in the petrous segment in conjunction with stenosis in the M1-segment of right MCA. After 3 months the patient's condition by somatic satisfactory. Neurologically: remained moderate paresis of the abducens nerve on the right. The patient is recommended dynamic observation with conducting magnetic resonance imaging of the brain and cerebral angiography at 6 and 12 months. The analysis of the result of combined surgical treatment in the combined pathology of the cerebral vessels (saccular aneurysm, stenosis of right ICA, stenosis of right MCA). Showed that surgical tactics was justified and can be used as a method of treating this pathology.