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Shetova I.M.

Scientific Center of Neurology;
Sklifosovsky Research Institute of Emergency Medicine

Lukyanchikov V.A.

Scientific Center of Neurology;
Pirogov Russian National Research Medical University

Shatokhin T.A.

Scientific Center of Neurology;
Pirogov Russian National Research Medical University

Yakovlev A.A.

Institute of Higher Nervous Activity and Neurophysiology

Piradov M.A.

Scientific Center of Neurology

Krylov V.V.

Pirogov Russian National Research Medical University

The effect of surgical technique on the long-term results of treatment of brain aneurysms

Authors:

Shetova I.M., Lukyanchikov V.A., Shatokhin T.A., Yakovlev A.A., Piradov M.A., Krylov V.V.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(8): 62‑70

DOI: 10.17116/jnevro202412408162

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Table of contents

THE EFFECT OF SURGICAL TECHNIQUE ON THE LONG-TERM RESULTS OF TREATMENT OF BRAIN ANEURYSMS
THE EFFECT OF SURGICAL TECHNIQUE ON THE LONG-TERM RESULTS OF TREATMENT OF BRAIN ANEURYSMS

To cite this article:

Shetova IM, Lukyanchikov VA, Shatokhin TA, Yakovlev AA, Piradov MA, Krylov VV. The effect of surgical technique on the long-term results of treatment of brain aneurysms. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;124(8):62‑70. (In Russ.)
https://doi.org/10.17116/jnevro202412408162

Подписка 2025-2 (S.S. Korsakov Journal of Neurology and Psychiatry)
 
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Thro­mbosed aneurysm of the inte­rnal caro­tid artery, complicated by the deve­lopment of ischemic stroke followed by suba­rachnoid hemo­rrhage. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(9):135-140
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OBJECTIVE

To study the long-term outcomes of surgical treatment of cerebral aneurysms (CA) after using different methods of excluding the aneurysm from the bloodstream.

MATERIAL AND METHODS

We analyzed the long-term results of surgical treatment of 311 patients for CA (on average after 3.5 years). Two hundred and one patients were operated after CA rupture, 110 for an unruptured aneurysm. Microsurgical or endovascular methods were used to isolate the aneurysm from the bloodstream. Upon admission to the hospital for surgical treatment, a clinical diagnostic examination was performed to confirm the diagnosis and determine the timing and type of intervention. In the long-term period, a clinical neurological study, including an assessment of disability with the Barthel index and the modified Rankin scale, cognitive functions (MoCA test) and the psycho-emotional sphere (HADS) was carried out.

RESULTS

In the long-term period of aneurysm surgery, symptoms of disability were identified in 49 patients (16%), severe and complete limitation of self-care in 17 (8%), and cognitive impairment in 212 (68%). Endovascular embolization performance of an aneurysm was associated with a higher proportion of favorable functional outcomes compared with the use of a microsurgical method (10% versus 17%), as well as preservation of cognitive functions (9% and 17%, respectively). Blood clots fibrinolysis was associated with severe disability and dependence in the long-term period (p=0.04). Patients treated with extra-intracranial shunting (EICS) demonstrated better cognitive functions; fibrinolysis, on the contrary, was a predictor of dementia (p=0.02). There was no relationship between symptoms of anxiety and depression in the long-term period and surgical treatment method.

CONCLUSIONS

Disability, dependence and disturbance of cognitive functions in the long-term period of CA surgical treatment are higher in patients after microsurgical clipping compared to endovascular embolization. Performance of blood clots fibrinolysis is associated with severe disability and dementia in patients with massive basal aneurysmal subarachnoid hemorrhage. Performing EICS is associated with a favorable prognosis for the recovery of cognitive functions.

Keywords:

cerebral aneurysm
subarachnoid hemorrhage
surgical method
long-term period

Authors:

Shetova I.M.

Scientific Center of Neurology;
Sklifosovsky Research Institute of Emergency Medicine

Lukyanchikov V.A.

Scientific Center of Neurology;
Pirogov Russian National Research Medical University

Shatokhin T.A.

Scientific Center of Neurology;
Pirogov Russian National Research Medical University

Yakovlev A.A.

Institute of Higher Nervous Activity and Neurophysiology

Piradov M.A.

Scientific Center of Neurology

Krylov V.V.

Pirogov Russian National Research Medical University

Received:

25.04.2024

Accepted:

03.05.2024

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