DIAGNOSIS AND TREATMENT OF RUPTURED CEREBRAL ARTERIAL ANEURYSMS (CURRENT ISSUES)

  • Andriy Netliukh Department of Neuropathology and Neurosurgery of the Faculty of Post-Graduate Education Danylo Halytsky Lviv National Medical University Lviv, Ukraine https://orcid.org/0000-0002-6499-1718
Keywords: intracranial cerebral, arterial aneurisms, subarachnoid haemorrhage, complications, endovascular surgical approach

Abstract

https://www.youtube.com/watch?v=WEam4rmV73E 

Introduction: The article is dedicated to current issues of improving outcomes of ruptured intracranial arterial aneurysms treatment by developing means to manage complications, refine indicators, terms, and methods of surgical treatment based on the analysis of the dynamics of clinical and angiometric perioperative indicators.
Objectives: To determine current issues and research areas for the treatment of brain aneurysms.
Methods: Literature sources on the diagnosis and treatment of intracranial arterial aneurysms published in the past 15 years have been analyzed using MEDLINE, Google Scholar, Researchgate medical databases, as well as our own prospective data obtained during the treatment of 184 patients with aneurysmal intracranial haemorrhage.
Results: The most common complications in patients with ruptured intracranial arterial aneurysms include angiospasm (37.2%); intracerebral and intraventricular haemorrhages (27.6%); secondary cerebral ischemia (22.2%); intraoperative complications (9.1%); repeated aneurysm rupture (6.5%). Reliable criteria for predicting the unfavourable outcome of the surgery are high Hunt-Hess (> 2.7 ± 0.2) and WFNS (> 2.1 ± 0.2) scores in patients at the time of aneurysms exclusion. During the acute period (1-14 days), postoperative mortality after clipping (16.2%) differs from the coiling group (10.2%). Intraoperative cerebral angiospasm is a leading factor contributing to complications following the surgery and leading to an increase in mortality up to 27.8% while preventing successful surgery in 38.8% of cases. Regardless of the surgery timing, significant (p<0,05) reduction in the diameter of the middle cerebral artery at the end of surgery compared to its beginning by an average of 30.1% constitutes an unfavourable criterion as opposed to a favourable course when there is an unreliable (p>0,2) narrowing of the artery by an average of 8.4%. Immediate hospitalization, transcranial interventions within 10.5-14.3 days, and endovascular interventions in the first day are strongly recommended for patients with ruptured intracranial arterial aneurysms. They provide the best clinical results. If the aneurysm is amenable by each of the methods, endovascular embolization is preferred, since in this case, the average patient day is statistically significantly shorter (p <0,01) than after transcranial clipping.
Conclusion: During 2008-2018, 789 intracranial arterial aneurysms were treated surgically in the Municipal Non-Profit Enterprise "Lviv Clinical Emergency Care Hospital". Postoperative mortality decreased from 29.9% in 2008 to 8.2% in 2018. Advantages of endovascular treatment in the early stages of haemorrhage and higher radicality of aneurysm exclusion using the microsurgical method have received theoretical justification and clinical confirmation. Provided literature, clinical, and instrumental data expand the understanding of the pathogenesis of complications in cases of ruptured intracranial arterial aneurysms and show their predictive value. The choice of the optimal surgery term and method constitutes an effective means to reduce the level of postoperative mortality in case of aneurysmal intracranial haemorrhages. We have developed and implemented a new method for determining intraoperative angiospasm severity, and optimized a choice of coil parameters for safe and effective cerebral aneurysms embolization.

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References

Zozulia IS, Zozulia AI, Volosovets AO, Kaminskyi AO. Anevryzmatychni subarakhnoidalni krovovylyvy

- suchasnyi pohliad na diahnostyku, kliniku, likuvannia. [Aneurysmal subarachnoid hemorrhages - a

modern look at diagnosis, clinic, treatment]. Mediczina neotlozhny'kh sostoyanij. 2017;8(87): 98-101. DOI: 10.22141/2224-0586.8.87.2017.121331 [in Ukrainian].

https://doi.org/10.22141/2224-0586.8.87.2017.121331

Nakaz Ministerstva okhorony zdorovia Ukrainy vid 17 kvitnia 2014 roku No 275. Unifi kovanyi klinichnyi

protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi), tretynnoi (vysokospetsializovanoi)

medychnoi dopomohy ta medychnoi reabilitatsii hemorahichnyi insult (vnutrishnomozkova hematoma,

anevryzmalnyi subarakhnoidalnyi krovovylyv) [Order of the Ministry of Health of Ukraine of April 27,

No. 275. Unifi ed clinical protocol of emergency, primary, secondary (specialized), tertiary (highly

specialized) medical care and medical rehabilitation for hemorrhagic stroke (intracerebral hematoma,

aeurysmal subarachnoid heamorrhage)]. [Internet resource]. rozrob.: MK Khobzei, TS Mishchenko,

AV Stepenenko [ta in.]. - K., 2014:99 [in Ukrainian].

Zoryn NA, Hryhoruk SP, Pliushchev YE [і dr.] Analiz rezul'tatov lecheniya bol'ny'kh pri razry've

arterial'ny'kh anevrizm golovnogo mozga [The analysis of treatment results of brain aneurysms

rupture]. Ukr. neirokhirurh. zhurnal. 2013;4:23-28 [in Russian].

Kry'lov VV, Dash'yan VG, Shatokhin TA, Sharifullin FA, Solodov AA, Prirodov AV, Levchenko OV,

Tokarev AS, Khamidova LT, Kuksova NS., Ajrapetyan A.A., Kalinkin A.A. Vy'bor srokov otkry'togo

khirurgicheskogo lecheniya bol'ny'kh s razry'vom czerebral'ny'kh anevrizm, oslozhnenny'kh

massivny'm bazal'ny'm subarakhnoidal'ny'm krovoizliyaniem (Fisher 3) [Choosing the timing of

open surgical treatment of patients with ruptured cerebral aneurysms complicated by massive basal

subarachnoid hemorrhage (Fisher 3)]. Nejrokhirurgiya. 2015;3:11-17 [in Russian].

Hloba MV. Prohnozuvannia ishemichnykh uskladnen tserebralnoho vazospazmu pry khirurhichnomu

likuvanni intrakranialnoi anevryzmy u hostromu periodi yii rozryvu [Prediction of ischemic complications

of cerebral vasospasm in surgical treatment of intracranial aneurysm in the acute period of its rupture].

Klinichna khirurhiia. 2014;9;44-47 [in Ukrainian].

Kry'lov VV. Sen'ko IV. Predoperaczionny'e faktory' riska neblagopriyatnogo iskhoda khirurgicheskogo

lecheniya anevrizm perednej mozgovoj i perednej soedinitel'noj arterij v ostrom periode krovoizliyaniya

[Preoperative Risk Factors for an Adverse Surgical Treatment of Aneurysms of the Anterior Cerebral

and Anterior Connective Arteries in the Acute Hemorrhage]. Nejrokhirurgiya. 2012;4:49-56 [in Rus-

sian].

Lytvak SO, Sydorak AD. Indyvidualizatsiia mikrokhirurhichnoho etapu operatsii pry arterialnykh

anevryzmakh dystalnykh viddiliv perednoi mozkovoi arterii [Individualization of the microsurgical stage

of the operation in cases of the distal segment anterior cerebral artery aneurysms]. Endovaskuliarna

neirorenthenokhirurhiia. 2017; 1:74-84. http://nbuv.gov.ua/UJRN/evnh_2017_1_10 [in Ukrainian].

Abbaszade EZ, Czimejko OA, Moroz VV, Skorokhoda II, Shakhin N. Vnutrimozgovy'e krovoizliyaniya

v rezul'tate razry'va arterial'ny'kh anevrizm srednej mozgovoj arterii. [Intracerebral hemorrhage

as a result of rupture of arterial aneurysms of the middle cerebral artery]. Ukr. med. al'manakh.

;14(2):7-10. Rezhim dostupa: http://nbuv.gov.ua/UJRN/Uma_2011_14_2_3 [in Russian].

Yeleynik MV, Yakovenko LM. Khirurhichne likuvannia khvorykh z rozryvom arterialnykh anevryzm

holovnoho mozku uskladnenykh hostroiu okliuziinoiu hidrotsefaliieiu [Surgical treatment of patients

with ruptured arterial aneurysms of brain complicated with acute hydrocephalus]. Endovaskuliarna

Pashkovskaya ID, Nechipurenko NI, Sidorovich RR, Zmachinskaya OL, Yudiczkaya VM. Osobennosti

patobiokhmicheskikh narushenij u paczientov s razorvavshimisya arterial'ny'mi anevrizmami

golovnogo mozga i e'pilepticheskimi pristupami [Peculiarities of pathobiochemical disorders in patients

with exploded arterial aneurysms of the brain and epileptic seizures]. Nevrologiya i nejrokhirurgiya.

Vostochnaya Evropa. 2018; 8(1):60-69 [in Russian].

Moroz VV. Khirurhichne likuvannia rozryviv arterialnykh anevryzm holovnoho mozku, uskladnenykh

anhiospazmom [Surgical treatment of ruptures of arterial aneurysms of the brain complicated

by angiospasm]: avtoref. dys. na zdobuttia nauk. stupenia kand. med. nauk: spets. 14.01.05

«Neirokhirurhiia». 2004: 22 р. [in Ukrainian].

Sano H, Inamasu J, Kato Y, Satoh A, Murayama Y. Modifi ed world federation of neurosurgical societies

subarachnoid hemorrhage grading system. Surg Neurol Int 01-Aug-2016;7: DOI:10.4103/2152-

187491

Hloba MV, Lisianyi MI, Tsimeiko OA, Belska LM. Doslidzhennia tsytokinovoho statusu u khvorykh u

hostromu periodi rozryvu intrakranialnoi arterialnoi anevryzmy [Investigation of cytokine status in

patients with acute rupture of intracranial arterial aneurysm]. Ukr. neirokhirurh. zhurnal. 2014;3:55-

[in Ukrainian].

Netlyukh AM. Biokhimichni markery uskladnenoho perebihu anevryzmatychnoho subarakhnoidalnoho

krovovylyvu v syrovattsi krovi ta likvori khvorykh [Biochemical markers of the complicated course

of aneurysmal subarachnoid hemorrhage in patients' blood serum and cerebrospinal fl uid].

Endovaskuliarna neirorenthenokhirurhiia. 2016;4:40-47 [in Ukrainian].

Friedrich B., Müller F., Feiler S. [et al.] Experimental subarachnoid hemorrhage causes early and

long-lasting microarterial constriction and microthrombosis: an in-vivo microscopy study. J. Cerebral.

Blood Flow & Metabolism. 2012;32:447-455.

https://doi.org/10.1038/jcbfm.2011.154

Gross BA, Rosalind Lai PM, Frerichs KU, Du R. Treatment modality and vasospasm after aneurysmal

subarachnoid hemorrhage. World Neurosurg. 2014;82(6):e725-730.

https://doi.org/10.1016/j.wneu.2013.08.017

Balanzar GG, Guinto-Nishimura Y. Vasospasm in subarachnoid hemorrhage. World Neurosurg.

;82(6):e677-e678.

Germans MR, Macdonald RL. Clip or Coil-is some of the eff ect on outcome related to the risk of

delayed cerebral ischemia? World Neurosurg. 2014;82(6):e679-e681.

https://doi.org/10.1016/j.wneu.2013.09.030

van Donkelaar CE, Bakker NA, Veeger NJ, Uyttenboogaart M, Metzemaekers JD, Eshghi O, et al.

Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment. J Neurosurg.

Jan;126(1):52-59. doi: 10.3171/2016.1.JNS152136. PMID: 27035175.

https://doi.org/10.3171/2016.1.JNS152136

AlMatter M, Aguilar Péreza M, Bhogal P, Hellstern V, Ganslandt O, Henkes H. Results of interdisciplinary

management of 693 patients with aneurysmal subarachnoid hemorrhage: Clinical outcome and

relevant prognostic factors. Clin Neurol Neurosurg. 2018 Apr;167:106-111. Available from: https://

https://doi.org/10.1016/j.clineuro.2018.02.022

doi.org/10.1016/j.clineuro.2018.02.022.

Kapadia FN, Jha AN. Simultaneous lumbar and intraventricular manometry to evaluate the role and

safety of lumbar puncture in raised intracranial pressure following subarachnoid haemorrhage. Br. J.

Neurosurg. 1996;10:585-587.

https://doi.org/10.1177/0950017096010003019

Rehush AV. Khirurhichne likuvannia vnutrishnoshlunochkovoho krovovylyvu z vykorystanniam

zovnishnoho likvorodrenuvannia [Surgical treatment of intraventricular hemorrhage using external

cerebrospinal fl uid draining]. Ukr. neirokhirurh. zhurnal. 2009;4: 44-50. https://doi.org/10.25305/

unj.108012 [in Ukrainian].

Zizjlstra IA, Gathier CS, Boers AM, Marquering HA, Slooter AJ, Velthuis BK, et al. Association of

automatically quantifi ed total blood volume after aneurysmal subarachnoid hemorrhage with delayed

cerebral ischemia. AJNR Am J Neuroradiol. 2016 Sep;37(9):1588-93. PMID: 27102313. DOI: 10.3174/

https://doi.org/10.3174/ajnr.A4771

ajnr.A4771.

Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT [et al.]. Guidelines for

the Management of Aneurysmal Subarachnoid Hemorrhage. A Guideline for Healthcare Professionals

From the American Heart Association/American Stroke Association Stroke. 2012;43:1711-1737.

https://doi.org/10.1161/STR.0b013e3182587839

Morgan TC, Dawson J, Spengler D, Lees KR, Aldrich C, Mishra NK [et al.]. The Modifi ed Graeb Score: An

Enhanced Tool for Intraventricular Hemorrhage Measurement and Prediction of Functional Outcome.

Stroke. 2013;44:635-641. Available from: https://doi.org/10.1161/STROKEAHA.112.670653

https://doi.org/10.1161/STROKEAHA.112.670653

Sydorak AD, Moroz VV, Tsimeiko OA. Intraoperatsiini uskladnennia v khirurhii anevryzm dystalnykh

sehmentiv perednoi mozkovoi arterii [Intraoperative complications in the surgery of distal segments of

aneurisms of anterior cerebral artery]. Endovaskuliarna neirorenthenokhirurhiia. 2015;2(12):16-22

[in Ukrainian].

Cheburakhin VV, Luhovskyi AH, Orlov MYu, Kostyuk MR, Yarotskiy YuR, Moroz VV, Skorokhoda ІI.

Porivnialnyi analiz rezultativ intraarterialnoho trombolizysu ta trombekstraktsii pry tromboembolichnykh

uskladnenniakh v endovaskuliarnii neirokhirurhii [A comparative analysis of intraarterial thrombolysis

and trombextraction in patients with thromboembolic complications in endovascular neurosurgery].

Endovaskuliarna neirorenthenokhirurhiia. 2015;2(12): 23-31 [in Ukrainian].

Cherednichenko YuV, Miroshnichenko AYu, Zorin NA, Grygoruk SP, Kuts AI. Rezul'taty' dlitel'nogo

nablyudeniya za paczientami s neotdelivshimisya v khode vy'polneniya e'ndovaskulyarnoj

e'mbolizaczii czerebral'noj anevrizmy' mikrospiralyami (2 nablyudeniya) [Results of long-term

observations of patients with undetached microcoils in the course of endovascular embolization of

cerebral aneurysm (2 observations)]. Endovaskuliarna neirorenthenokhirurhiia. 2015;2(12):50-62 [in

Russian].

Kukharuk VF, Bobryk IS, Bobryk SI, Fetsyak SV, Chyrko AL. Uskladnennia pry embolizatsii

mishkopodibnykh anevryzm sudyn holovnoho mozku [The complications of saccular cerebral aneu-

rysms embolization]. Endovaskuliarna neirorenthenokhirurhiia. 2015;1(11):16-22 [in Ukrainian].

Shevaha VM, Paienok AV, Netliukh AM, Salo VM, Tokarskyi AYu, Hryshchuk OI,. Kobyletskiy O.JA,

Dyakiv VV. Rezultaty vprovadzhennia v praktyku suchasnykh metodiv likuvannia sudynnykh anomalii

holovnoho mozku u Lvovi ta Lvivskii oblasti i perspektyvy yikh rozvytku [Historical, theoretical

considerations and practical results of modern methods application on treatment of cerebral

vascular abnormalities in Lviv and Lviv region and perspectives of future development]. Endovaskuliarna

neirorenthenokhirurhiia. 2013;2:11-20 [in Ukrainian].

Scheglov DV. Diahnostyka ta endovaskuliarne likuvannia vnutrishnocherepnykh arterialnykh anevryzm

[Diagnostics and endovascular treatment of intracranial arterial aneurysms].: avtoref. dys. na zdobuttia

nauk. stupenia doktora med. nauk: 14.01.05 «Neirokhirurhiia». Kyiv, 2014. 46 s. [in Ukrainian].

Danura H, Schatlo B, Marbacher S, Kerkeni H, Soleman J, Coluccia D, Diepers M, Remonda L, Fathi AR,

Fandino J. Does intraoperative angiographic vasospasm during aneurysm clipping infl uence the

incidence of delayed cerebral vasospasm and delayed neurological defi cits? J Neurol Surg A Cent Eur

Neurosurg 2014; 75 - p21. DOI: 10.1055/s-0034-1383757

https://doi.org/10.1055/s-0034-1383757

Siironen J, Porras M, Varis J, Poussa K, Hernesniemi J, Juvela S. Early ischemic lesion on computed

tomography: predictor of poor outcome among survivors of aneurysmal subarachnoid hemorrhage. J

Neurosurg. 2007 Dec;107(6):1074-9. PMID: 18077942 DOI: 10.3171/JNS-07/12/1074

https://doi.org/10.3171/JNS-07/12/1074

Shevaha VM, Netliukh AM, Kobyletskyi OYa, Hryshchuk OI, Salo VM, Pryshliak HM. Vnutrishnoarterialna

farmakoterapiia ta rannii intraoperatsiinyi kombinovanyi trombolizys pry rozvytku tserebralnoho

vazospazmu i tromboishemichnykh uskladnen pid chas neiroendovaskuliarnykh operatsii [Intraarterial

pharmacotherapy and early intraoperative combined thrombolysis for treatment of cerebral vasospasm

and thrombo-ischemic complications appeared during neuroendovascular operations]. Endovaskuliarna

neirorenthenokhirurhiia. 2012;3-4:37-43 [in Ukrainian].

Chaloui N., Jabbour P., Singkhal S, Drueding R, Starke RM, Dalyai RT, et al. Stent-assisted coiling of

intracranial aneurysms: Predictors of complications, recanalization, and outcome in 508 cases. Stroke,

;44(5):1348 1353. https://doi.org/10.1161/STROKEAHA.111.000641.

https://doi.org/10.1161/STROKEAHA.111.000641

Klymov A. B. E'ndovaskulyarnoe lechenie arterial'ny'kh anevrizm golovnogo mozga [Endovascular

treatment of arterial aneurysms of the brain]: avtoref. dys. na soyskanye uchenoi stepeny kand. med.

nauk: spets. 14.00.28 «Neirokhyrurhyia»; 14.00.19 «Luchevaia dyahnostyka, luchevaia terapyia,

:26 s. [in Russian].

Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Viñuela F. Guglielmi detachable

coil embolization of cerebral aneurysms: 11 years experience. J Neurosurg. 2003 May;98(5):959-66.

https://doi.org/10.3171/jns.2003.98.5.0959

Svystov DV, Kandyba DV, Savello AV, Landyk SA. Sravnitel'nyy analiz rezul'tatov khirurgicheskogo

lecheniya anevrizm golovnogo mozga [Comparative analysis of the results of surgical treatment of

cerebral aneurysms]. Voen.-med. zhurnal. 2008.;11:36-42 [in Russian].

Vergouwen MD, Vermeulen M, van Gijn J, Rinkel GJ, Wijdicks EF, Muizelaar JP, et al. Defi nition of

delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in

clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010

Oct;41(10):2391-5. doi: 10.1161/STROKEAHA.110.589275. Epub 2010 Aug 26.

https://doi.org/10.1161/STROKEAHA.110.589275

Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, Connolly ES, Mayer SA. Eff ect of

cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage:

the Fisher scale revisited. Stroke. 2001 Sep;32(9):2012-20. PMID: 11546890 DOI: 10.1161/

hs0901.095677.

Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized

by computerized tomographic scanning. Neurosurgery. 1980 Jan;6(1):1-9. PMID: 7354892 DOI:

1227/00006123-198001000-00001.

https://doi.org/10.1227/00006123-198001000-00001

Al-Tamimi YZ, Bhargava D, Feltbower RG, Hall G, Goddard AJP, Quinn AC, Ross SA. Lumbar Drainage of

Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage: A Prospective, Randomized, Controlled

Trial (LUMAS) Stroke. 2012 Jan;43:677-682. https://doi.org/10.1161/STROKEAHA.111.625731

https://doi.org/10.1161/STROKEAHA.111.625731

Tuettenberg J1, Czabanka M, Horn P, Woitzik J, Barth M, Thomé C, Vajkoczy P, Schmiedek P, Muench

E. Clinical evaluation of the safety and effi cacy of lumbar cerebrospinal fl uid drainage for the

treatment of refractory increased intracranial pressure. J Neurosurg. 2009 Jun;110(6):1200-8. doi:

https://doi.org/10.3171/2008.10.JNS08293

3171/2008.10.JNS08293.

https://doi.org/10.3171/2008.10.JNS08293

Hrynenko E. A., Parfenov A. L. Pat. 2353297 Rossyiskaia Federatsyia, MPK A 61 V 8/06. Sposob

prognozirovaniya razvitiya ishemicheskogo porazheniya golovnogo mozga posle ostrogo

subarakhnoidal'nogo krovoizliyaniya vsledstviye razryva arterial'nykh anevrizm pri vnutricherepnoy

gipertenzii v usloviyakh spazma sosudov golovnogo mozga [A method for predicting the development

of ischemic brain damage after acute subarachnoid hemorrhage due to rupture of arterial aneurysms in

case of intracranial hypertension under conditions of cerebral vasospasm]; zaiavytel y patentoobladatel

Hrynenko Elena Anatolevna, Parfenov Aleksandr Leonydovych, HU «Nauchno-yssledovatelskyi ynstytut

neirokhyrurhyy ym. akad. N.N. Burdenko RAMN». - No 2007145238/14; zaiavl. 7.12.2007; opubl.

04.2009. Biul. No 12 [in Russian].

Nasonova T.I. Optymizatsiia likuvannia hostroho porushennia mozkovoho krovoobihu [Optimization

of treatment of acute cerebral circulation disorders]. Zhurnal nevrolohii im. B.M. Mankovskoho.

;1:42-49. ,http://nbuv.gov.ua/UJRN/jorn_2016_1_9 [in Ukrainian].

Oshorov AV, Goriachev AS, Popugaev KA, Polupan AA, Savin IA, Lubnin A.Yu. Monitoring tserebral'nogo

perfuzionnogo davleniya v intensivnoy terapii [Cerebral perfusion pressure monitoring in intensive

care]. Vestnyk anestezyolohyy y reanymatolohyy. 2013;10(2);52-59 [in Russian].

Bijlenga P, Czosnyka M, Budohoski KP, Soehle M, Pickard JD, Kirkpatrick PJ, Smielewski P. «Optimal

cerebral perfusion pressure» in poor grade patients after subarachnoid hemorrhage. Neurocrit. Care.

;13:17-23.

Vinichuk SM, Prokopiv MM, Fartushnaya YeYe, Trepet LN, Pustovaya OA. Vnutrimozgovoye

krovoizliyaniye: faktory, opredelyayushchiye tyazhest' sostoyaniya i iskhod zabolevaniya [Intracerebral

hemorrhage: factors that determine the severity of the condition and the outcome of the disease].

Ukr. med. chasopys. 2007;5(61):25-32 [in Russian].

Fernandes HM, Siddique S, Banister K, Chambers I, Wooldridge T, Gregson B, Mendelow AD. Continuous

monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical

parameters. Acta Neurochir. 2000;76, Suppl:463-466. PMID: 11450068 DOI: 10.1007/978-3-7091-

-7_96

Ziai WC, Torbey MT, Naff NJ, Williams MA, Bullock R, Marmarou A, Tuhrim S, Schmutzhard E, Pfausler

B, Hanley DF. Frequency of sustained intracranial pressure elevation during treatment of severe

intraventricular hemorrhage Cerebrovasc Dis. 2009;27(4):403-10. doi: 10.1159/000209241. Epub

https://doi.org/10.1159/000209241

Mar 18.

Morgenstern LB, Hemphill 3rd JC, Anderson C, Becker K. Guidelines for the management of

spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American

Heart Association/American Stroke Association. Stroke.2010;41:2108-2129.

https://doi.org/10.1161/STR.0b013e3181ec611b

de Rooij NK, Velthuis BK, Algra A, Rinkel GJ. Confi guration of the circle of Willis, direction of fl ow,

and shape of the aneurysm as risk factors for rupture of intracranial aneurysms. J Neurol. 2009

Jan;256(1):45-50. doi: 10.1007/s00415-009-0028-x. Epub 2009 Feb 9.

https://doi.org/10.1007/s00415-009-0028-x

Cebral JR, Raschi M. Suggested Connections between Risk Factors of Intracranial Aneurysms: A

Review. Ann. Biomed. Eng. 2013;41(7):1366-1383. doi: 10.1007/s10439-012-0723-0. Epub 2012

https://doi.org/10.1007/s10439-012-0723-0

Dec 14.

Trufanov GYe, Rameshvili TYe, Fokin VA, Svistov DV. Luchevaya diagnostika sosudistykh mal'formatsiy

i arterial'nykh anevrizm golovnogo mozga: rukovodstvo dlya vrachey [Radiation diagnosis of vascular

malformations and arterial aneurysms of the brain: a guide for doctors]. Voen.-med. akad. SPb.:

Elby-SPb, 2006; 224 s. [in Russian].

Krylov VV, Grigor'yeva UV. Komp'yuternaya tomografi ya i magnitno-rezonansnaya tomografi ya v

diagnostike anevrizm golovnogo mozga [Computed tomography and magnetic resonance imaging in

the diagnosis of cerebral aneurysms]. Neyrokhirurgiya. 2012;3:9-17 [in Russian].

Tsimeyko OA, Abbaszade YeZ, Moroz VV, Skorokhoda II, Shakhin N. Vazospazm u bol'nykh s razryvom

arterial'nykh anevrizm perednego polukol'tsa, oslozhnennykh vnutrimozgovymi i vnutrizheludochkovymi

krovoizliyaniyami [Vasospasm in patients with rupture of arterial aneurysms of the anterior half ring

complicated by intracerebral and intraventricular hemorrhages]. Ukr. med. chasopys. 2011;2 (82):98-

[in Russian].

Rosen DS, Macdonald RL, Huo D, Goldenberg FD, Novakovic RL, Frank JI, Rosengart AJ. Intraventricular

hemorrhage from ruptured aneurysm: clinical characteristics, complications and outcomes in a large,

prospective, multicenter study population. J Neurosurg. 2007 Aug;107(2):261-5. PMID: 17695378

https://doi.org/10.3171/JNS-07/08/0261

DOI: 10.3171/JNS-07/08/0261.

https://doi.org/10.3171/JNS-07/08/0261

Molyneux AJ, Kerr RSC, Yu L-M, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid

aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with

ruptured intracranial aneurysms: a randomised comparison of eff ects on survival, dependency,

seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366 (9488):809-817. DOI:

https://doi.org/10.1016/S0140-6736(05)67214-5

https://doi.org/10.1016/S0140-6736(05)67214-5.

https://doi.org/10.1016/S0140-6736(05)67214-5

Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, Shi X, Tang Y, Peng Y. Clipping versus coiling for

ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke. 2013 Jan;44(1):29-

https://doi.org/10.1161/STROKEAHA.112.663559

doi: 10.1161/STROKEAHA.112.663559. Epub 2012 Dec 13.

https://doi.org/10.1161/STROKEAHA.112.663559

Gross BA, Rosalind Lai PM, Frerichs KU, Du R. Treatment modality and vasospasm after aneurysmal

subarachnoid hemorrhage . World Neurosurg. 2014 Dec;82(6):e725-30. doi: 10.1016/j.

https://doi.org/10.1016/j.wneu.2013.08.017

wneu.2013.08.017. Epub 2013 Aug 14.

https://doi.org/10.1088/1475-7516/2013/08/017

Germans MR, Macdonald RL. Clip or Coil-Is some of the eff ect on outcome related to the risk of delayed

cerebral ischemia? World Neurosurg. 2014 Dec;82(6):e679-81. doi: 10.1016/j.wneu.2013.09.030.

https://doi.org/10.1016/j.wneu.2013.09.030

Epub 2013 Sep 25.

Zhao XB, Tan XX, Yang XH, Li XZ, Zheng XK, Xiong XY, Zhong XM. Endovascular Coiling versus Surgical

Clipping for Poor-Grade Ruptured Intracranial Aneurysms: Postoperative Complications and Clinical

Outcome in a Multicenter Poor-Grade Aneurysm Study. AJNR Am J Neuroradiol. 2016;37:873-78.

https://doi.org/10.3174/ajnr.A4649

DOI: https://doi.org/10.3174/ajnr.A4649.

https://doi.org/10.3174/ajnr.A4649

Alberto Falk Delgado, Anna Falk Delgado. Bättre utfall för patienter med endovaskulärt behandlade

aneurysm Läkartidningen 17, April 2016 Access mode: https://www.lakartidningen.se/Klinik-och-

vetenskap/Nya-ron/2016/04/Battre-utfall-for-patienter-med-endovaskulart-behandlade-aneurysm/

Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, Karis JP, Wallace RC.

Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial / // J Neurosurg.

;8;1-6. doi: 10.3171/2018.8.JNS181846

https://doi.org/10.3171/2018.8.JNS181846

Hloba M. V. Predyktory rozvytku symptomnoho tserebralnoho vazospazmu u khvorykh z

anevryzmatychnym subarakhnoidalnym krovovylyvom [Predictors of development of symptomatic

cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage]. Zb. nauk. prats

spivrobitnykiv NMAPO im. P.L. Shupyka. K., 2014;23(1):113-120 [in Ukrainian].

Shevaha V.M., Netliukh A.M., Kobyletskyi O.Ia., Hryshchuk O.I., Salo V.M., Shchybovyk D.V. Sposib

vstanovlennia tiazhkosti intraoperatsiinoho anhiospazmu pry endovaskuliarnomu vykliuchenni

vnutrishnocherepnykh arterialnykh anevryzm [Method of establishing severity of intraoperative

angiospasm in endovascular exclusion of intracranial arterial aneurysms]. Informatsiinyi lyst pro

novovvedennia v sferi okhorony zdorovia. - Vypusk 2 z problemy «Neirokhirurhiia», No98-201766 [in

Ukrainian].

Dzenys YuL. Osnovnyye oslozhneniya pri lechenii netravmaticheskikh vnutrimozgovykh gematom

polushariy bol'shogo mozga [The main complications in the treatment of nontraumatic intracerebral

hematoma of the cerebral hemispheres]. Ukrainskyi neirokhirurhichnyi zhurnal. 2014;1:16-25 [in

Russian].

Honcharuk OM, Scheglov DV. Sudynnyi spazm pry krovovylyvakh u zadniu cherepnu yamu [Vascular

spasm for hemorrhage into the posterior cranial fossa]. Zdobutky klinich. i eksperym. medytsyny.

;2:35-38 [in Ukrainian].

Crowley RW, Medel R, Dumont AS, Ilodigwe D, Kassell NF, Mayer SA, Ruefenacht D, et al. Angiographic

vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke.

;42(4):919-923.

Shevaha VM, Netliukh AM, Kobyletskyi OYa, Hryshchuk OI, Salo VM, Shchybovyk DV. Anhiohrafi chni

vyiavy i klinichni naslidky intraoperatsiinoho vazospazmu pry endovaskuliarnomu vykliuchenni

arterialnykh anevryzm [Angiographic appearance and clinical sequences of intraoperative vasospasm

during endovascular cerebral aneurysms repair]. Endovaskuliarna neirorenthenokhirurhiia. 2013;3:35-

[in Ukrainian].

Danura H., Schatlo B., Marbacher S., Hassen K, Soleman J, Coluccia D, Diepers M, et al. Does

intraoperative angiographic vasospasm during aneurysm clipping infl uence the incidence of delayed

cerebral vasospasm and delayed neurological defi cits? 12th International Conference on Neurovascular

Events after Subarachnoid Hemorrhage, July, 10-12, 2013, Lucerne, Switzerland. P. 58.

Netliukh AM, Shevaha VM, Kobyletskyi OYa, Salo VM. Pat. 107570 Ukraina, MPK A61B 17/00. Sposib

pidboru dovzhyny spirali dlia endovaskuliarnoi embolizatsii vnutrishnocherepnykh arterialnykh

mikroanevryzm [Method for selecting coil length for endovascular embolization of intracranial arterial

microanurysm].; zaiavnyk i patentovlasnyk Lvivskyi nats. med. un-t imeni Danyla Halytskoho. - No

u201513135; zaiavl. 31.12.2015; opubl. 10.06.2016, Biul.No 11 [in Ukrainian].

Netlyukh АМ. Osoblyvosti khirurhichnoho likuvannya tserebralʹnykh mikroanevryzm endovaskulyarnym

metodom u hostryy period subarakhnoyidalʹnoho krovovylyvu [Pecularities of surgical treatment of

cerebral microaneurysms by endovascular approach in the acute period of subarachnoid hemorrhage].

Endovaskuliarna neirorenthenokhirurhiia. 2014;2:48-53.

Shevaha VM, Netliukh AM, Kobyletskyi OYa, Salo VM, Lozynskyi RM, Kovalyk MV. Chynnyky ryzyku rozryvu

vnutrishnocherepnykh arterialnykh anevryzm yak kryterii vstanovlennia pokazan do khirurhichnoho

likuvannia [Risk factors of intracranial arterial aneurysms rupture as criteria forestablished indications

for surgical treatment ]. Endovaskuliarna neirorenthenokhirurhiia. 2015;1:9-15 [in Ukrainian].

Dudhani RV, Kyle M, Dedeo C, Riordan M, Deshaies EM. A Low Mortality Rat Model to Assess Delayed

Cerebral Vasospasm After Experimental Subarachnoid Hemorrhage. J. Vis. Exp. 2013;71:e4157.

doi:10.3791/4157.

https://doi.org/10.3791/4157


Abstract views: 335
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Published
2019-12-24
How to Cite
1.
Netliukh A. DIAGNOSIS AND TREATMENT OF RUPTURED CEREBRAL ARTERIAL ANEURYSMS (CURRENT ISSUES). Proc Shevchenko Sci Soc Med Sci [Internet]. 2019Dec.24 [cited 2021Sep.18];57(2). Available from: https://mspsss.org.ua/index.php/journal/article/view/211