Сheburakhin V. Individualization of surgical treatment of patients with middle cerebral artery aneurysms with their clinical-anatomic features

There are the theoretical summary and the new approach to the solution of the actual applied science issue in the given dissertation presented - the improvement of the efficacy of the diagnostic and treatment of the patients that are suffering from AA MCA, using the individual approach to the choice of surgical technique. There were the results of clinical and instrumental examination and the treatment of 186 patients with verified diagnosis of AA MCA analyzed. This decision about whether the endovascular or opened surgical technique was used was made after the estimation of the results of the digital selective cerebral angiography and the CT of the head. The endovascular intervention was the method of choice in the case of the appropriate technical support and the absence of the contraindications. The endovascular treatment of AA MCA was less invasive, however, its application was limited by the range of individual factors. The appliance of the protection technologies in the case of the thick neck of the aneurysm provides the opportunity to perform the effective embolization and markedly enlarges the possibilities of this method. The endovascular embolization of AA MCA (radicality 85,1%) allows to effectively predict the early and late hemorrhages. There was the conclusion reached: the microsurgical intervention provided higher rate of radicality in contrast to the embolization of the aneurysms using the coils. However, the frequency of occlusion (total and subtotal) of the aneurysm from the blood stream was identical. The analysis of the provided treatment indicated that the rates of lethality (4,1%), invalidity (10,8%) and the normal quality of life (85,1%) were better in the patients after endovascular procedure in comparison with the microsurgical technique (lethality (7,1%), invalidity (21,5%) and the normal quality of life (75,9%)). This fact allows to recommend the endovascular embolisation of the aneurysm as the method of priority treatment in the case of appropriate anatomical features of the AA MCA. There was explored by our team, that the results of endovascular and microsurgical treatment of AA MCA in the acute and not acute periods are dependent on the severity and form of SAH, the general condition, presence of the complications of SAH, the anatomical features of aneurysm and the period when operative procedure was performed. The individual approach to whether the microsurgical or endovascular method of treatment is used is based on the complex analysis of the features of symptoms, clinical and anatomical form of the haemorrhage and radio-anatomical parameters of the aneurysm; it provides the base for the justification the choice and the differential application of the microsurgical or endovascular technique of treatment that improves the results in patients with the diagnosis of AA MCA