Neurosurgery
doi: 10.25005/2074-0581-2022-24-4-553-561
SURGICAL TREATMENT OF PATIENTS WITH MULTIPLE INTRACRANIAL ANEURYSMS AND ACUTE SEVERE SUBARACHNOID HEMORRHAGE

D.V. Litvinenko1, E.I. Zyablova1,2, V.V. Tkachyov1,3, G.G. Muzlaev3

1Research Institute – Prof. S.V. Ochapovsky Regional Clinical Hospital № 1, Krasnodar, Russian Federation
2Department of Radiodiagnostics № 2, Kuban State Medical University, Krasnodar, Russian Federation
3Department of Neurology and Neurosurgery, Kuban State Medical University, Krasnodar, Russian Federation

About 40% of patients with multiple intracranial aneurysms (MIAs) are admitted with poor-grade subarachnoid haemorrhage (Hunt & Hess Grades IVV). Therefore, an approach to identify the most appropriate strategy for an individual patient should be applied to obtain the best functional outcomes. However, there is still no consensus on selecting proper MIAs treatment in patients with acute subarachnoid haemorrhage with localization of all aneurysms in the surgical intervention area. The article presents a case of a 43-year-old patient with MIAs: a ruptured aneurysm of the anterior communicating artery (ACA) and intact right pericallosal and right middle cerebral arteries (MCA). The first stage included clipping the ruptured ACA aneurysm and decompressive craniectomy. After stabilization of the patient's condition, the second stage of treatment was performed: clipping the aneurysms of the right pericallosal and right MCA and autologous cranioplasty. The patient was discharged from the hospital in satisfactory condition. The presented case demonstrates the need for a flexible individual approach to treating patients with MIAs and acute subarachnoid bleeding. Staged surgical treatment and performing as the second stage clipping of intact aneurysms with simultaneous early cranioplasty after compensating the patient's condition allowed for good treatment outcomes.

Keywords: Multiple intracranial aneurysms, aneurysm clipping, decompressive craniectomy, staged surgical treatment, cerebral aneurysm rupture.

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Authors' information:

Litvinenko Dmitry Viktorovich
Candidate of Medical Sciences, Neurosurgeon, Department of Neurosurgery № 2, Research Institute – Prof. S.V. Ochapovsky Regional Clinical Hospital № 1
Researcher ID: AHD-0975-2022
ORCID ID: 0000-0002-4831-1874
SPIN: 7737-9484
Author ID: 1149006
E-mail: dlmalit73@gmail.com

Zyablova Elena Igorevna
Candidate of Medical Sciences, Head of the Radiology Department, Research Institute – Prof. S.V. Ochapovsky Regional Clinical Hospital № 1; Head of the Department of Radiodiagnostics № 2, Kuban State Medical University
ORCID ID: 0000-0002-6845-5613
SPIN: 1618-0141
Author ID: 1075691
E-mail: Elenazyablova@inbox.ru

Tkachyov Vyacheslav Valerievich
Doctor of Medical Sciences, Head of the Department of Neurosurgery № 2, Research Institute – Prof. S.V. Ochapovsky Regional Clinical Hospital № 1; Professor of the Department of Neurology and Neurosurgery, Kuban State Medical University
Researcher ID: AHD-4631-2022
Scopus ID: 23499756100
ORCID ID: 0000-0002-5600-329X
SPIN: 8060-6844
Author ID: 672138
E-mail: tkachovvv@yandex.ru

Muzlaev Gerasim Grigorievich
Doctor of Medical Sciences, Full Professor, Head of the Department of Neurology and Neurosurgery, Kuban State Medical University
ORCID ID: 0000-0001-9258-5330
SPIN: 5671-7076
Author ID: 389171
E-mail: muzlaev@kubannet.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Litvinenko Dmitry Viktorovich
Candidate of Medical Sciences, Neurosurgeon, Department of Neurosurgery № 2, Research Institute – Prof. S.V. Ochapovsky Regional Clinical Hospital № 1

350086, Russian Federation, Krasnodar, 1 May str., 167

Tel.: +7 (928) 2178634

E-mail: dlmalit73@gmail.com

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