Efficiency study of microsurgical treatment of cerebral aneurysms: reducing the risk of disability

BACKGROUND: Despite the improvement of diagnostic and microsurgery techniques used to treat cerebral aneurysms (CAs), the risk of mortality and permanent disability in the working-age population is still high.

AIM: To determine the efficiency factors of surgical treatment of patients with cerebral aneurysms (CAs).

METHODS: The article shows the results of examination and surgical treatment of 86 patients in the Neurosurgery Clinic of the National Hospital of the Kyrgyz Republic from 2017 to 2023. The patients’ age ranged from 23 to 78 with an average age of (47±1.7), including 48 (55.8%) men and 38 (44.2%) women. In 47 patients (54.6%), cerebral aneurysm was confirmed by selective cerebral angiography. The aneurysm size ranged from miliary (3 mm) to giant (25–30 mm).

RESULTS: In patients with ruptured cerebral aneurysms (CAs), clinical findings were associated with extensive subarachnoid hemorrhage, site and volume of intracerebral hematomas. In patients with unruptured aneurysms, the findings were associated with the site and the size of CAs. Rupture of the aneurysm sac at different stages of the surgery (15.1% of cases) is a severe intraoperative complication. The worst outcomes with a mortality rate of up to 4.17% were observed in patients with ruptured CAs who have Hunt & Hess grade III and IV, and Glasgow Coma Scale scores of 7–8 and 9–10. If it is difficult to directly access the aneurysm, it is reasonable to perform microsurgical subpial resection of abnormal brain tissues around the aneurysm to avoid traumatic injury of aneurysm walls, and artery spasm. To avoid aneurysmal rupture when isolating the aneurysmal neck, it is reasonable to temporarily use special removable (temporary) clips on the proximal and distal segments of the carrier vessel. Once the aneurysmal neck has been isolated, a special clip is applied. If possible, the patency and integrity of the carrier vessel and its branches shall be preserved. To confirm that there is no blood flow in the aneurysm and assess the arterial patency, we recommend to use intraoperative microvascular Doppler ultrasonography.

CONCLUSION: The outcome of surgical treatment for ruptured aneurysms depended on the preoperative patient status. Microsurgical cerebral aneurysm (CA) clipping effectively prevents recurrent subarachnoid hemorrhage. While the patients may have no intraoperative and early postoperative complications, late complications requiring additional surgery are still possible.