[Microsurgical treatment of 723 cerebral aneurysms: a single-center prospective study].

Abstract

Background: Treatment of cerebral aneurysms is followed by more favorable results in hospitals with at least 50-100 patients annually. In this regard, analysis and comparison of data from various clinics are of interest.

Objective: To analyze the features of microsurgical treatment of cerebral aneurysms, immediate clinical and angiographic results.

Material and methods: There were 600 patients with cerebral aneurysms aged 16-79 years (mean 53.7±12) between 01/09/2024 and 12/29/2024. There were multiple aneurysms in 29.7% of patients. Saccular and fusiform aneurysms were observed in 95% and 5% of patients. Giant aneurysms were detected in 1.8% of cases. Aneurysms of anterior and middle cerebral arteries accounted for 74.3%. Forty-nine (8.2%), 29 (4.8%) and 99 (16.5%) patients underwent surgery in acute (1-14 days), subacute (15-21 days) and delayed (>21 days) period of hemorrhage. Cerebral aneurysms with mass effect were noted in 8 patients (1.3%), ischemia - in 15 (2.5%) cases. Incidental aneurysms were diagnosed in 400 patients (66.7%).

Results: Aneurysm neck clipping was performed in 97.5% of cases, trapping without anastomosis - 0.6%, trapping with anastomosis - 1.2%, reinforcement of microaneurysms with autologous muscle - in 0.7% of cases. There was mRS score 0-2 after 14 postoperative days in 96.3% of patients. Postoperative complications were noted in 14% of cases. There were no fatal cases. Complete exclusion of saccular aneurysms was achieved in 92.2% of cases, fusiform aneurysms - in 69.5% of cases.

Conclusion: Microsurgical treatment of patients with cerebral aneurysms in high-flow hospitals demonstrates favorable clinical and angiographic results. Favorable postoperative results require modern methods of preoperative diagnostics, accumulation of experience by neurosurgeons, adherence to algorithms for choosing a treatment method and current intensive care protocols, as well as preparation for surgery taking into account surgical risks associated with concomitant diseases.