pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMUpmj-521Research ArticleМЕТОДИКАMETHODSПревентивное клипирование аневризм головного мозга: к вопросу о взвешенном принятии решения и важности оперативной техники для оптимального исходаPreventive brain aneurysm clipping: decision making and importance of surgical techniques for the optimal outcomeБелыхЕ. Г.BelykhE. G.e.belykh@yandex.ruКикутаК. ..KikutaK. ..noemail@neicon.ruЖдановичГ. С.ZhdanovichG. S.noemail@neicon.ruИркутский научный центр хирургии и травматологииРоссияIrkutsk Scientific Center of Surgery and TraumatologyRussian FederationГоспиталь Университета ФукуиРоссияDivision of Neurosurgery, Faculty of Medical Sciences, University of FuruiRussian FederationИркутский государственный медицинский университетРоссияIrkutsk State Medical UniversityRussian Federation201528122015045962Copyright © Белых Е.Г., Кикута К..., Жданович Г.С., 20152015Белых Е.Г., Кикута К..., Жданович Г.С.Belykh E.G., Kikuta K..., Zhdanovich G.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/521

Изучены факторы, влияющие на решение о микрохирургическом лечении небольших неразорвавшихся аневризм передней мозговой артерии. На клиническом примере представлена оперативная техника. Детально описаны факторы, учитываемые при оценке риска и пользы различных опций лечения, включая анализ кумуляционного риска разрыва аневризмы в течение ожидаемой продолжительности жизни.

Factors that should considered in the assessment of the risks and benefits of different treatment options, including an analysis of cumulative risk of aneurysm rupture during the life expectancy are described. Surgical technique is presented in the illustrative case of a patient with an unruptured anterior communicating artery aneurysm. Skill of sharp arachnoidal dissection by micro-scissors in different directions is an important component of operative technique for opening of arachnoidal cysterns and dissection of arachnoid membrane adhesions that allows to perform adequate brain relaxation by removing the liquor, as well as producing a bloodless exposure to areas of interest, access to the proximal and distal vascular branches for temporarily clipping. Sharp dissection is important for identification and protection of perforating and exiting arterial branches, dissection of aneurysm neck without tension of aneurysmal sac walls by arachnoid adhesions.

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The authors declare that there are no conflicts of interest present.