[Stage-by-stage treatment of multiple cerebral aneurysms using endovascular and microsurgical techniques]

Aim of the study was to substantiate effectiveness of stage-to-stage application of microsurgical and endovascular techniques in treatment of patients with multiple cerebral aneurysms (MA). 22 patients with MA were included in this study. 70 aneurysms of different location were found in this series. Aneurysms of MCA were the most frequent. Unilateral aneurysms were found in 6 patients, bilateral -- in 7, unilateral with aneurysm of vertebro-basilar system -- in 4, bilateral with aneurysm of vertebro-basilar system -- in 5. All 22 patients underwent surgical treatment with stage-to-stage application of endovascular and microsurgical techniques. 6 patients were operated in acute period of SAH. In 16 cases two-stage surgeries were made, in 5 -- three-stage. Totally 42 operations were performed. Intervals between stages varied from 1 day to 4 months. Total occlusion of aneurysms was achieved in 91.4% of cases. 40 aneurysms were clipped and 22 were coiled. In 2 cases aneurysms were occluded using coils and stent. Enforcement of aneurysmal walls by oxycellulose and different glue compositions was used in 4 cases. There was no mortality in the series. In 1 female patient with 6 aneurysms transient neurological deficit occurred after third stage of surgical treatment (stenting of basilar artery with coiling of aneurysm of this artery). We did not observe complications demanding wound revision. Obtained results of stage-to-stage surgical treatment of MA are the evidence of high effectiveness of multimodal approach with integration of endovascular and microsurgical techniques. This tactics allows to decrease mortality and disability in acute period of SAH as well in cold period. Described approach can be the treatment of choice in surgical management of MA.