Суфианов Альберт Акрамович - д-р мед. наук, профессор, член-корреспондент РАН, главный врач ФГБУ «Федеральный центр нейрохирургии» Минздрава России; зав. кафедрой нейрохирургии ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России (Сеченовский Университет); директор учебно-научного института нейрохирургии РУДН.
4-й км Червишевского тракта, д. 5, Тюмень, 625032; ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991; ул. Миклухо-Маклая, д. 6, г. Москва, 117198
Albert A. Sufianov - Dr. of Sci. (Medicine), Professor, Corresponding Member of RAS, Chief Physician of Federal Center of Neurosurgery; Head of the Department of Neurosurgery, Sechenov First MSMU (Sechenov University); Director of Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia (RUDN University).
5, 4th km Chervishevskogo trakta, Tyumen, 625032; 8/2, Trubetskaya str., Moscow, 119991; 6, Miklukho-Maklaya str., Moscow, 117198
Рустамов Рахмонжон Равшанович - канд. мед. наук, заведующий отделением цереброваскулярной патологии.
4-й км Червишевского тракта, д. 5, Тюмень, 625032
Rakhmonzhon R. Rustamov - Cand. of Sci. (Medicine), Head of the Cerebrovascular Pathology Department of “Federal Center of Neurosurgery” of the Ministry of Health of the Russian Federation (Tyumen).
5, 4th km Chervishevskogo trakta, Tyumen, 625032
Чахмахчева Маргарита Фотиевна – студентка.
Ул. Одесская, д. 54, Тюмень, 625023
Margarita F. Chakhmacheva – student.
54, Odesskaya str., Tyumen, 625023
Суфианов Ринат Альбертович - канд. мед. наук, доцент кафедры нейрохирургии.
Ул. Трубецкая, д. 8, стр. 2, Москва, 119991
Rinat A. Sufianov - Cand. of Sci. (Medicine), Associate Professor, Department of Neurosurgery.
8/2, Trubetskaya str., Moscow, 119991
Microsurgical clipping of aneurysms of the bifurcation of the middle cerebral artery (MCA) and the ophthalmic segment of the internal carotid artery (ICA) requires precise access and minimization of the risk of damage to structures. This video case presents successful clipping of a multiple aneurysm of the above segments using a combined Minimally Invasive Posterolateral Transcavernous Transtentorial Approach (MIPLATTA). A 45-year-old female was admitted with complaints of long-term headache in the occipital and temporal regions, which had been bothering her for 20 years. Computed tomography (CT) angiography revealed saccular aneurysms of the M1-M2 segments of the right MCA and the ophthalmic segment of the right ICA. Complete clipping of the MCA aneurysm was performed, then the ICA aneurysm. Postoperative CT angiography did not reveal any signs of contrasting of the aneurysm necks. The use of MIPLATTA, due to the visualization of important anatomical structures and complete proximal and distal control of the ICA, allows for radical exclusion of aneurysms from the bloodstream without complications.
Compliance with ethical standards. Consent statement. The patient consented to the publication of the article “Microsurgical clipping of aneurysms of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery using MIPLATTA approach: a clinical video case study” in the “Sechenov Medical Journal”.
Conflict of interest. Albert A. Sufianov is a member of the editorial board and did not participate in the editorial review or decision-making on this article.
Financing. The study had no sponsorship (own resources).
Микрохирургическое клипирование аневризм бифуркации средней мозговой артерии (СМА) и офтальмического сегмента внутренней сонной артерии (ВСА) требует точного доступа и минимизации рисков повреждения структур. В видеослучае представлено успешное клипирование сочетанной аневризмы указанных сегментов с использованием комбинированного минимально инвазивного заднебокового транскавернозного транстенториального доступа (Minimally Invasive Posterolateral Transcavernous Transtentorial Approach, MIPLATTA). Пациентка 45 лет поступила с жалобами на длительную головную боль в затылочной и височной областях, беспокоящую в течение 20 лет. При компьютерно-томографической (КТ) ангиографии выявлены мешотчатые аневризмы М1-М2 сегментов правой СМА и офтальмического сегмента правой ВСА. Проведено полное клипирование аневризмы СМА, затем аневризмы ВСА. Послеоперационная КТ- ангиография признаков контрастирования шеек аневризм не обнаружила. Применение MIPLATTA за счет визуализации важных анатомических структур, полного проксимального и дистального контроля ВСА позволяет добиться радикального выключения аневризм из кровотока без осложнений.
Соблюдение этических норм. Заявление о согласии. Пациент дал согласие на публикацию представленной статьи «Микрохирургическое клипирование аневризм бифуркации правой средней мозговой артерии, офтальмического сегмента правой внутренней сонной артерии с использованием доступа MIPLATTA: клинический видеослучай» в журнале «Сеченовский вестник».
Конфликт интересов. Суфианов А.А. – член редакционной коллегии, не принимал участия в редакционном рассмотрении и принятии решений по данной статье.
Финансирование. Исследование не имело спонсорской поддержки (собственные ресурсы)
[ 0:03] We present a microsurgical clipping of aneurysms of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery using MIPLATTA approach.
[ 0:14] The patient is a 45-year-old female, presented with complaints of headache for a long time (about 20 years), in occipital and temporal areas, takes paracetamol and nonsteroidal anti-inflammatory drugs for headache relief. Computed tomography angiography of the head was performed. The examination revealed an aneurysm of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery.
[ 0:41] After the skull trepanation, the dura matter was opened. Then a sharp dissection of the superficial Sylvian vein was performed.
[ 0:51] Dissection of the Sylvian fissure.
[ 0:56] Basal cisterns dissection.
[ 01:01] Internal carotid artery dissection. Optic nerve, chiasmatic cistern dissection. Internal carotid artery aneurysm dissection.
[ 01:16] The first step was to begin clipping the middle cerebral artery aneurysm.
Middle cerebral artery dissection. Dissection of the proximal and distal segments of the middle cerebral artery.
[ 01:35] Aneurysm dissection.
[ 01:42] Clipping of the aneurysm neck. In this case, a lap-shaped clip was used to clip the neck of the aneurysm, which allowed complete disconnection of the aneurysm from the blood flow.
[ 01:52] Intra-operative Indocyanine green video-angiography shows that the aneurysm is fully clipped.
[ 02:00] The next step is to clip the aneurysm of the right internal carotid artery.
Sphenoid wing drilling.
[ 02:07] Dissection of the small wing of the sphenoid bone. Removal of the small wing of the sphenoid bone.
[ 02:15] Anterior clinoid process dissection.
[ 02:23] Anterior clinoid process removal.
[ 02:27] Peeling of lateral wall of the cavernous sinus.
[ 02:34] Middle meningeal artery dissection. Middle meningeal artery coagulation and cutting.
[ 02:41] To improve the dissection, a traction of the dura matter of the temporal lobe was performed.
[ 02:49] Dissection of the cavernous segment of the internal carotid artery in the Parkinson’s triangle.
[ 02:54] Trial temporary clipping of the internal carotid artery in the Parkinson’s triangle.
[ 02:59] Distal opening of the dura matter. Optic nerve decompression by excision of the dura matter.
[ 03:06] Dissection of the clinoid segment of the internal carotid artery by excision of the distal dural ring.
[ 03:12] Oculomotor nerve decompression.
[ 03:17] Ophthalmic artery dissection.
[ 03:22] Proximal temporary clipping of the internal carotid artery in the Parkinson’s triangle.
[ 03:27] Distal temporary clipping of the internal carotid artery.
[ 03:30] Application of a permanent curved mini-clip. Removal of temporary clips.
[ 03:36] Intra-operative Indocyanine green video-angiography shows that the aneurysm is fully clipped.
[ 03:43] Post-operative images: Computed tomography angiography of the head was performed.
No signs of neck contrast were detected.
[ 03:54] Thank you for your attention.
The video can be found here: https://rutube.ru/video/private/1ae87cb2c464d4a07d18edd6f90e8597/?p=BoTD4duuPN0wEoYNp4NuMA (RuTube).
Compliance with ethical standards. Consent statement. The patient consented to the publication of the article “Microsurgical clipping of aneurysms of the right middle cerebral artery bifurcation, ophthalmic segment of right internal carotid artery using MIPLATTA approach: a clinical video case study” in the “Sechenov Medical Journal”.
Conflict of interest. Albert A. Sufianov is a member of the editorial board and did not participate in the editorial review or decisionmaking on this article.
Financing. The study had no sponsorship (own resources).
The authors declare that there are no conflicts of interest present.