vmireavizВестник медицинского института «РЕАВИЗ». Реабилитация, Врач и ЗдоровьеBulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH)2226-762X2782-1579РЕАВИЗ10.20340/vmi-rvz.2022.3.MORPH.1vmireaviz-406Research ArticleМорфология, патологияMorphology, pathologyТранскавернозный трансмеккелевый доступ в хирургии труднодоступных аневризм базилярной артерииTranscavernosal transmekkel access in surgery of hard-to-reach basilar artery aneurysmshttps://orcid.org/0000-0003-1830-7492ЛюньковаР. Н.LunkovaR. N.

Люнькова Регина Николаевна, кандидат медицинских наук, врач-нейрохирург

Москва

Moscow

Городская клиническая больница имени В.П. ДемиховаРоссияCity Clinical Hospital named after V.P. DemikhovaRussian Federation2022110320221232248Copyright © Люнькова Р.Н., 20222022Люнькова Р.Н.Lunkova R.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestnik.reaviz.ru/jour/article/view/406

В работе приведено клинико-анатомическое обоснование вмешательств на труднодоступных аневризмах основания черепа из транскавернозного доступа. Влияние базальной хирургии улучшило возможности применяемых доступов в сосудистой нейрохирургии, обеспечило обзор труднодоступного сегмента АКБМ и качество клипирования аневризмы. Низкое расположение верхушки БА, фетальный тип строения, короткие размеры ВСА и анатомические характеристики аневризмы (АА с направлением купола к межножковой ямке, кальцинированные стенки АА, аневризма с широкой шейкой) осложняют использование птерионального доступа. Для антеролатеральных доступов остается проблема обзора хирургической цели из выбранного промежутка, одной из границ которого является ВСА (оптико-каротидный, каротидно-окуломоторный промежутки). Для латеральных доступов не решена проблема тракционных повреждений височной доли в ходе оперативного вмешательства. Предлагаемый вариант трансмеккелевого транскавернозного доступа, при котором проводится резекция латеральных отделов верхнего ската, верхушки пирамидки височной кости и разрушение канала Дорелло в области описанного «заднемедиального треугольника основания черепа» открывает I зону ската, позволяет базально подойти к стволу и верхушке БА, особенно при низком ее залегании.

The manuscript provides clinical and anatomical rationale for interventions on hard-to-reach skull base aneurysms from transcavernosal access. The impact of basal surgery improved the capabilities of the accesses used in vascular neurosurgery, provided an overview of the hard-to-reach segment of the ACBM and the quality of aneurysm clipping. The low location of the BA apex, fetal type of structure, short size of the VAS and anatomical characteristics of the aneurysm (AA with dome direction to intercostal fossa, calcified AA walls, aneurysm with wide neck) complicate the use of pterional access. For anterolateral accesses the problem of surgical target view from the selected interspace, one of the boundaries of which is the ACA (optico-carotid, carotid-oculomotor interspace) remains. The problem of temporal lobe traction damage during surgical intervention has not been solved for lateral accesses. The proposed variant of trans-mechanteric transcavernosal access with resection of lateral parts of the upper scape, the apex of the temporal bone pyramid and destruction of the Dorello channel in the area of the described "postero-medial triangle of the skull base" opens the scape I zone and allows basal approach to the BA trunk and apex, especially at its low location.

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