title: [The use of extra-intracranial microanastomosis in the treatment of cerebral ischemia in patients with nontraumatic subarachnoid hemorrhage].
abstract: OBJECTIVE
  to evaluate the use of extra-intracranial microanastomosis (EICMA) in the treatment of brain ischemia in patients with nontraumatic subarachnoid hemorrhage (SAH).
  
  
  METHODS
  In the period from 01.01.14 to 01.07.15, there were 229 surgeries for ruptured intracranial aneurysms performed in the urgent surgery unit. Nine patients with marked and widespread angiospasm, subcompensated and decompensated cerebral ischemia underwent the simultaneous clipping of ruptured intracranial aneurysms and EICMA. The age of patients varied from 32 to 52 years (mean 36 years). The severity of patient's state was assessed as III-IV grades on the Hunt and Hess scale before operation. The surgery was performed 1-2 days after admission to the hospital, 1-8 days after the development of SAH.
  
  
  CONCLUSIONS
  Excellent and good outcome was recorded in 4 patients, severe disability in 3 patients, fatal outcome in 2 patients. The fatal outcome was due to decompensated cerebral ischemia and progressive angiospasm with the high linear blood flow rate and the following reduction in perfusion in the affected hemisphere. The simultaneous clipping of ruptured intracranial aneurysms and EICMA in the acute stage of SAH of patients with subcompensated cerebral ischemia allow to improve treatment
  
  
  RESULTS
  This technique is most applicable for patients with proximal angiospasm of M1- and M2-segments of the middle cerebral artery in the first 24 h of the development of a focal neurological deficit supported by the reduction in perfusion in the corresponding vascular area.
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: V V
authors.initials: VV
authors.lastname: Krylov
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: V G
authors.initials: VG
authors.lastname: Dash'yan
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: V A
authors.initials: VA
authors.lastname: Luk'yanchikov
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: A S
authors.initials: AS
authors.lastname: Tokarev
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: N A
authors.initials: NA
authors.lastname: Polunina
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: A V
authors.initials: AV
authors.lastname: Sytnik
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: A A
authors.initials: AA
authors.lastname: Solodov
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: E V
authors.initials: EV
authors.lastname: Grigor'eva
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: N E
authors.initials: NE
authors.lastname: Kudryashova
authors.affiliation: Sklifosovsky Research Institute fof Emergensy Medicine, Moscow.
authors.forename: G K
authors.initials: GK
authors.lastname: Guseinova
mesh_terms: D000714:Anastomosis, Surgical; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002545:Brain Ischemia / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery; D020768:Middle Cerebral Artery; D013345:Subarachnoid Hemorrhage / Q000601:surgery*