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Assessment of patients with intracranial aneurysms in the late postoperative period consists of both determining structural changes in computed tomography (CT) and the neurological and cognitive status of the patient. Meantime, the topic of the relationship between structural pathology in CT and cognitive impairment has not been suffi ciently disclosed.Objective: to determine CT, functional and cognitive outcomes in the long-term period of surgical treatment of cerebral aneurysms.Material and methods. The data of CT angiography of 49 patients operated on for intracranial aneurysms were analyzed. 39 patients were examined neurologically for 2.3 years using a range of rating scales.Results. The residual part of the aneurysm after surgery was found in 50% of patients with complex aneurysms, more often in patients with PMA-PSA aneurysms. The connection between the method of surgery and the preserved cervical part with structural changes in the brain and the development of cognitive impairment in the late postoperative period has not been proven.Conclusion. CT angiography preoperatively makes it possible to identify a group of complex aneurysms with a high risk of preservation of the cervical part and the development of brain structural changes. The predictors of the development of ischemic changes in the brain, hydrocephalus, and cognitive dysfunctions was the advanced age of patients, the duration of the operation, and a history of hypertension.

There is no unified management of patients with the consequences of subarachnoid hemorrhage in the long term.Purpose of the study. To study the nature and severity of SAH, the clinical manifestation of hemorrhage, the choice of the intervention technique in the acute period of the disease for the long-term results of the treatment of aneurysms.Materials and methods. In the long-term period, at an average time of 3.5 years after aneurysmal subarachnoid hemorrhage, 100 patients were examined who underwent microsurgical intervention (n = 48), endovascular exclusion of the aneurysm from the bloodstream (n = 14), simultaneous intervention, including microsurgical intervention and extra-intracranial vascular bypass (n = 23), as well as microsurgical intervention followed by the introduction of a fibrinolytic agent into the subarachnoid space (n = 15).Results. Risk factors for unfavorable clinical recovery of patients, as well as the development of cognitive and mental disorders, were: intracerebral hematoma, dislocation syndrome, duration of temporary clipping more than 7 minutes, the volume of intraoperative blood loss of more than 300 ml. The best functional recovery in the long-term period was noted in patients who underwent microsurgical clipping of the aneurysm, supplemented by surgical revascularization (p = 0.003).Conclusion. The results of our study demonstrated the persistence of the consequences of surgical intervention for the rupture of cerebral aneurysms for a long time, which necessitates long-term observation of patients, the development of individual programs of physical and psychological rehabilitation, and clinical examination of persons at high risk.

Study objective. To determine the role of transcranial duplex sonography measurements in prognosing the risk of adverse outcome in patients with nontraumatic subarachnoid haemorrhage.Materials and Methods. In 2010–2020 413 patients admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department with aneurysmatic subarachnoid haemorrhage were enrolled into the study, including 201 males (48.7 %) and 212 females (51.3 %). Mean age was 51 ± 12 years. All patients were treated surgically (aneurysm clipping). Patients’ status on admission and before surgery was evaluated according to Hunt and Hess scoring system. Transcranial duplex sonography was conducted in all patients on admission, before surgical treatment and on a daily basis after aneurysm clipping (up to the 10th day after aneurysm rupture, 2,612 examinations in total). The degree of angiospasm in middle cerebral artery, Lindegaard ratio and the presence of diffuse angiospasm in all arteries of Willis circle were assessed according to a previously described classification system. Brain computed tomography scans were used to determine the extent of subarachnoid haemorrhage according to C. M. Fisher scale and volume of ischemic lesions in areas supplied by middle cerebral artery. Outcomes were rated according to Glasgow Outcome Scale. Study sample was divided into two groups according to outcome. Group 1: adverse outcome (Glasgow Outcome Scale 1–3). Group 2: favorable outcome (Glasgow Outcome Scale 4–5). Binary logistic regression was applied to reveal risk factors for adverse outcome. To define long-term treatment outcome 104 patients (68 females, 36 males) were examined using neurologic scoring systems: Modified Rankin Scale, Barthel Index, Mini-Mental State Exam, Hospital Anxiety and Depression Scale.Results. Favorable outcome (group 2) was ascertained in 221 (53.5 %), unfavorable outcome (group 1) – in 192 (46.5 %) patients. The following independent risk factors for unfavorable outcome were detected: angiospasm in middle cerebral artery before surgery, severe angiospasm in middle cerebral artery and diffuse angiospasm. According to univariate analysis, daily increase in middle cerebral artery peak systolic velocity by 51.6 cm / s was associated with adverse outcome either. Binary logistic regression model was able to predict unfavorable outcome with sensitivity 88.5 %, specificity 76.0 %. Daily increase in middle cerebral artery peak systolic velocity by 58.7 cm / s was associated with Modified Rankin Scale increase by 1 point. Angiospasm proved to be strongly connected with cognitive and self-care ability impairment on follow-up.Conclusion. Ultrasonic signs of angiospasm in patients with aneurysmatic subarachnoid haemorrhage are independent predictors of adverse outcome and long-term results worsening.