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Microneurosurgical treatment of saccular aneurysms of the anterior part of Willis circle

Author: Andronachi Victor
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 11 November, 2015
Approved by NCAA on the 22 December, 2015


Adobe PDF document6.80 Mb / in romanian


CZU 616.33 - 007.64 - 089

Adobe PDF document 16.00 Mb / in romanian
164 pages


cerebral aneurysm, microneurosurgical technique, minimal invasive neurosurgery, „keyhole” supraorbital approach, postoperative complications


Thesis includes 140 text pages and is structured as follows: introduction, 5 chapters, discussions, conclusions and practical recommendations, bibliography made up of 220 titles, 5 annexes, 37 pictures, 17 tables and 17 formulas. The obtained results have been covered in 17 scientific works, inclusive 7 recenssed articles, 2 works are published in international scientific journals; 9 works are published by single author.

Field of research: neurosurgery, 321.21 vascular pathology of central nervous system.

Aim of research: improving the surgical treatment results of the patients with saccular aneurysms of the anterior part of Willis circle by using and adaptation of minimal invasive „keyhole” supraorbital approach.

Thesis goals: To perform a comparative analysis of CT Angio and classic cerebral angiography data; evaluation of self-descriptiveness of this information obtained by these methods for diagnosis and surgical approach efficient planning for saccular aneurysms of anterior part of Willis. Also this information can be used for the diagnosis algorithm for the treatment of cerebral aneurysms in addition to its improvement. This work estimates supraorbital minimal invasive „keyhole” approach indications and contraindications and evaluation of efficiency of supraorbital „keyhole” approach in supraorbital cerebral aneurysm clipping in comparison with other classic approaches. Obtained results can be used for determination of the intra- and postoperative complication apparition risks of the operated patients with the cerebral aneurysms depends on performed surgical approach.

The scientific novelty and originality: A research oriented to determine the effectiveness of minimal invasive approach for optimizing the surgical treatment of patients with cerebral aneurysms of the anterior part of Willis circle was performed. Scientific issue solved: Surgical treatment of patients with saccular cerebral aneurysms of the anterior part of Willis circle was optimized, which means efficient utilization of modern cerebral angiographic methods on the surgery planning stage; using of the efficient cerebral relaxation methods; using of the surgical microscope and the principles of the minimal invasive surgical treatment.

Theoretical significance of research: Being commensurable with internationally accepted management of cerebral aneurysms, our results supplement the theoretical principles of preoperative planning of surgical approach for the cerebral aneurysm clipping. Nowadays, definition and prevention of difficulties, errors, complications in dealing with cerebral aneurysms is important.

The applicative value of the research: Elaboration of a step-by-step algorithm of use of SAH management in aggregate with modern diagnostic methods improved its efficiency. Obtained data have allowed to perform accurate preoperative planning and to use minimal invasive methods in supratentorial cerebral aneurysms treatment.

Practical implementationof supraorbital minimal invasive „keyhole” approach in daily surgical activity in the INN has led to a decreased rate of postoperative complications in cerebral aneurysm surgery and to improve the better outcome of those patients. The main concepts are implemented into the training program of the chair of neurosurgery of the State University of Medicine and Pharmacy „Nicolae Testemiţanu”.