This paper presents a computer vision-based approach to chronic subdural hematoma segmentation that can be performed by one click. Chronic subdural hematoma is estimated to occur in 0.002–0.02% of the general population each year and the risk increases with age, with a high frequency of about 0.05–0.06% in people aged 70 years and above. In our research, we developed our own dataset, which includes 53 series of CT scans collected from 21 patients with one or two hematomas. Based on the dataset, we trained two neural network models based on U-Net architecture to automate the manual segmentation process. One of the models performed segmentation based only on the current frame, while the other additionally processed multiple adjacent images to provide context, a technique that is more similar to the behavior of a doctor. We used a 10-fold cross-validation technique to better estimate the developed models’ efficiency. We used the Dice metric for segmentation accuracy estimation, which was 0.77. Also, for testing our approach, we used scans from five additional patients who did not form part of the dataset, and created a scenario in which three medical experts carried out a hematoma segmentation before we carried out segmentation using our best model. We developed the OsiriX DICOM Viewer plugin to implement our solution into the segmentation process. We compared the segmentation time, which was more than seven times faster using the one-click approach, and the experts agreed that the segmentation quality was acceptable for clinical usage.

Introduction. Postoperative angiographic examinations after endovascular treatment of cerebral aneurysms may demonstrate unstable results, both in the form of recurrence formation, and in the form of increased degree of occlusion with initially incomplete occlusion of the aneurysm sac. Cerebral aneurysm recurrences represent an important medical and social problem comparable in terms of hemorrhage risks with nonoperated aneurysms.Aim. To estimate the early and long‑term results of endovascular treatment of patients with cerebral aneurysms ope rated on using different endovascular techniques. Materials and methods. The present study included 167 patients (48 men and 119 women) with 195 cerebral aneurysms aged from 18 to 75 years who were operated on using endovascular techniques at the neurosurgical department No. 3 of the Russian Research Neurosurgical Institute named after Prof. A. L. Polenov from 2013 to 2016. The average age of the patients was 52 ± 12 years, the minimum age was 18 years, and the maximum age was 75 years. The choice of endovascular treatment method in the patients included in the study was based on anatomico‑topographic and morphometric features of aneurysm, as well as taking into account the period of aneurysmal disease course.Results. The study of data of control angiographic examinations after endovascular treatment of patients with cerebral aneurysms showed that in the remote postoperative period the degree of aneurysm occlusion may differ from that initially achieved. The probability of aneurysm recurrence after its isolated occlusion with coils may reach 13.1 % already in 6 months after surgical treatment, 31.7 % after 12 months and 22.3 % after 36 months, averaging 22.5 % (p < 0.05).Conclusion. The personalized approach in choosing optimal surgical tactics for the treatment of patients with cerebral aneurysms allows to achieve stable radical aneurysm occlusion, to decrease the incidence of postoperative complications and aneurysm recurrences in the long‑term postoperative period.

There are proximal, distal and intranidal AVM-associated aneurysms (G. Redekop, 1998). To evaluate treatment outcomes in 120 patients with AVM-associated aneurysms. We analyzed treatment outcomes in 639 patients with cerebral AVM who underwent 1992 endovascular procedures between 2010 and 2019. AVM-associated aneurysms were found in 120 (18.8%) cases: 81 (67.5%) patients with 69 proximal and 29 distal aneurysms, 33 (27.5%) AVMs with intranidal aneurysms and 6 (5%) aneurysms without hemodynamic connection with AVM. One hundred and one malformations (16.9%) out of 596 supratentorial AVMs and 19 (44.2%) out of 43 subtentorial AVMs were associated with aneurysms. Intracranial hemorrhage occurred in 349 (53.3%) out of 639 patients with AVM: 97 (80.8%) out of 120 patients with AVM-associated aneurysms and 252 (48.6%) out of 519 ones with AVM and no aneurysms. All 33 patients with intranidal aneurysms in the AVM structure and 18 (94.7%) out of 19 patients with AVM-associated aneurysms and AVM in posterior cranial fossa had intracranial hemorrhage. There were 98 aneurysms in 81 patients with AVM-associated aneurysms. Eighty-nine (90.8%) ones underwent endovascular treatment, 6 (6.1%) patients with proximal aneurysms required microsurgery. Three distal aneurysms were not repaired. Thirty-four aneurysms were embolized with spirals. Embolization with spirals and balloon assistance was performed for 41 aneurysms, spirals with stent-assistance - for 9 aneurysms (including 1 distal MCA aneurysm in hemorrhagic period). Implantation of a flow-diverting stent was performed for 5 aneurysms (1 distal and 4 proximal aneurysms). There were 8 (8.9%) complications after embolization of 89 AVM-associated aneurysms (5 thromboembolic and 3 hemorrhagic events). According to our data, intranidal aneurysms require exclusion of the parent AVM segment due to high risk of hemorrhage. Treatment of proximal AVM-associated aneurysms should be carried out prior to AVM embolization. Distal aneurysms do not regress after definitive AVM treatment and should be operated on after total AVM embolization.

Infectious aneurysms (IA) are cerebral aneurysms that are formed due to the infectious inflammation of the arterial wall. They are a rather rare pathology and in most cases prove to be a complication of infectious (bacterial) endocarditis of the left heart chambers. Timely diagnosis of IA in the pre-hemorrhagic period is problematic due to the variability of the clinical picture of IA, frequent blurred or low-symptomatic clinical course, the possibility of IA formation in the remote period after septic embolism, even despite the background of antibiotic therapy. The presented clinical case illustrates the first successful use of a low-profile flow-diverting stent for the treatment of a young patient with a mechanical heart valve and an infectious aneurysm of the left middle cerebral artery, developed at the site of septic embolism in the acute period of septic bacterial endocarditis accompanied by ischemic stroke. This observation demonstrates the effectiveness of the chosen method of treatment, peculiarities of adequate preoperative preparation, possible postoperative complications and detailed correction of anticoagulant and antiplatelet therapy.

Giant aneurysms of the vertebrobasilar basin manifesting as brain stem compression are a rare pathology with an incidence ranging from 3 to 13,5 %. Surgery of such aneurysms is often associated with unsatisfactory treatment results due to the high traumatic nature of direct surgery on aneurysms of this region, as well as the close proximity of vital brain structures. Surgical intervention is also hampered by the large volume of the aneurysm, possible presence of thrombus in the sac, frequent absence of the neck, location in the anatomically difficult region, and small volume of the posterior cranial fossa (PCF). The above factors make it difficult to clip the aneurysm and increase the risk of perioperative complications. Endovascular intervention is a method of choice in most cases allowing to switch an aneurysm off the blood flow, however in the presence of mass effect aneurysm occlusion does not always achieve a clinical effect due to the preservation of brain stem compression. The aim of this publication was to demonstrate the possibility of successful combined surgical treatment of a giant aneurysm located in the PCF and accompanied by brain stem compression.