?? ??????????? ??? ?????????: ?? ?????? ?? ????????? ??? ??? ??????? ???? ???????? ??? ?? ???????? ????

?? ????????? ???????? ??? ????????? ???????? ?????????? ????????????? ????? ?????? ??????????:

  • ?? ?????????? ???????????: ?????????? ??????? ??? ?????????? ???? ??????????? ???????? (???. 1)
  • ??? ????????? ?????????? (AVM-AVF) ??? ????????? ??? ??? ???????? ??????: ?????? ??????? ??????????? ?????? ???? ???????? ??? ???? ??????, ??? ?????? ??? ?????????? ???? ??????????? ???????????? ???? ????????? ??????? (??? 2)
  • ???? ?????? ?????????

1.?
???. 1
2.?
???. 2


?? ????? ?? ????????? ??? ?????????;

?? ?????????? ? ???????????? ????????? ????? ??? ?????? ?????????? ??????? ??? ?????????? ???? ??????? ??? ????????? (???. 3). ? ??????? ??? ??????? ???????? ??? ??????? ??? ???????? ???????? ???????? ??? ????????? ?????????? ??? ???????????? ????, ?? ??????? ?? ??????? ???? (???. 4), ?????? ?? ??????, ??????????? ?????????? ???? ???????? ??? ??? ???????????? ????? ??????????.

3.? 4.?

???. 3

5.?
6.?

???. 4:

?? ??????? ?????? ????????? (4-7) ??? ????? (8) ???? ??????????? ????????????

???? ??????????? ??? 1 ??? 17 ????? ???? ???????? ????????? ?? ????????? ????????? ????????? ??? ???????? ??? ???? ???. ??? ????????? ??? ?????????? ??? ????????? ??? ?? ???????, ???? ???????????? ?? ??? ?????? ??? ???? ??? ??????? ??????????? ???? ??? ?????? ??? 30. ?? ?????? ????? ??? ????????? ?? ?????????? ???? ??????????? ???????????? ??? ????? ??????, ???? ?????? ????????????? ?????????? ????? ? ????????? ????????, ?? ????????, ?? ????????? ????, ?? ???????????? ???????? ?.?.

??????????? ??????? (screeningtest) ??? ?? ??????????? ? ???????? ???? ??????????? ???????????? ?????? ?? ??????? ???? ?? ??????????? ???? ???????? ??????????? 2 ??????????? ???????????? ? ????????? ??????????????? ??????????? ?? ?????? ?????? ????????? ???? ???? ??????????. ?? ????? ??? ??????????? ? ????????? ???????????? (MRA) ????????? ????? ? ????? ???????????? ????????????? ???????.

???????, ?? ?????????? ????????? ????? ???????, ??????????? ?????? ?? ??? ???? ??? ?????? ??? ?????????. ??????, ?? 25% ??? ??????????? ?????? ?? ??????????? ??????????? ??? ???? ??????????? ??? ???? ? ?? ??????????? ?????? ???? ???? ??????.

???? ????? ? ??????? ??????? ???? ??????????? ????????????;

? ??? ?????????? ???????? ??? ??? ???????? ???? ???????????? ??? ?????????? ?????? ????? ? ???? ???, ??? ???????? ?????????? ?????????? ?? ?????????????? ????????, ??????????? ??? ???? ?????? ??? ????????? ??? ??????????? ??? ???????? ??? ?????????? ????????????? ?????????? (???. 5).

7.?

???. 5: ????????????? ?????????? ??????????? ?????????? ?????????

????, ??? ?????????? ????????? ????????????? ???? ???? ??? ???? ??? ???? ?? ?????? ?????? ???? ?? ???????? ??????? ?????????????? ???????. ??? ???? ??? ???????????, ? ???????? ???????? ??? ?? ????????? ??? ?????????? ?????????? ??????????.


? ????????????? ?????????? ??? ???? ???????????? ??? ? ??????? ???

? ?????????? ?????????? ??? ??? ????????? ????????? ????? ??? ?? ??????? ?????? ??????? ?????? ??? ?????? ?? ???????? ?? ?????????? ?????? ?????????? ?????.

? ????????? ????????? ?????????????? ??????????? ??? ?????? ???????? ????? ???? ???? ??? 10 / 100.000 ????????? ??? ????. ???? ???????? ??? ??? ??? ???????? ????????, ? ????????? ????????? ????? ??? ????? ??? ??????????? ??????????? ??? ???? ???? ???????????? ????????? ????? ??????? 1000 ????????? ???? ?????.

8.? 9.?

???. 6: ????????? ????????? ??? ??? ???? ?? ???? ??? 10-15% ??? ?????? ???? ???????? ?? ???????? ?????? ??????? ??? ??????????, ??? ???? ??? ?? 50% ?? ???????? ???? ???? ?????? 30 ?????? ??? ??? ???? ??? ?? ????????? ??? ?????????????? ???????. ????? ?????? ???????? ??? ??? ????? ????????? ????????? ???????? ????????? ????????? ??? ?????? ?? ?????????????? ?? ??????????? ??????? ??? ?? ??????????? ?? ?????????.

???????? ?? ??????????? ??? ??? ?? ????? ????????? ?? ?????? ????? 2-4% ???????, ??????? ??? ????????? ??? ??????? ?????????? ??? ?? ?????? ?? ??????????????? ??? ?? ????????? ?????. ????, ? ???????????? ??? ?????? ?? ????? ?? ???????????????? ???? ????? ??? ????? ??? ??????????.

??? ???????????????? ?? ?????????? ???????????;

?????? ??? ????????? ??? ???????????? ????????? ????? ? ??????????? ???? ??? ??? ?????????? ?????????? ???? ??????? ????? ???? ?? ??? ???????????? ?????????.

?? ??????????? ????????? ???????????????? ??????????? ??? ????????? ?? ??????????? ????????? ???? ??? ???????????. ????????? ??? ?? ??????? ???????????? ???????, ??? ??? ???????????? ???????? ?? ??? ??? ????? ???????????????? ?? ?? ???, ???????? ??????????, ??????????? ??????, ???????? ?????? ??? ?? ??? ??? ??????????

(???. 7)

??????? ????? ????????? ????? ??? ? ??????????? ???????? ???? ???????? ???????????? ??? ?? ??????????? ????????? ??? ? ??????? ???? ???????? ??????? ??????.

10.? 11.?

???. 7: ??????????? ????????? (clipping)(????????)) ??? ??????????????????????? (??????????) (?????) ??????????? ????????????

?? ????? ? ??????????? ????????? ??? ????????????;

????????? ??? ??????? ??????????? ???????? ??? ???????????? ?????? ???????????, ?????? ???????? ???????? ??? ??????? ??????????? ? ??????????????? ?? ??????????? ??? ??????? ??? ????????? ???? ????????? ?? ?????????. ????????? ??????????? ??????????? ??? ???????????? ??? ?? ???? ?????????? ???? ??? ???? ?????? ?????????? ???????? (????) ???????????? ???? ????? ??? ?????? (????) ??? ???????????? (???. 8). ???? ??? ?????????? ??? ???? ??? ??? ?????????? ??? ???????????? ??? ??? ?????????? ??????????, ?? ???? ??? ??????? ????????????????? ??? ??????????? ???? ?????? ??? ???? ??? ????????? ? ????.

12.? 13.?

???.8: ?????????? ????????? ??????? (????) ???? ????????????????? ????????????

?? ????? ? ??????????? ????????;

? ??????????? ???????? ? ?????????? ????? ??? ???????? ?????????? (minimally invasive) ???????, ???? ??? ????? ? ?????????? ??? ???????? ??? ???????????? ??????? ???? ??? ?? ???????? ??????, ????? ?? ????????? ??????? ??????????? ????????. ? ??????? ???? ??????? ??? ????????? ??????????????? ??????? ?? ?? ??????? ??????? ????????????? ??????????? ??? ???????? ???????? ???????????? (???. 9).

14.? 15.?

???. 9: ??????? ???????? ???????????

?? ??? ?????? ??? ?????? ??????????, ???? ??? ?? ??????? ??????? ???????????? ??? ?????????? ??????? ?????? ??????????????? ?????????, ?? ????? ???????????? ?? ?? ??????? ??? ???????? ???????????? ???? ??? ????????? ?????? ??? ????????? ??? ?????? ???? ??? ????????? (???. 10).

16.?

???. 10

17.?

???. 11

???????, ???? ????? ????????????????? ?????????? ??? ??????? (coils) (???. 12) ???????????? ???? ??? ????????????? ??? ???????????????? (???. 11) ???? ??? ???? ??? ???????????? ??????????? ?? ???????? ??? (???. 13) ??? ??? ?????????? ??? ??? ??? ?????????? ??????????, ??????????? ?? ????? ????????.

18.? 19.?

???. 12: ???????????????? ???????? ??? ??????? (coil)

20.? 21.? 22.? 23.?

???. 13: ??????????? ??? ???????????? ????? ??? ??????? ????????? ????

?? ?? ?????? ??? ?????????? ?? coils ????? ????? ?????????????? ?? ???????? ??????????? ???????? ???????? ?? ??? ??? ????? (???. 14) ??? ????????? ????? ? ??????? ??????? ??? ???????????? ???????????, ??????? ??? ??.

?? 2002 ??????? ???????????? ??? ???????????? ? ???? ???????????? ????????? ?????????????? ?????????? ??????? ?????? ??? ????????? ?? ??????????? ????????? ?? ??? ??????????? ????????? ??? ???????? ??????????? ????????????. ? ??????? ???? ?????? ????????????? ???????????? I.S.A.T. (InternationalSubarachnoidAneurysmTrial) ? ????? ?????????? ??? ?????????? ???? ???????, ???????? ??? ?????????? ????? ??? ??????????? ??? ???????????? ?????? ??? ???????????? ??????? ???? ???????????? ??? ???????????? ????????? ??? ??? ????????? ????? ??????????? ??????? ?? ???? ??????????? ???? ????? ?????????.

24.? 25.?

26.? 27.?

???. 14

???? ??? ????????? ???? ??? ?????????

? ?????????? ?? ?? ??????? ???????????, ?? ???????? ?????????? ???????, ??????? ???????????? ???????????????? ????????, ????? ? ??????? ?????????? ??? ????? ?? 2 ?????? ????? ??????????? ??????, ??????? ?.?.?. ??? ??????????? ???? ??????? ??? ??? ???????? ?????????????? ?? ??? ????????.

??? ??????? ???????????, ? ?????? ???????????? ???? ??? ????????? ?????????? ?? ??? ???-?????????? ??????? ????????? ??? ????????. ??????, ? ?????????? ???????????? ??????????? ??? ???????????? ????? ???? ?? ????????? ??? ?????????????? ??????????? ??? ????? ?? ????? ???????????? ????????? ? ????????? ???? ??? ????????????? ??? ?????????? ????????, ????????? ??? ???????????? ???????? ??? ??? ???????? ??? ??????????? ??????? ??? ??? ????????? ????? ?? ????? ??? ????????? ?????? ??? ?? ?????? ????? ?????????? ????????????? ?????????? ????????????? ??? ????????? (?????????????, ???????????) ??? ??????? ?? ????????? ???????? ??? ???????????? ??????????? ???????????.

?????????? ???????????? ????????? (??????????) ???????????? ????????? ???????? ?? ?????? ??? ????????? ??? ?????????? ???????????? ??????? ??? ??? ??????? ??????????? ??????????? ? ??????????????? ????????? ??????????????? ???? ??? ?????? ?????????? ????????? 1- 2 ???? ??? ??????????? ???? ?? ?????? ?????? ??? ??????????.

? ???????????? ??? ??????????? ???????????? ??? ??????????????? ???????????????? ?? ??? ??????? ?????????? ??? ????????, ????????? ?? ?????????? ??????????? ??? ??????????? ???????????? ??? ???????????? ????????? ???? ??? ??? ??????? ?????? ? ???????? ????????? ??? ??? ???? ?????????.

11.?

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