Flow diversion treatment for giant intracranial serpentine aneurysms

Abstract

BackgroundGiant serpentine aneurysms (GSAs) are among the most complex and challenging type of intracranial aneurysms. Surgical clipping, bypass, or endovascular parent artery occlusion has been the main treatment of GSAs in the past. However, studies on flow diversion (FD) are limited. Therefore, we reported our experience with patients with GSAs treated with FD.MethodsPatients with GSAs treated with FD from 2012 to 2020 in our single center were retrospectively reviewed. Angiographic outcomes were graded according to the O’Kelly–Marotta scale as complete occlusion (D), trace filling (C), entry remnant (B), or aneurysm filling (A). Clinical outcomes were assessed using the modified Rankin scale (mRS) score. We also collected the patients’ treatment details and perioperative complications.ResultsThirteen patients with 14 aneurysms were included, including three in the anterior circulation and 11 in the posterior circulation. Grades B–D were found in 72.7% (8/11) of the GSAs. Good prognosis (mRS score, 0–2) was found in 66.7% (8/12) and 50.0% (6/12) of the patients at the 6-month and latest follow-up, respectively. Parent artery occlusion was found in three cases of GSAs. Five postoperative complications were observed, including two minor complications and three major complications.ConclusionAlthough reconstructive treatment with FD could be considered as one of the treatment strategies for patients with both anterior and posterior circulation GSAs, however, the risk of complications and parent artery occlusion should be considered.

Failure of Reconstructive Technique to Repair a Giant Intracranial Fusiform Aneurysm of the Basilar Artery: Case Report and Literature Review in the Pediatric Population

“…Advantages of FDDs include decreasing the aneurysm volume and mass effect 4 ; therefore, we chose to deploy a single FDD, which was also the procedure of choice in 53% of pediatric patients in the series reviewed. Of note, placement of a second FDD was required in 42% of patients.…”

“…In the case series, 40% reported fusiform aneurysm; however, the most frequent was aneurysm associated with dissection in 53% of cases (►Table 1). Advantages of FDDs include decreasing the aneurysm volume and mass effect 4 ; therefore, we chose to deploy a single FDD, which was also the procedure of choice in 53% of pediatric patients in the series reviewed. Of note, placement of a second FDD was required in 42% of patients.…”

“…Large intracranial aneurysm is defined as more than or equal to 10 mm, and giant aneurysm as more than or equal to 25mm in greatest diameter 1 ; these aneurysms account for less than 5% of all intracranial aneurysms. 2 3 Mortality and morbidity rates vary across different settings from 10.6 4 to 30% 1 5 6 and 12 6 to 80%, respectively. 1 5 Most reports include few cases of giant vertebrobasilar (VB) aneurysm in the pediatric population.…”

“…3 7 Serpentine aneurysms, a type of giant aneurysm with a “serpiginous-like” shape, and size more than 25mm and separate inflow and outflow from the parent artery, that is often partially thrombosed, represent a treatment challenge due to the high risk of occlusion of important branches of the VB system. 4 Serpentine arteries can occur in the anterior or posterior circulation, 7 and are more frequent in people 60 years of age or older. 4 The natural history of unruptured VB aneurysm in pediatric population is not well documented.…”

“…5 Endovascular treatment is associated with high rates of longterm occlusion (87%), low recurrence (7%), and good neurologic outcome (84%); while 3% cases require retreatment. 4,9 Evidence supporting reconstructive and deconstructive treatment of large and giant basilar aneurysms in the pediatric population is limited to a few case series, as a result, most conclusions are based on the adult population. Reconstructive technique consists of maintaining the parent artery in contrast to deconstructive technique of occluding the parent artery.…”