Giant Aneurysm Management

Song, Jianping; Mao, Ying

doi:10.1007/978-3-030-87649-4_7

Cited by 4 publications

(13 citation statements)

References 124 publications

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“…Seizures or ischemic strokes secondary to thrombus formation within the giant aneurysm, subsequent embolus, or vascular compromise due to aneurysm bulkiness are also observed in a few cases. Incidental discovery of these lesions is rare [3][4][5][6][7][8][9][10][11][12][13] . The pathogenesis of giant intracranial saccular aneurysms remains poorly understood.…”

Section: Introductionmentioning

confidence: 99%

“…Direct surgical neck occlusion through clipping the aneurysm while preserving the original artery is considered the ideal treatment method, but its feasibility varies in different series due to factors such as a broad, bulbous, rm, or calci ed neck 1,[4][5][6]8,10,11,13 . Additional clips may be required to reinforce the closing tension, with longer clips being less effective at the tip compared to shorter clips 4,10,22,23 .…”

Section: Yasargil Et Al Introduced the Extracranial-intracranial Bypa...mentioning

confidence: 99%

“…Endovascular techniques have shown promising results in the treatment of inoperable giant aneurysms. Serbinenko introduced the detachable balloon occlusion method for carotid cavernous stula and aneurysms, preserving the internal carotid artery 13,28 . However, this approach is suitable only for selected cases.…”

Section: Yasargil Et Al Introduced the Extracranial-intracranial Bypa...mentioning

confidence: 99%

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Surgical Management and Outcome of Large and Giant Intracranial Aneurysm

Barbarawi,

Alawneh,

Bqour

et al. 2023

Preprint

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Large and giant intracranial aneurysms, exceeding 10 mm and 25 mm in diameter, respectively, are rare in neurosurgery. These lesions carry substantial morbidity and mortality risks, often causing mass effects, intracranial hemorrhage, stroke, or seizures. We present our experience with 54 patients diagnosed with these aneurysms at King Abdullah University Hospital. We conducted neurological assessments and preoperative evaluations using the modified Rankin Scale. Individualized treatment strategies, employing surgical techniques or endovascular embolization, were tailored to each patient. Surgical interventions, including direct clipping, aneurysmal wall resection, aneurysmorrhaphy with clipping, and cross-clamping (average duration: 20 minutes), were performed in 32 cases (59.2%). Endovascular coiling was utilized in 22 patients (40.8%), with 10 requiring flow diverter stents. Of the cases, 32 were giant aneurysms, and 22 were large aneurysms. The cohort included 28 females and 26 males, averaging 46.9 years. Aneurysms were predominantly in the anterior circulation (80.6%), with initial symptoms including mass effect (78.7%), cerebral ischemia (8.3%), intracranial hemorrhage (3%), and seizures (2.8%). Outcomes ranged from favorable to excellent in 70.4% of patients, while 18.5% experienced poor outcomes, primarily in posterior circulation aneurysms or due to poor preoperative conditions. The overall mortality rate was 11.1%, with eight fatalities. Management of giant intracranial aneurysms remains challenging, with higher morbidity and mortality rates compared to other neurosurgical conditions. No universally effective technique exists, emphasizing the importance of meticulous perioperative planning and surgical expertise. Further research and treatment advancements are needed to enhance the management of these complex aneurysms.

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Section: Introductionmentioning

confidence: 99%

Section: Yasargil Et Al Introduced the Extracranial-intracranial Bypa...mentioning

confidence: 99%

Section: Yasargil Et Al Introduced the Extracranial-intracranial Bypa...mentioning

confidence: 99%

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Surgical Management and Outcome of Large and Giant Intracranial Aneurysm

Barbarawi,

Alawneh,

Bqour

et al. 2023

Preprint

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“…Some cases of spontaneous thrombosis in unruptured GIAs have also been reported, with varying degrees of severity [5] . The clinical manifestation of GIAs can be gradual or sudden, depending on the size, location, and perifocal edema caused by the condition [6] . Therefore, this case report presents an unruptured GIA that manifests as spontaneous thrombosis.…”

Section: Introductionmentioning

confidence: 99%

A rare case report of spontaneous thrombosis in unruptured giant intracranial aneurysm

Ghassani,

Sani,

Kurniawan

2023

Radiology Case Reports

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“…Symptoms range from gradual neurological deficits to catastrophic SAH and certain patients may suffer multifocal cerebral infarcts or transient ischemic attacks caused by dislodged intra-luminal thrombus [ 3 , 4 ]. In SAH, vasospasm severity correlates with the amount of blood in the subarachnoid space [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Follow-Up by Transcranial Doppler After Rupture of a Giant Intracranial Aneurysm

Lemos¹,

Almeida²,

Soares³

et al. 2022

Cureus

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Giant intracranial aneurysms (GIA) are rare and manifest primarily through subarachnoid hemorrhage (SAH), cerebral ischemia, or progressive symptoms of mass effect. Transcranial Doppler (TCD) can be used to monitor cerebral vasospasm after treatment of intracranial aneurysm allowing the adjustment of therapeutics and avoiding complications. The authors present a clinical case of a patient with a ruptured intracranial giant aneurysm in which TCD was essential to monitor vasospasm and intracranial hypertension (IH). A 53-year-old male was admitted due to a sudden headache and impaired consciousness, left hemiparesis, and dysarthria. Cerebral CT scan and CT angiography at admission showed a giant aneurysm of the right middle cerebral artery (MCA) with extensive and diffuse intraventricular SAH of Fisher grade IV and Hunt and Hess grade 4. Clipping, placement of an intracranial pressure sensor, and external ventricular drain (EVD) were performed on the same day, with difficulty in preserving the M2 branch and complicated by postoperative extensive right MCA ischemia. On day three of hospitalization, TCD revealed an increased pulsatility index (>1.5) with clinical deterioration leading to re-intervention for a decompressive craniectomy. On day six, a TCD follow-up was performed to monitor blood flow complications, and particularly vasospasm, showing a severe increase in middle blood flow velocity (MBFV) in the right MCA of 205 cm/s and Lindegaard Index > 6. Daily surveillance by TCD was maintained to guide clinical management since the attempt to withdraw the EVD led to clinical deterioration with subsequent worsening of vasospasm. Improvement occurred after surgery as ventriculoperitoneal shunt insertion was performed. TCD had a major role in the clinical orientation of SAH as well as in intracranial pressure management and was decisive to establish long-term treatment.

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Giant Aneurysm Management

Cited by 4 publications

References 124 publications

Surgical Management and Outcome of Large and Giant Intracranial Aneurysm

Surgical Management and Outcome of Large and Giant Intracranial Aneurysm

A rare case report of spontaneous thrombosis in unruptured giant intracranial aneurysm

Follow-Up by Transcranial Doppler After Rupture of a Giant Intracranial Aneurysm

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