Multimodal management of giant cerebral aneurysms: review of literature and case presentation

Abstract

The pathophysiology of giant cerebral aneurysms renders them difficult to treat. Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies. Since the introduction of the flow diversion technique, the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms. A subset of these giant aneurysms may persistent despite any treatment modality. Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach—both surgical and endovascular—rather than any single technique to provide a curative result with favourable patient outcomes. This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms. Additionally, an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.

Endovascular coiling versus neurosurgical clipping for treatment of ruptured and unruptured intracranial aneurysms during pregnancy and postpartum period

“…This finding suggests a higher significance of the difference in stroke rate between EC and NC during pregnancy as compared with the postpartum period. This also potentially suggests that a staged strategy with emergent endovascular treatment to secure the ruptured aneurysm to protect against rebleed during pregnancy followed by definitive treatment with NC or EC after delivery may be considered in the appropriate clinical scenario 28…”

Case Report: Persistent Primitive Hypoglossal Artery Accompanied by a Basilar Bifurcation Aneurysm Treated by Y-Stent-Assisted Coil Embolization

“…Surgical clipping and endovascular treatment remain the predominant modality in the management of intracranial aneurysms ( 26 , 27 ). Management of posterior circulation aneurysms is still a formidable challenge, especially aneurysms of the bifurcation of the BA, because these aneurysms are adjacent to the brainstem and the cranial nerves, and blood supply to the brainstem derives from its pontine perforators.…”

Giant vertebral artery aneurysms presenting acutely with WFNS grade five subarachnoid haemorrhage, report of 4 cases treated with endovascular or surgical proximal parent artery occlusion achieving good functional outcome

“…Surgical clipping of aneurysm sac or aneurysmorrhaphy eliminates the aneurysm sac from the circulation and preserve the flow in the parent artery. 4) Endovascular reconstructive techniques include stent assisted coiling of aneurysm or flow diversion with some coil packing in the giant aneurysm. 2)3) Deconstructive techniques include surgical or endovascular proximal occlusion or trapping.…”

“…Currently the management of giant aneurysms include reconstructive or deconstructive techniques. Surgical clipping of aneurysm sac or aneurysmorrhaphy eliminates the aneurysm sac from the circulation and preserve the flow in the parent artery [ 4 ]. Endovascular reconstructive techniques include stent assisted coiling of aneurysm or flow diversion with some coil packing in the giant aneurysm [ 2 , 3 ].…”