Complex Aneurysm: The Unpredictable Pathological Entity

Acta Neurochirurgica. Supplement
L PescatoriA Santoro

Abstract

Surgical treatment of complex aneurysms often requires the execution of a revascularization procedure. Even if avoiding the concomitant trapping of the aneurysm during the bypass procedure (waiting for the subsequent endovascular or spontaneous closure) permits one to verify the graft's patency and patient's adaptation to increased flow, the hemodynamic changes induced by the bypass may cause the aneurysmal rupture. Whether or not to perform the concomitant trapping of the aneurysm still remains a dilemma. Here we illustrate our management protocol through the critical analysis of some illustrative cases of our series. Between 1990 and 2016, 48 of 157 patients affected by complex aneurysms underwent a revascularization procedure. In 19 cases (1990-1997) only a bypass procedure was performed. Spontaneous or endovascular closure was obtained within the first postoperative week once the graft patency had been verified (staged revascularization strategy). In the remaining 29 cases. The total amount of cases is 48. 19 cases staged revascularization strategy. 29 cases single stage revascularization strategy. In the staged revascularization era, one patient died because of the rupture of the aneurysm before its closure.In the single-s...Continue Reading

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