Giant and Very Large Intracranial Aneurysms: Surgical Strategies and Special Issues

Acta Neurochirurgica. Supplement
Sabino LuzziRenato Galzio

Abstract

Giant intracranial aneurysms (GIAs) and very large intracranial aneurysms (VLAs) have a poor natural history because of a high incidence of bleeding and strokes. These lesions always represent a great challenge for neurosurgeons and interventional neuroradiologists because of some peculiar intrinsic features such as size, angioarchitecture, wide neck, mass effect, intraluminal thrombosis, atherosclerotic changes, involvement of branches and perforators, and a frequent need to perform revascularization procedures. The results of a cumulative surgical series of 75 VLAs and GIAs are reported. Thirty-three aneurysms were unruptured. Sixty aneurysms underwent direct surgical treatment consisting of 56 direct clippings, 3 trappings w/o revascularization, and 1 wrapping. Fifteen aneurysms were treated by means of extracranial to intracranial (EC-IC) high-flow bypass. An mRS score ranging between 0 and 2 was observed in 54 patients, whereas an mRS of 3 was seen in 5 patients. Four patients had a severe disability (mRS 4-5) and six patients died. Aneurysm's fragmentation, with stacking and seating clips, thrombectomy, and aneurysmorrhaphy were the techniques most frequently employed. Revascularization options involving EC-IC high-flow b...Continue Reading

Citations

Apr 30, 2020·Medicina·Gabriele SavioliMaria Antonietta Bressan
Jul 12, 2020·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Francesca OliveroSalvatore Savasta
Jul 17, 2020·Heliyon·Gabriele SavioliMaria Antonietta Bressan
May 21, 2021·The Journal of Craniofacial Surgery·Alfio SpinaPietro Mortini
Sep 12, 2021·Neurology India·Basant K MisraShah Sarit
Dec 28, 2021·Frontiers in Surgery·Matias BaldonciniMichael T Lawton

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