scholarly journals Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 4 (1) ◽  
pp. E1 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Cerebrospinal Fluid ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Cerebrospinal Fluid Drainage ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation

Object The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 88 (3) ◽  
pp. 425-429 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation ◽  
Fine Print

Object. The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods. The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions. Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

scholarly journals GIANT ANEURYSMS:OUR REVIEW OVER 10 YEARS

2020 ◽  
pp. 1-2
Author(s):  
Anindya Mukherjee ◽  
Parthasarathi Datta
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Minimum Diameter ◽  
Giant Aneurysms ◽  
Rupture Rate ◽  
Giant Intracranial Aneurysms ◽  
Natural History Studies ◽  
Intraoperative Rupture ◽  
Small Aneurysms

GIANT INTRACRANIAL ANEURYSMS HAVE A MINIMUM DIAMETER OF AT LEAST 25mm.THEY REPRESENT 2-5% OF ALL INTRACRANIAL ANEURYSMS AND HAVE A FEMALE PREPONDERANCE .OVER A SPAN OF 10 YEARS(JANUARY 2010 TO JANUARY 2020) WE OPERATED 7 GIANT ANEURYSMS AND 45 SMALL ANEURYSMS.RECENT NATURAL HISTORY STUDIES HAVE DEMONSTRATED AN ANNUAL RUPTURE RATE FOR GIANT INTRACRANIAL ANEURYSMS(GIA) TO BE AROUND 6% WHICH IS HIGHER THAN FOR SMALL ANEURYSMS(1-3%).WE ANALYZED INTRAOPERATIVE RUPTURE RATE FOR GIANT ANEURYSMS AND COMPARED WITH SMALL ANEURYSMS.THE INTRAOPERATIVE RUPTURE RATE OF GIA IS CLINICALLY LESS THAN SMALL ANEURYSMS BUT IS NOT STATISTICALLY SIGNIFICANT. CONCLUSION:INTRAOPERATIVE RUPTURE RATE OF GIA IS NOT MORE THAN SMALL ANEURYSMS STATISTICALLY.

Surgical approach to giant intracranial aneurysms

1979 ◽  
Vol 51 (6) ◽  
pp. 731-742 ◽  
Author(s):  
Thoralf M. Sundt ◽  
David G. Piepgras
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Circulatory Arrest ◽  
Mass Effect ◽  
Apparent Difference ◽  
Flow Measurements ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Blood Flow Measurements

✓ The authors report experience with the surgical management of 80 giant intracranial aneurysms (> 2.5cm in diameter) during a 10-year period in which they performed 594 operations for aneurysms. The overall incidence of giant aneurysms was 13% but varied according to location: 20% of aneurysms of the internal carotid artery (ICA); 13% of middle cerebral artery (MCA) aneurysms; 1% of anterior cerebral artery (ACA) aneurysms; 15% of aneurysms of the basilar artery caput (BAC); and 18% of vertebrobasilar trunk(VB) aneurysms. Twenty-five patients had a subarachnoid hemorrhage (SAH), 49 had mass effect from the aneurysm, and six had ischemic events. There was no apparent difference in results related to the presence or absence of an SAH. Poor results were attributable to the operation except in the two cases of ACA aneurysm in which preexisting dementia persisted. Mortality was 4% and morbidity was 14%, varying from a combined low morbidity-mortality of 8% for ICA lesions to a high of 50% for BAC aneurysms. During the period of the study, different techniques were developed in an attempt to lower the risks of surgery.Ultimately ICA aneurysms were monitored with cerebral blood flow measurements and electroencephalography before and after temporary ICA ligation, then approached following resection of the anterior clinoid or treated with bypass in combination with ICA ligation. Aneurysms of the MCA were either opened during temporary MCA occlusion or resected in combination with a bypass procedure. Bypass grafts and circulatory arrest with extracorporeal circulation may have a role in giant aneurysms of the posterior circulation.

scholarly journals Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms

2018 ◽  
Vol 8 (1) ◽  
pp. 38-54 ◽  
Author(s):  
Fawaz Al-Mufti ◽  
Eric R. Cohen ◽  
Krishna Amuluru ◽  
Vikas Patel ◽  
Mohammad El-Ghanem ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Perioperative Period ◽  
Google Scholar ◽  
Endovascular Management ◽  
Background Flow ◽  
Qualitative Review ◽  
Giant Aneurysms ◽  
Management Of Complications ◽  
Delayed Complications

Background: Flow-diverting stents (FDS) have revolutionized the endovascular management of unruptured, complex, wide-necked, and giant aneurysms. There is no consensus on management of complications associated with the placement of these devices. This review focuses on the management of complications of FDS for the treatment of intracranial aneurysms. Summary: We performed a systematic, qualitative review using electronic databases MEDLINE and Google Scholar. Complications of FDS placement generally occur during the perioperative period. Key Message: Complications associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. We sought to review these complications and novel management strategies that have been reported in the literature.

Giant Pediatric Aneurysm Treated with Ligation of the Middle Cerebral Artery with the Drake Tourniquet and Extracranial-Intracranial Bypass

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Thomas A. Lansen ◽  
Samuel S. Kasoff ◽  
Joseph H. Arguelles
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Superficial Temporal Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Giant Aneurysms ◽  
The Right ◽  
Pediatric Aneurysm

Abstract Saccular intracranial aneurysms occur infrequently in children, and the incidence of pediatric giant aneurysms is statistically in the same proportion as in adults. The management of these giant aneurysms can be treacherous. This paper presents a case of a 9-year-old boy with a giant aneurysm of the right middle cerebral artery that was successfully managed by ligation of the middle cerebral artery using a Drake tourniquet with the patient awake and by augmentation of the middle cerebral artery circulation with superficial temporal artery-middle cerebral artery anastomosis without excision of the lesion.

Direct surgical treatment of giant intracranial aneurysms

1979 ◽  
Vol 51 (6) ◽  
pp. 743-756 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Approaches ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Artery Ligation ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Fine Print

✓ The author has operated on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30 to 60 years. Patients presented with subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2), and cerebrospinal fluid rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5), and the middle cerebral artery (2). Eight of 40 patients had one or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1), and aneurysmorrhaphy (1). After as much as 8 years of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; two patients (5%) had a poor recovery. There were six surgical mortalities (15%). Giant aneurysms can be treated with respectable results if the surgeon selects the technique best suited to the particular aneurysm. In general, neck occlusion, trapping, and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.

Treatment of Large and Giant Intracranial Aneurysms with Onyx. Preliminary Findings

2005 ◽  
Vol 18 (1) ◽  
pp. 101-112
Author(s):  
W. Lauriola ◽  
S. Mangiafico ◽  
M. Nardella ◽  
V. Strizzi ◽  
V. D'Angelo ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Endovascular Embolization ◽  
Maximum Diameter ◽  
Progressive Reduction ◽  
Giant Aneurysms ◽  
Area Of Interest ◽  
Giant Intracranial Aneurysms ◽  
Angiography Suite

Large and giant aneurysms account for three to seven per cent of intracranial aneurysms. They are mainly located in the carotid siphon or vertebrobasilar junction and usually give rise to mass effect, headache, haemorrhage or ischaemia. Treatment consists of surgical clipping or endovascular embolization and aims to exclude the aneurysm from the cerebral circulation to prevent haemorrhage. We describe our preliminary clinical and angiographic findings after endovascular embolization of large and giant intracranial aneurysms using Onyx and the remodelling technique. Six patients with large or giant intracranial aneurysms were treated. The maximum diameter of the aneurysmal sac varied from 15 to 33 mm, the neck measured from 5 to 10 mm and the sac-neck ratio varied from 2.14 a 4.7. Treatment (planned sessions in five patients and one in emergency) was performed in the angiography suite after detailed angiographic diagnosis including 3D formatting of the area of interest. Informed consent was obtained from the patients and their relatives. Intracranial compensation was tested angiographically and clinically before treatment. The polymer (Onyx HD 500 – 20% EVOH; 80% DMSO) was selectively injected into the lumen of the aneurysmal sac during balloon catheter occlusion of the aneurysm neck and parent vessel. Clinical and angiographic follow-up varied from three to 12 months and all patients were assessed angiographically 12 months after treatment. Complete occlusion was achieved after treatment in two aneurysms, both treated by Onyx alone. Occlusion was between 95 and 100% in two patients (one treated with Onyx alone, the other with GDCs + Onyx). Occlusion was more than 90% and less than 95% in one patient (GDCs + Onyx). Occlusion was less than 90% in the remaining patient treated with GDC + Onyx. In the four aneurysms not completely occluded, the residual part involved the neck region. Only one complication arose during treatment consisting of controlateral hemiparesis at the site of the aneurysm due to thrombus occlusion of the middle cerebral artery trifurcation, with full recovery of neurological deficit a month after treatment. Angiographic follow-up disclosed findings the same as those at the end of treatment in three patients whereas the residual aneurysm had increased by 5% in one patient. Two giant aneurysms showed a major recanalization of the aneurysmal sac. At clinical follow-up three patients reported a progressive reduction of ocular symptoms caused by compression: symptoms had slightly improved in one patient after treatment and in the remaining two with aneurysm recanalization diplopia and palpebral ptosis remained unchanged. All patients treated reported a mild progressive reduction of headache except for the patient presenting recanalization at follow-up after ten months. No major complications were found at follow-up. We plan to reserve this procedure for selected cases of large aneurysms not amenable to other treatments. Embolization should always be undertaken by physicians skilled in the remodelling technique and complete embolization of the aneurysm is crucial. The availability of new materials, easier to handle and more viscous and adhesive than Onyx, will simplify the procedure and prevent aneurysm recanalization.

Challenges in the Endovascular Treatment of Giant Intracranial Aneurysms

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S3-113-S3-124 ◽  
Author(s):  
Nestor R. Gonzalez ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
Yuichi Murayama ◽  
Fernando Viñuela
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Manifestations ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Parent Artery Occlusion ◽  
Hemodynamic Characteristics

Abstract OBJECTIVE: Giant intracranial aneurysms present unique therapeutic intricacies. The purpose of this study was to evaluate the anatomic and hemodynamic characteristics of these lesions and the current endovascular and combined surgical and endovascular techniques available for their treatment. METHODS: A review of the literature and the personal experiences of the authors with endovascular treatment of giant aneurysms are presented. This review included anatomic and hemodynamic features and analysis of the diverse endovascular techniques that have been reported for the management of these aneurysms. RESULTS: Anatomic features that create particular challenges in the therapeutic approach of giant aneurysms include size, shape (saccular, fusiform, serpentine), neck dimensions, branch involvement, intraluminal thrombosis, and location. Hemodynamic characteristics that affect endovascular treatment are lateral or terminal aneurysm type of flow and embolic material placement (inflow versus outflow aneurysmal region). The current endovascular therapeutic approaches include parent artery occlusion, trapping, endosaccular embolization with or without adjunctive techniques such as balloon-assisted or stent placement, and combined surgical and endovascular approaches, mainly with surgical revascularization and endovascular occlusion. CONCLUSION: Although there are a wide variety of endovascular therapeutic options for the treatment of giant intracranial aneurysms, none of the current techniques is completely successful and free of complications in the management of these complex lesions. A detailed and individualized analysis of each case in conjunction with sufficient understanding of the anatomy and hemodynamics of a particular aneurysm should guide the therapeutic decision. Further research advances will assist in elucidating the factors predisposing to genesis, progression, and aggressive clinical manifestations of these giant lesions.

scholarly journals Significance of the spatial reconstruction based on mathematical modeling in the surgical treatment of giant intracranial aneurysms

2006 ◽  
Vol 63 (1) ◽  
pp. 65-68 ◽  
Author(s):  
Igor Nikolic ◽  
Mirjana Nagulic ◽  
Vaso Antunovic
Keyword(s):  
Blood Vessels ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Diagnostic Procedures ◽  
Left Middle Cerebral Artery ◽  
Conventional Angiography ◽  
3 Dimensional ◽  
Giant Intracranial Aneurysms ◽  
Spatial Reconstruction ◽  
Dimensional Reconstruction

Background. The use of computer models for the 3- dimensional reconstruction could be a reliable method to overcome technical imperfections of diagnostic procedures for the microsurgical operation of giant intracranial aneurysms. Case report. We presented a case of successfully operated 52-year-old woman with giant intracranial aneurysm, in which the computer 3-dimensional reconstruction of blood vessels and the aneurysmal neck had been decisive for making the diagnosis. The model for 3- dimensional reconstruction of blood vessels was based on the two 2-dimensional projections of the conventional angiography. Standard neuroradiologic diagnostic procedures showed a giant aneurysm on the left middle cerebral artery, but the conventional subtraction and CT angiography did not reveal enough information. By the use of a personal computer, we performed a 3-dimensional spatial reconstruction of the left carotid artery to visualize the neck of aneurysm and its supplying blood vessels. Conclusion. The 3-dimensional spatial reconstruction of the cerebral vessels of a giant aneurysm based on the conventional angiography could be useful for planning the surgical procedure.

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