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Treatment and results of partially thrombosed giant aneurysms
Insights
Partially thrombosed giant aneurysms present significant neurosurgical challenges. Surgical approaches, including clipping or arterial reconstruction, are crucial for managing these complex vascular lesions.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Partially thrombosed giant aneurysms are complex neurosurgical conditions.
- These aneurysms occur in various cerebral arteries, including vertebral, basilar, internal carotid, middle cerebral, and anterior communicating arteries.
Observation:
- The study reviewed 18 cases of partially thrombosed giant aneurysms.
- Treatment strategies included clipping (9 cases), aneurysm removal with anastomosis (2 cases), interventional treatment (2 cases), and conservative management (5 cases).
- Conservative management of serpentine and fusiform internal carotid artery bifurcation aneurysms resulted in patient mortality due to infarction.
Findings:
- Surgical approach is paramount for securing the neck of thrombosed giant aneurysms.
- Three-dimensional computed tomography angiography aids in surgical strategy planning.
- For large necks, arterial reconstruction is preferred, requiring adequate artery size due to wall thickness.
- Aneurysmectomy with anastomosis is an alternative when the aneurysm neck is too small for reconstruction.
Implications:
- Optimal surgical strategy selection is vital for managing partially thrombosed giant aneurysms.
- Advanced imaging like 3D CT angiography improves surgical planning and outcomes.
- Arterial reconstruction or aneurysmectomy with anastomosis are key surgical techniques for complex aneurysms.
- Conservative management may be associated with poor outcomes in specific aneurysm types.
Abstract:
Partially thrombosed giant aneurysms are one of the most difficult diseases in the neurosurgical field. We have had 18 of these cases namely, three in vertebral artery, four in basilar artery, four in internal carotid artery, five in middle cerebral artery, and two in anterior communicating artery. Nine aneurysms were clipped, two aneurysms were removed with anastomosis, two cases were treated interventionally, and five cases were treated conservatively because of serpentine and fusiform types of aneurysms in internal carotid artery bifurcation. These conservatively treated patients died due to infarction. When surgery is selected in the thrombosed giant aneurysms, the approach is the most important to secure the neck. Three-dimensional computed tomography angiography was useful to plan the strategy for surgery. If the neck is big enough for placement of a clip, arterial reconstruction is the choice. The reconstruction must be done including an adequate size of the artery because of the thick wall. If the aneurysm neck is too small to reconstruct, aneurysmectomy with anastomosis is one of the choices.