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Complex Aneurysm: The Unpredictable Pathological Entity
L Pescatori1, M P Tropeano2, A Santoro2
1Department of Neurosurgery, Sapienza University of Rome, Rome, Italy. lore.pesca84@gmail.com.
Acta Neurochirurgica. Supplement
|September 2, 2018
Summary
Performing bypass surgery for complex aneurysms requires careful consideration. Concomitant aneurysm trapping during bypass surgery is safer, reducing rupture risk compared to staged closure after revascularization.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Interventional Neurology
Background:
- Complex aneurysms often necessitate revascularization procedures.
- The decision to trap the aneurysm during bypass remains a clinical dilemma.
- Hemodynamic shifts post-bypass can precipitate aneurysm rupture.
Observation:
- A retrospective analysis of 48 complex aneurysm cases between 1990 and 2016.
- 19 patients underwent a staged revascularization strategy (bypass only).
- 29 patients underwent a single-stage revascularization strategy (bypass with concomitant trapping).
Findings:
- The staged revascularization group experienced one aneurysm rupture-related death.
- The single-stage strategy group reported no rebleeding events.
- Neurological outcomes in the single-stage group were stable or improved.
Implications:
- Single-stage revascularization with aneurysm trapping is recommended for complex aneurysms.
- This approach mitigates the risk of aneurysm rupture due to hemodynamic changes.
- Prioritizing concomitant trapping enhances patient safety in complex aneurysm treatment.
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