| Title: | Giant and Very Large Intracranial Aneurysms: Surgical Strategies and Special Issues |
| Author(s): | Luzzi S; Gallieni M; Del Maestro M; Trovarelli D; Ricci A; Galzio R; |
| Address: | "Department of Neurosurgery, San Salvatore City Hospital, L'Aquila, Italy. Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy. drgallieni@gmail.com. Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy. Department of Anesthesiology, San Salvatore City Hospital, L'Aquila, Italy" |
| DOI: | 10.1007/978-3-319-73739-3_4 |
| ISSN/ISBN: | 0065-1419 (Print) 0065-1419 (Linking) |
| 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 bypass were used in cases not amenable for direct treatment. Some technical tips and special issues related to the surgical management of these complex lesions are discussed" |
| Keywords: | "Adolescent Adult Aged Aged, 80 and over Cerebral Revascularization/*methods Female Humans Intracranial Aneurysm/pathology/*surgery Male Middle Aged Neurosurgical Procedures/*methods Treatment Outcome Young Adult By-pass surgery Clipping Giant intracranial;" |
| Notes: | "MedlineLuzzi, Sabino Gallieni, Massimo Del Maestro, Mattia Trovarelli, Donatella Ricci, Alessandro Galzio, Renato eng Austria 2018/09/02 Acta Neurochir Suppl. 2018; 129:25-31. doi: 10.1007/978-3-319-73739-3_4" |
