Man-Bin Yim, Chang-Young Lee
Department of Neurosurgery and Brain Research Institute, Keimyung University School of Medicine, Taegu, Korea
Objectives: The goal of the surgical management of large and giant aneurysm is complete extirpation of the aneurysms with preservation or reconstruction of the parent artery. To improve the surgical management results of those aneurysms in the future, we review our experience and discuss technical maneuvers and strategies used to avoid potential complications of those aneurysms surgery.
Material and Methods: During the past 22 years, 2,037 cases of cerebral aneurysm were managed with surgical and/or endovascular methods. Among these patients, sixty four cases were regarded as large and giant aneurysm (diameter>19mm). The treatment strategies, surgical complications and outcome of those cases were analyzed retrospectively.
Results: The locationsof those aneurysms were anterior circulation in 54 cases and posterior circulation in 10 cases. The aneurysms were managed surgically by direct clipping of aneurysmal neck in 49 cases, aneurysm trapping or clipping followed by extracranial- intracranial bypass in 6 cases, excision of aneurysm with or without end to end anastomosis of parent artery, proximal clipping or coiling of parent artery, GDC aneurysm coiling in each two cases, and aneurysmorrhaphy, wrapping and bypass only in each one case. Surgical complications occurred in 20 cases. A parent vessel occlusion by thrombus formation and parent vessel stenosis after clipping of aneurysm were the main complications. We obtained good outcome in 46, fair 89, poor 4 and dead in 5 cases.
Conclusion: We conclude that selection of suitable management method for each case, high quality of surgical technique, and combination of endovascular, clipping and bypass methods are important key points for the successful treatment of complex aneurysm. The aneurysmal decompression during dissection and clipping of aneurysm and avoiding the narrowing of parent vessel after clipping of aneurysm were the main technical maneuvers used to avoid complications of those aneurysm surgery.