TY - JOUR
T1 - A Retrospective Study in Microsurgical Procedures of Large and Giant Intracranial Aneurysms
T2 - An Outcome Analysis
AU - Balaji, Arun
AU - Rajagopal, Niranjana
AU - Yamada, Yasuhiro
AU - Teranishi, Takao
AU - Kawase, Tsukasa
AU - Kato, Yoko
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/4
Y1 - 2019/4
N2 - Objective: Intracranial aneurysms are considered large if >10 mm and giant if >25 mm. The risk of aneurysmal rupture compounds with increase in size of the aneurysm, thus, warranting appropriate intervention. In this study, we have analyzed the outcome and effectiveness of microsurgical procedures in large and giant aneurysms. Methods: A retrospective analysis of all the patients who underwent microsurgical procedures for large and giant cerebral aneurysms from 2014–2018 in our institute was conducted. There were a total of 52 patients, in which direct clipping was performed in 42 (80.7%) patients, proximal trapping in 3 (5.7%) patients, trapping with bypass in 3 (5.7%) patients, suction decompression in 3 (5.7%) patients, and 1 (1.9%) patient underwent surgical reconstruction. Results: Among the 52 patients, in the postoperative period, 1 (1.9%) patient became comatose, 1 (1.9%) patient developed hemiplegia, 1 (1.9%) patient had a transient hemiparesis, and 1 (1.9%) patient had transient lower cranial nerve palsy. Two (3.8%) patients had chronic subdural hematoma during the 3-month follow-up. There was no mortality in our series. Conclusions: There are several treatment strategies available to manage large and giant cerebral aneurysms. In this study, we had minimal morbidity (3.8%), favorable outcome (96.1%), and no mortality. Therefore, we would like to conclude that appropriate microsurgical procedures, in experienced hands, can be considered as first line in the management for large and giant intracranial aneurysms, especially those with complex anatomy, wide neck, mass effect, partial thrombosis, and the presence of critical perforating vessels from the aneurysm wall.
AB - Objective: Intracranial aneurysms are considered large if >10 mm and giant if >25 mm. The risk of aneurysmal rupture compounds with increase in size of the aneurysm, thus, warranting appropriate intervention. In this study, we have analyzed the outcome and effectiveness of microsurgical procedures in large and giant aneurysms. Methods: A retrospective analysis of all the patients who underwent microsurgical procedures for large and giant cerebral aneurysms from 2014–2018 in our institute was conducted. There were a total of 52 patients, in which direct clipping was performed in 42 (80.7%) patients, proximal trapping in 3 (5.7%) patients, trapping with bypass in 3 (5.7%) patients, suction decompression in 3 (5.7%) patients, and 1 (1.9%) patient underwent surgical reconstruction. Results: Among the 52 patients, in the postoperative period, 1 (1.9%) patient became comatose, 1 (1.9%) patient developed hemiplegia, 1 (1.9%) patient had a transient hemiparesis, and 1 (1.9%) patient had transient lower cranial nerve palsy. Two (3.8%) patients had chronic subdural hematoma during the 3-month follow-up. There was no mortality in our series. Conclusions: There are several treatment strategies available to manage large and giant cerebral aneurysms. In this study, we had minimal morbidity (3.8%), favorable outcome (96.1%), and no mortality. Therefore, we would like to conclude that appropriate microsurgical procedures, in experienced hands, can be considered as first line in the management for large and giant intracranial aneurysms, especially those with complex anatomy, wide neck, mass effect, partial thrombosis, and the presence of critical perforating vessels from the aneurysm wall.
KW - Bypass
KW - Clipping
KW - DIVA
KW - Giant
KW - Intracranial aneurysm
KW - Outcome
KW - Trapping
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U2 - 10.1016/j.wnsx.2019.100007
DO - 10.1016/j.wnsx.2019.100007
M3 - Article
AN - SCOPUS:85061155546
SN - 2590-1397
VL - 2
JO - World Neurosurgery: X
JF - World Neurosurgery: X
M1 - 100007
ER -