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- Title
Treatment Strategies of Complex Intracranial aneurysm.
- Authors
Abdelrahman, N. N.; Habib, M. A.; Shehata, T. H.; Fakhr, M. A.; Alabyad, A. G.; Desouky, A. E.
- Abstract
Introduction: Treatment of complex aneurysms is amongst the most challenging for neurosurgeons. Complex aneurysms are those aneurysms that could not be normally clipped or treated by conventional endovascular approaches, labeling an aneurysm complex implies increased risk of worse outcome in terms of natural history and/or therapy. Aim of the Work: To detect the validity of different lines of management, either surgical or endovascular interventions in treating complex intracranial aneurysms. Methods: A prospective cohort study for 80 patients diagnosed with complex intracranial aneurysm lesions that were treated in Ain-Shams and Alexandria University hospitals by surgical or endovascular intervention. Clinical evaluation, radiological diagnosis, treatment options were offered for all patients in details and follow-up after six months were recorded and analyzed. Results: The mean age of patients was 39.6 years, with a male to female ratio of 1:0.87 and the commonest age of presentation was (41-60y age group). Amongst 80 patients with 83 aneurysms, 52 (65%) were non-ruptured and 28 (35%) were ruptured. Initial radiological diagnostic tools were CT brain and the commonest finding was SAH in 28 (35%) patients. CT angiogram showed 74 (89%) of the aneurysms in the anterior circulation and 9 (10.8%) in the posterior circulation. Among the 83 aneurysms 56 (67%) were giant and 20 (24.1%) were large in size. ICA aneurysm were 65 and were further sub-classified to Infra-ophthalmic segment (40.9%), Ophthalmic segment (19.2%) and Supra-ophthalmic segment (18.1%). Aneurysms in the vertebrobasilar system 9 aneurysms were further sub-classified to Infrapica segment (3.61%), PICA segment (1.2%) and Supra-pica segment (6.02%). In this study 22 (26.5%) aneurysms underwent surgical intervention, 12 had ICA ligation PVO, 7 (31.8%) patients clip reconstruction and 3 (13.6%) did STA-MCA bypass surgery. As for Endovascular interventions 61 (76.2%) aneurysms underwent 78 endovascular procedures and five aneurysms did combined endovascular with surgical procedures. All patients were followed by GOS and mRS score over a period of 6 months. Conclusion: Patient with ischemic tolerance to BOT, PVO either surgical or by endovascular approach is the first line of management. Surgical clip reconstruction takes the higher hand to endovascular intervention for complex aneurysms with wide neck or those with intracerebral hematoma. Follow-up of all patients post-procedure over a time period is most important for early avoiding any early complications.
- Subjects
INTRACRANIAL aneurysms; ENDOVASCULAR surgery; OPERATIVE surgery; ANEURYSMS; UNIVERSITY hospitals; DISSECTING aneurysms; INTRACEREBRAL hematoma
- Publication
QJM: An International Journal of Medicine, 2020, Vol 113, pi154
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcaa055.001