Management of giant aneurysms

Dei-Anang, K.; Hey, O.; Borges, G.; Schürmann, K.; Müller, W.

doi:10.1590/S0004-282X1990000200016

Abstracts

Technical aspects and anatomical difficulties involved in the management of this entity and the risks associated give giant aneurysms a special place in the treatment of aneurysms as a whole. The direct attack needs careful planning and the right choice of instruments, especially clips. In spite of the progress in recent years, the rate of mortality is still very high. The indirect approach requires in many cases the occlusion of a major cerebral vessel, which in some cases could result in cerebral ischemia. However, by means of extra-intracranial by-pass operation this risk could be reduced. The method of baloon embolisation has progressed recently. This procedure brings the least discomfort to the patient. Results of this method of treatment must be observed critically for future assessment.

Os aneurismas gigantes merecem atenção especial no que se refere a seus aspectos anatômicos, riscos e, principalmente, dificuldades técnicas ao seu manuseio. A abordagem de tais aneurismas necessita de planejamento adequado e, sobremaneira, de material apropriado para sua clipagem. A mortalidade ainda permanece alta, apesar dos recentes progressos observados nos últimos anos. For outro lado, a abordagem indireta requer, muitas vezes, oclusão de um vaso cerebral importante, o que pode acarretar isquemia cerebral. Entretanto, por anastomose extra-intracraniana tais riscos podem ser diminuídos. O método de embolização por balões tem-se mostrado eficaz. Este processo oferece menor incômodo ao paciente. Os resultados deste método devem ser observados criteriosamente para melhor avaliação no futuro.

K. Dei-Anang^I; O. Hey^I; G. Borges^I; K. Schürmann^I; W. Müller^II

^IDepartment of Neurosurgery (Head: Prof. Dr. h. c. K. Schürmann)

^IIDepartment of Neuroradiology (Head: Prof. Dr. S. Wende), University Hospital, Mainz (Langenbeck-strasse 1, 6500 Mainz 1, DBR)

SUMMARY

Technical aspects and anatomical difficulties involved in the management of this entity and the risks associated give giant aneurysms a special place in the treatment of aneurysms as a whole. The direct attack needs careful planning and the right choice of instruments, especially clips. In spite of the progress in recent years, the rate of mortality is still very high. The indirect approach requires in many cases the occlusion of a major cerebral vessel, which in some cases could result in cerebral ischemia. However, by means of extra-intracranial by-pass operation this risk could be reduced. The method of baloon embolisation has progressed recently. This procedure brings the least discomfort to the patient. Results of this method of treatment must be observed critically for future assessment.

RESUMO

Os aneurismas gigantes merecem atenção especial no que se refere a seus aspectos anatômicos, riscos e, principalmente, dificuldades técnicas ao seu manuseio. A abordagem de tais aneurismas necessita de planejamento adequado e, sobremaneira, de material apropriado para sua clipagem. A mortalidade ainda permanece alta, apesar dos recentes progressos observados nos últimos anos. For outro lado, a abordagem indireta requer, muitas vezes, oclusão de um vaso cerebral importante, o que pode acarretar isquemia cerebral. Entretanto, por anastomose extra-intracraniana tais riscos podem ser diminuídos. O método de embolização por balões tem-se mostrado eficaz. Este processo oferece menor incômodo ao paciente. Os resultados deste método devem ser observados criteriosamente para melhor avaliação no futuro.

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Dr. Guilherme Borges - Disciplina de Neurocirurgia, Departamento de Neurologia - Faculdade de Ciências Médicas, UNICAMP - Caixa Postal 6111 - 13083 Campinas SP - Brasil

1. Chiappa KH, Burke SR. Young RR - Results of electroencephalographic monitoring after 367 cerotid endarterectomies. Stroke 10:381, 1979.
2. Debrun G, Fox A, Drake G, Peerless S, Girvin J, Fereuson G - Giant unclippable aneurysms: treatment with detachable balloons. Am J Neuroradiol 2:167, 1981.
3. Diaz FG, Ausman JI, Pearce JG - Ischemic complications after internal carotid artery occlusion and extracranial-intracranial anastomosis. Neurosurgery 10:563, 1982.
4. German WJ, Black SPW - Cervical ligation for internal carotid aneurysms. J Neurosurg 23:572, 1965.
5. Giannotta SL McGillicuddy JE, Kindt GW - Gradual carotid artery occlusion in the. treatment of inaccessible carotid artery aneurysms. Neurosurgery 5:417, 1979.
6. Hopkins LN, Grand W - Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5:21, 1979.
7. Koos WT, Perneczky A, Schuster H, Vorkapic P - Zerebrale Riesenaneurysmen. In Der zerebrale Notfall. Urban & Schwarzenberg, München, 1985, pg 163.
8. Pia HW - Large and giant aneurysms. Neurosurg Rev 3:7, 1980.
9. Swann KW, Heros RC, Debrun GM, Nelson C - Inadvertent MCA embolism by a detachable ballcon: management by embolectomy. Case report. Neurosurgery 64:309, 1986.
10. Swearingen B, Heros RC - Common carotid occlusion for urclippable carotid aneurysms: an old but still effective operation. J Neurosurg 21:288, 1987.
11. Ulrich P, Meining G, Ludwig B, Prohl U, Krämer G - Die traumatische Sinus-cavernosus-Fistel - Cerebrale Hämodynamik prä- und postoperativ. Paper presented at 21. Jahrestagung «Deutsche Gesellschaft für Hirntraumatologie und klinische Hirnpathologie», Mannheim, 1985.
12 Ulrich P, Ludwig B, Süss W, Meinig G - nrCBF- and EEG-monitoring during probatory balloon occlusion of the internal carotid artery. Advances in Neurosurgery, Vol 13. Springer, Eerlin, 1985, pg 317.
13. Yasargil MG - Microneurosurgery, Vol I. Thieme, Stuttgart, 1984.
14. Yasargil MG - Microneurosurgery, Vol II, Thieme, Stuttgart, 1984.

Management of giant aneurysms

Conduta em aneurismas gigantes

Publication Dates

Publication in this collection
25 May 2011
Date of issue
June 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Chiappa KH, Burke SR. Young RR - Results of electroencephalographic monitoring after 367 cerotid endarterectomies. Stroke 10:381, 1979.

[2] 2. Debrun G, Fox A, Drake G, Peerless S, Girvin J, Fereuson G - Giant unclippable aneurysms: treatment with detachable balloons. Am J Neuroradiol 2:167, 1981.

[3] 3. Diaz FG, Ausman JI, Pearce JG - Ischemic complications after internal carotid artery occlusion and extracranial-intracranial anastomosis. Neurosurgery 10:563, 1982.

[4] 4. German WJ, Black SPW - Cervical ligation for internal carotid aneurysms. J Neurosurg 23:572, 1965.

[5] 5. Giannotta SL McGillicuddy JE, Kindt GW - Gradual carotid artery occlusion in the. treatment of inaccessible carotid artery aneurysms. Neurosurgery 5:417, 1979.

[6] 6. Hopkins LN, Grand W - Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5:21, 1979.

[7] 7. Koos WT, Perneczky A, Schuster H, Vorkapic P - Zerebrale Riesenaneurysmen. In Der zerebrale Notfall. Urban & Schwarzenberg, München, 1985, pg 163.

[8] 8. Pia HW - Large and giant aneurysms. Neurosurg Rev 3:7, 1980.

[9] 9. Swann KW, Heros RC, Debrun GM, Nelson C - Inadvertent MCA embolism by a detachable ballcon: management by embolectomy. Case report. Neurosurgery 64:309, 1986.

[10] 10. Swearingen B, Heros RC - Common carotid occlusion for urclippable carotid aneurysms: an old but still effective operation. J Neurosurg 21:288, 1987.

[11] 11. Ulrich P, Meining G, Ludwig B, Prohl U, Krämer G - Die traumatische Sinus-cavernosus-Fistel - Cerebrale Hämodynamik prä- und postoperativ. Paper presented at 21. Jahrestagung «Deutsche Gesellschaft für Hirntraumatologie und klinische Hirnpathologie», Mannheim, 1985.

[12] 12 Ulrich P, Ludwig B, Süss W, Meinig G - nrCBF- and EEG-monitoring during probatory balloon occlusion of the internal carotid artery. Advances in Neurosurgery, Vol 13. Springer, Eerlin, 1985, pg 317.

[13] 13. Yasargil MG - Microneurosurgery, Vol I. Thieme, Stuttgart, 1984.

[14] 14. Yasargil MG - Microneurosurgery, Vol II, Thieme, Stuttgart, 1984.