Giacomo Pavesi1, Stavros Dimitriadis1, Stefano Baroni2, Stefano Vallone3, Franco Valzania4, Giovanni Battista Costella1, Alberto Feletti5. 1. Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy. 2. Department of Anesthesiology, NOCSAE Modena Hospital, Modena, Italy. 3. Department of Neuroradiology, NOCSAE Modena Hospital, Modena, Italy. 4. Department of Neurology, NOCSAE Modena Hospital, Modena, Italy. 5. Department of Neurosurgery, NOCSAE Modena Hospital, Modena, Italy. Electronic address: alberto.feletti@gmail.com.
Abstract
BACKGROUND: Giant serpentine aneurysms are a rare entity, which can be managed using either endovascular or surgical techniques. Although the perioperative morbidity and mortality have decreased since the development of bypass revascularization procedures, their surgical treatment is still challenging. Intraoperative functional and perfusion monitoring techniques can be precious to make better decisions and improve outcomes. CASE DESCRIPTION: We report on the case of a giant, unruptured, partially thrombosed, serpentine middle cerebral artery aneurysm that was treated with partial endovascular coiling of intra-aneurysmal vascular channels, surgical resection of the aneurysm, and end-to-end M1-temporal M2 anastomosis. CONCLUSIONS: Intraoperative continuous motor evoked potentials monitoring, flowmetry, and indocyanine-green angiography provide precise and reproducible information about cerebral function and perfusion, respectively, allowing for more rational decision making during surgery for these challenging malformations.
BACKGROUND: Giant serpentine aneurysms are a rare entity, which can be managed using either endovascular or surgical techniques. Although the perioperative morbidity and mortality have decreased since the development of bypass revascularization procedures, their surgical treatment is still challenging. Intraoperative functional and perfusion monitoring techniques can be precious to make better decisions and improve outcomes. CASE DESCRIPTION: We report on the case of a giant, unruptured, partially thrombosed, serpentine middle cerebral artery aneurysm that was treated with partial endovascular coiling of intra-aneurysmal vascular channels, surgical resection of the aneurysm, and end-to-end M1-temporal M2 anastomosis. CONCLUSIONS: Intraoperative continuous motor evoked potentials monitoring, flowmetry, and indocyanine-green angiography provide precise and reproducible information about cerebral function and perfusion, respectively, allowing for more rational decision making during surgery for these challenging malformations.
Authors: Alba Scerrati; Giovanni Sabatino; Giuseppe Maria Della Pepa; Alessio Albanese; Enrico Marchese; Alfredo Puca; Alessandro Olivi; Carmelo Lucio Sturiale Journal: Neurosurg Rev Date: 2018-05-22 Impact factor: 3.042