Matthias Gmeiner1,2, Andreas Gruber3,4. 1. Department of Neurosurgery, Kepler University Hospital, Linz, Austria. 2. Johannes Kepler University (JKU) Linz, Linz, Austria. 3. Department of Neurosurgery, Kepler University Hospital, Linz, Austria. andreas.gruber_1@kepleruniklinikum.at. 4. Johannes Kepler University (JKU) Linz, Linz, Austria. andreas.gruber_1@kepleruniklinikum.at.
Abstract
INTRODUCTION: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery. METHODS: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies. RESULTS: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity. CONCLUSIONS: Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.
INTRODUCTION: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery. METHODS: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies. RESULTS: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity. CONCLUSIONS:Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.
Authors: Yasha Kadkhodayan; Josser E Delgado Almandoz; Jennifer L Fease; Jill M Scholz; Anna M Blem; Kira Tran; Benjamin M Crandall; David E Tubman Journal: Neurosurgery Date: 2015-01 Impact factor: 4.654
Authors: Jacoba P Greving; Marieke J H Wermer; Robert D Brown; Akio Morita; Seppo Juvela; Masahiro Yonekura; Toshihiro Ishibashi; James C Torner; Takeo Nakayama; Gabriël J E Rinkel; Ale Algra Journal: Lancet Neurol Date: 2013-11-27 Impact factor: 44.182
Authors: Julius Dengler; Nicolai Maldaner; Sven Gläsker; Matthias Endres; Martin Wagner; Uwe Malzahn; Peter U Heuschmann; Peter Vajkoczy Journal: Cerebrovasc Dis Date: 2016-01-15 Impact factor: 2.762
Authors: Nicolai Maldaner; Susanne Guhl; Dorothee Mielke; Christian Musahl; Nils Ole Schmidt; Maria Wostrack; Daniel A Rüfenacht; Peter Vajkoczy; Julius Dengler Journal: Acta Neurochir (Wien) Date: 2015-05-23 Impact factor: 2.216