Endovascular Management of Intracranial Giant Aneurysms: Experience on 25 Patients
Lakshmi Sudha Prasanna Karanam, Santhosh Joseph
Dr. (Prof) S.Joseph
Department of Interventional Radiology,
Sri Ramachandra University,Porur,Chennai, India.
Background & Aim: Various endovascular modalities are available for the management of intracranial aneurysms. We present our experience with these modalities in the management of the giant aneurysms.
Methods: A retrospective analysis of the patients presenting with intracranial giant aneurysms, suspected clinically and confirmed on neuroimaging, in our institute between February 2003 and July 2008. Patients were treated by parent vessel occlusion, stent assisted coiling, balloon assisted coiling, stent grafts or onyx based upon clinical findings, cross compression and balloon occlusion test. Clinical and angiographic follow up done at intervals of 1, 3, 6, 12, 24 and 48 months.
Results: The records of 25 patients (7 males and 18 females; aged 9 to 76 years) from the study period were available for analysis. In 21 of the 25 patients, the giant aneurysms were localized in the anterior circulation (majority in caroticopthalmic segment) while in 4, they were found in the posterior circulation. Total occlusion was seen in 19 of the 25 cases. A worsening of the mass effect was seen in 3 cases, and ICH was seen in 2. Transient neurological deficits were observed in 6 patients, while permanent deficits affected 3 patients. Death occurred in one patient in our study. During the follow-up period, an improvement in mass effect was seen in 23 patients. Recanalisation was observed in 2 patients who underwent a conservative treatment. Four patients continued to have persistent symptoms and one patient expired during the follow up.
Conclusion: Various endovascular modalities appear to be an effective and safe alternative treatment for the management of intracranial giant aneurysms.
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