Introduction: Giant or fusiform aneurysms cannot always be treated with either conventional clipping or endovascular surgery. For those unclippable or uncoilable aneurysms, cerebral revascularization should be considered. We report our experience with clinical and angiographic outcomes.
Methods: Nine patients with unclippable aneurysms were managed during a period 5 years at our institution. We retrospectively reviewed all patients with aneurysms who underwent trapping of aneurysms with cerebral revascularization. The mean age of the 9 patients (5 males, 4 females) was 56.5±45 years (range, 27-64 yr). The mean clinical follow-up was 28.1±26 months (range, 4-84 months). Six patients presented with subarachnoid hemorrhage and 1 showed diplopia. In 2 patients, the aneurysms were found incidentally. Locations of the aneurysms were as follows: posterior inferior cerebellar artery (PICA) in 3, vertebral artery (VA) in 3, middle cerebral artery in 2, and internal carotid artery in 1 patient.
Results: Eight aneurysms were fusiform and 1 was saccular. In fusiform aneurysms, the etiology was dissection in 3 cases and mycotic in 1. A saccular aneurysm was giant in size. Treatment included surgical trapping with bypass in 4, endovascular trapping with bypass in 4, and in-situ bypass in 1 patient. Among bypass surgery, high-flow bypass was performed in a giant ICA aneurysm. In two VA aneurysms with PICA involvement, occipital artery (OA)-PICA bypass followed by immediate trapping of aneurysms with coil was performed. Follow up angiography showed well maintained revascularization without evidence of aneurysm recurrence. In all patients, postoperative course was uneventful.
Conclusions: Revascularization technique is mandatory option for unclippable aneurysms.
Patient Care: Expert bypass technique helps management of unclippable aneurysms.
Learning Objectives: 1) bypass technique
2) understand for pathophysiology of giant aneurysm