Management of Complex Cerebral Aneurysm

Keimyung Medical Journal 2012;31(2):199-213.

Man-Bin Yim

Abstract

To obtain the successful management of complex aneurysm require multimodality methods; including clipping and/or bypass procedure and/or endovascular method. In this paper; author’s management experiences of complex aneurysms and key points of surgical and management strategies for those lesions are described. During the past 26 years; 2;821 cases of cerebral aneurysm were managed with surgical and/or endovascular methods. Among these patients; one hundred eleven cases are regarded as complex aneurysm (large size; complex wide neck; intraaneurysmal thrombus; fusiform or bizarre shape; aneurysm associated with vessel anomaly). The treatment strategies; surgical complications and outcome of those cases are analyzed and; based on those experiences; the author would like to suggest key points of the management methods for those aneurysms. The aneurysms were managed by direct clipping of aneurysmal neck in 79 cases; coiling with Guglielmi detachable coil (GDC) in 11; aneurysm trapping or clipping followed by extracranial- intracranial (EC-IC) bypass in 7; excision of aneurysm with or without endto- end anastomosis of parent artery in 6; proximal clipping or coiling of parent artery in 3; and aneurysmorrhaphy; bypass; or wrapping only in 5. Management complications occurred in 28 cases. Distal thromboembolism; parent vessel stenosis and important vessel injury after clipping or endovascular management of aneurysm are the main complications. The author obtained good outcome in 91 (82.0%) and poor outcome in 11 (9.9%) cases. The author concludes that selection of suitable management method for each case; high quality of surgical and endovascular technique; and combination of endovascular; clipping and bypass methods are important key points for the successful treatment of complex aneurysm.

Key Words: Bypass, Clipping, Coiling, Complex aneurysm, Management, Outcome