Abstract
Endovascular treatment of large and giant intracranial aneurysms of the anterior circulation, are now being treated by detachable silicone balloons, coils, and electrolytic platinum coils in selected cases. From a transfemoral approach, under local anesthesia, a catheter is navigated through the intracranial vessels to the aneurysm. For fusiform, ectatic aneurysms, without a well defined neck, test occlusion followed by parent artery occlusion can be performed with detachable balloons. For aneurysms with a well defined anatomical neck, detachable balloons and/or coils can be placed directly into the aneurysm to exclude it from the circulation. Angiography is performed immediately after the procedure and long term follow-up is obtained at 6-12 months post- treatment, to document exclusion of the aneurysm from the circulation.
Of the 321 cases treated by endovascular techniques by our group, 74 patients were treated for a giant aneurysm (>2.5cm) involving the anterior circulation. The presenting symptoms were mass effect in 65/74 cases (87.8%), subarachnoid hemorrhage in 6/74 cases (8.1%), and thromboembolic symptoms in 3/74 cases (4.1%). The embolic materials utilized were balloons in 67 cases, electrolytic coils in 6 cases, and balloons and coils in combination in 1 case. In 51 cases (68.9%) parent vessel occlusion was performed and in 23 cases (31.1%) direct aneurysm occlusion was achieved. Complications related to treatment included 9 cases (12.2%) of stroke, 4 cases (5.4%) of transient, reversible, cerebral ischemia, and 5 deaths (6.8%).
Endovascular treatment appears to be a feasible alternative to surgery for giant anterior circulation intracranial aneurysms in selected cases. As improvements in these techniques evolve, the morbidity associated with therapy should improve.
