Surgical management of giant intracranial aneurysms

Sharma, Bhawani Shankar; Gupta, Aditya; Ahmad, Faiz U.; Suri, Ashish; Mehta, Veer Singh

doi:10.1016/j.clineuro.2008.04.001

Cited by 72 publications

(52 citation statements)

References 27 publications

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“…1 ) [1, . Patient data description was aggregate in 15 study populations (854 GIA) [1,[15][16][17][18][19][20][21][22][23][24][25][26] and individual in 49 study populations (415 GIA) . Table 1 [67] 2002 R E 7 100 50.6 Yes Yes P = Prospective; R = retrospective; S = surgical; E = endovascular; C = combined; N/A = not available.…”

Section: Resultsmentioning

confidence: 99%

Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis

et al. 2016

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BACKGROUND Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. METHODS Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. RESULTS We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. CONCLUSIONS We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA. .7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions:We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.© 2016 S. Karger AG, Basel Key WordsGiant intracranial aneurysm · Endovascular treatment · Surgical aneurysm treatment Abstract Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all...

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Section: Resultsmentioning

confidence: 99%

Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis

et al. 2016

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“…Surgical mortality of GIAs is estimated on average rate at 10% and may range from 4 to 21% (Sharma, 2008). Short-term outcome of ruptured GIAs achieved in a multicentre study was worse than smaller ones (Kassell, 1990).…”

Section: Outcomementioning

confidence: 99%

“…It seems impossible to provide one and ultimately the best treatment modality or to perform randomized trials for patients suffering from GIAs. (Gruber, 1999;Sluzewski, 2003;Jahromi, 2008;Shi, 2009;Lylyk, 2009;Lawton, 2002;Jafar, 2002;Hauck, 2008;Sharma, 2008;Sano, 2010;Sughrue, 2010;.…”

Section: Treatment Considerationsmentioning

confidence: 99%

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Giant Intracranial Aneurysms - Surgical Treatment, Accessory Techniques and Outcome

Szmuda¹,

Słoniewski²

2012

Aneurysm

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“…Many intraoperative surgical techniques may result truly effective in the treatment of VB aneurysms; temporary clipping or trapping of the parental vessel allows, in many instances, an effective decompression of the aneurismal sac and the possibility to expose the implant base of the lesion which has to be dissected from perforators and efferent arteries before definitively clipping [Taylor, 1996;Baussart, 2005]; the "stacking-seating" technique, which consists in the use of differently shaped and sized clips which are progressively apposed and eventually removed until obtaining definitive exclusion of the sac, may prevent injuries to perforators and perilesional vasculature and may avoid constriction of flow through the parent vessel [Levy, 1995;Giannotta, 2002]; intraluminal decompression is often necessary to achieve a definitive exclusion of the aneurysm, and in case of thrombosed lesions it can be obtained using the ultrasonic aspirator [de Oliveira, 2009]; the use of multiple, variously shaped and sized clips apposed in embricated way ("tandem" clipping, "dome" clipping) results especially helpful when dealing with giant and very large VB aneurysms [Lawton, 1998;Kato, 2003;Sharma, 2008]; bipolar coagulation to reconstruct the parental vessels in wide based lesions; definitive trapping has been used in 2 cases of massively thrombosed aneurysms located in the distal branches, one in the superior cerebellar artery (SCA) and the other in the P2 tract of the posterior cerebral artery (PCA); aneurismorraphy has been used in one case of giant partially thrombosed aneurysm of the P1 tract of the left PCA [Hosobuchi, 1979;Samii, 1985].…”

Section: Surgical Proceduresmentioning

confidence: 99%