Two cases of giant serpentine aneurysm

Abstract

Giant serpentine aneurysm (GSA) is an entity defined on radiological and pathological grounds as a giant, partially thrombosed aneurysm containing tortuous vascular channels. We have had the opportunity to study two patients with GSAs, which has allowed for a complete comparative anatomical and radiological study. This report emphasizes the etiology of the GSAs. Twenty-two patients with GSAs have been reported in the literature, of which pathological studies were done in 10. In most of these, the aneurysm was found to be filled with an organized thrombus, but in our patients the aneurysm was filled with relatively new clot. The aneurysm enlarged and a change in the tortuous vascular channel was observed over a period of 1 year in the first patient, whereas a globoid aneurysm developed into a GSA in the brief period of just 2 weeks in the second patient. This rapid transformation of a globoid aneurysm into a GSA is of particular interest when the etiology of GSAs is considered. Our patients therefore shed some interesting light on the possible pathophysiology of GSAs. That is, the bloodstream may change dynamically in a giant aneurysm and may become a serpentine channel under conditions that lead to a "Coanda effect."

Giant Vertebrobasilar Aneurysms: Endovascular Treatment and Long-term Follow-up

“…Therefore, there is a higher probability of perforating vessels arising from fusiform aneurysms (11). The serpentine aneurysm is a mostly thrombosed aneurysm with a tortuous and irregular vascular channel inside (26,33). All of these aneurysms can present with mass effect (75% of cases), ischemia, or hemorrhage, but serpentine aneurysms are less likely to bleed (33).…”

Endovascular Treatment of Giant Serpentine Aneurysm of the Middle Cerebral Artery

“…Aggressive surgical treatment is recommended for the giant serpentine aneurysms as a non-surgical management will eventually result in a continuous aneurysmal growth, neurological deterioration and poor outcomes 5)6)7). Total surgical excision, carotid ligation, entrapment, or aneurysm wrapping were traditionally recommended 1)3). These methods were primarily implemented in the field of revascularization operation of neurosurgery even though surgical morbidity and mortality rates of giant serpentine aneurysms were as high as 33% 1)4)8).…”

“…Since its first description in 1977, a giant serpentine aneurysm is now known to be a subgroup of large aneurysms with a persistent serpentine vascular channel 3)7)9). Its size is usually > 25 mm in diameter with a partial filling of thrombus in the sac 3)6)9). The blood flow passing through the aneurysm is usually slow and the aneurysmal sac is connected to the distal branch of a feeding artery causing a mass effect.…”

Coil embolization of giant serpentine aneurysms: report of two cases arising from the posterior cerebral artery

“…Dissecting intracranial aneurysms typically present with subarachnoid haemorrhage and have a high incidence of early rebleeding 1 whereas giant fusiform lesions present with progressive mass effect and pose less risk of haemorrhage. [2][3][4][5][6][7][8][9] Furthermore, fusiform aneurysms should be differentiated from dolichoectatic arteries in which the elongated, tortuous artery can act as a source of emboli and might therefore be best managed with antiplatelet agents or anticoagulation.…”