Management of Complex Cerebral Aneurysm

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.