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Multimodal management of giant cerebral aneurysms: review of literature and case presentation
  1. Jessica K Campos1,
  2. Benjamin Z Ball1,
  3. Barry Cheaney II2,
  4. Alexander J Sweidan3,
  5. Bima J Hasjim1,
  6. Frank P K Hsu1,
  7. Alice S Wang4,
  8. Li-Mei Lin5
  1. 1 Department of Neurosurgery, University of California Irvine Medical Center, Orange, California, USA
  2. 2 Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
  3. 3 Department of Neurology, University of California Irvine Medical Center, Orange, California, USA
  4. 4 Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California, USA
  5. 5 Carondelet Neurological Institute, St Joseph’s Hospital, Carondelet Health Network, Tucson, Arizona, USA
  1. Correspondence to Dr Li-Mei Lin; drlimeilin{at}gmail.com

Abstract

The pathophysiology of giant cerebral aneurysms renders them difficult to treat. Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies. Since the introduction of the flow diversion technique, the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms. A subset of these giant aneurysms may persistent despite any treatment modality. Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach—both surgical and endovascular—rather than any single technique to provide a curative result with favourable patient outcomes. This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms. Additionally, an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.

  • aneurysm
  • flow diverter
  • coil
  • artery
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @drjessicacampos

  • Contributors JKC, BZB, BCII, ASW, AJS and BJH: participated in literature search and drafted the manuscript. FPKH: assisted with patient management. L-ML: conceptualised and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests L-ML is a consultant/proctor for Stryker Neurovascular and a consultant for MicroVention & Cerenovus.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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