AneurysmStent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms
Introduction
Unruptured giant intracranial aneurysms remain a challenge for the team of treating physicians. If left untreated, the risk of rupture resulting in the patient's death or disability is as high as 40% to 50% over a 5-year period [21]. Treatment, however, is complicated because of the giant size, partial thrombosis, calcification, and usually presence of a wide neck. Surgical options have been pioneered by CG Drake [6]. Since then, decompression of the aneurysm mass, complete exclusion from circulation, and clip ligation have been our favored treatment, if possible. Endovascular management with optional use of stenting is a newer and less invasive alternative. In light of the small number of very large and giant aneurysms (≥2 cm) and the recent evolution of stents, there are little data about treatment using all modalities available today. Various interventional treatment options are under debate [12], [18]. The goal of the present study is to investigate the outcome of stent and/or coil treatment of unruptured very large and giant intracranial aneurysms ≥2 cm starting at the time the neuroform stents became available.
Section snippets
Patients
Neuroform stents were introduced to our institution in 2002. Chart review revealed 95 patients who were treated for unruptured intracranial aneurysms ≥2 cm at the University of Texas Medical Center in Dallas between 2002 and 2006. Surgery was typically the treatment of choice to reduce the mass effect of the aneurysm. Seventy-four patients underwent surgery as the only treatment. Five patients underwent endovascular parent vessel sacrifice with good outcome. One patient's initial surgery was
Patient and aneurysm characteristics
There was a female predominance with 12 patients (75%); 3 patients were male (25%). The median age was 65 years (13-76 years). All patients presented with vision loss or diplopia attributable to cranial nerve compression by mass effect. Furthermore, 73% complained of headaches. Nine aneurysms were localized on the right side, 6 on the left. Eight aneurysms originated in the cavernous segment of the carotid artery. Seven aneurysms originated from the ophthalmic segment of the carotid artery. The
Discussion
The current study shows stent and/or coil treatment of very large and giant cavernous and ophthalmic aneurysms can be performed safely. Using current stent and coil equipment, morbidity and mortality can be very low. Rupture could be prevented at least during the median follow-up time of 22 months. Disadvantage of the stent/coil therapy is the frequently incomplete occlusion of the aneurysm with need for multiple treatments and follow-up angiography.
Conclusion
Endovascular treatment of giant intracranial aneurysms is constantly evolving as newer stent and coil technology becomes available. Using up-to-date equipment, stent/coil treatment of unruptured giant intracranial aneurysms is promising because it seems to be fairly safe and to cause some protection from rupture. Disadvantage is the often incomplete occlusion with unknown risk of future rupture. We believe stent/coil treatment represents a considerable alternative to surgical treatment of giant
Acknowledgment
We thank Jerri Thomas for her help. We further thank Suzanne “Jorlam” Truex for assistance with the figure.
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