Article Figures & Data
Figures
- Figure 1
Giant, non-ruptured, 50 mm left PCoA aneurysm that persisted after initial endovascular treatment. (A) DSA (lateral view) of left internal carotid artery demonstrating partial filling of a persistent giant PCoA aneurysm treated first with stent-assisted coiling followed by flow diversion with the pipeline embolisation device. (B) DSA (lateral view) of left vertebral artery demonstrating partial filling of the aneurysm from the posterior circulation in mid-arterial (B) and late-arterial (C) phases. DSA, digital subtraction angiogram; PCoA, posterior communicating artery.
- Figure 2
MRI reveals a mass lesion with brainstem compression. Axial cranial T2 MRI demonstrating a partially thrombosed persistent giant PCoA aneurysm causing brainstem compression. MRI, magnetic resonance imaging; PCoA, posterior communicating artery.
- Figure 3
Microsurgical aneurysm debulking and clipping following endovascular coil occlusion of left internal carotid artery for treatment of a persistent giant PCoA aneurysm. Intraoperative image with the pipeline embolisation device flow diverter visualised through the debulked PCoA aneurysm dome. PCoA, posterior communicating artery.
- Figure 4
Postoperative cerebral angiography following endovascular coiling of the left internal carotid artery and microsurgical aneurysm debulking and clipping of a giant left PCoA aneurysm. Postoperative angiography of the (A) right lateral internal carotid artery and (B) vertebral artery cerebral demonstrating complete occlusion of the giant PCoA aneurysm. PCoA, posterior communicating artery.
- Figure 5
Delayed postoperative MRI following endovascular coiling of the left internal carotid artery and microsurgical aneurysm debulking and clipping of a giant left PCoA aneurysm. Delayed postoperative axial T2 MRI demonstrating the residual coil mass in a thrombosed giant PCoA aneurysm, with significant reduction in brainstem compression compared with preoperative MRI. Artifact from coil mass and aneurysm clips. MRI, magnetic resonance imaging; PCoA, posterior communicating artery.
Tables
- Table 1
Literature review of giant intracranial aneurysms treated with combined concomitant endovascular and microsurgical interventions.
References Patients with giant aneurysms (n) Aneurysm location Treatment modalities Outcomes Serbinenko et al 49 9 Internal carotid artery Vascular bypass and endovascular parent artery occlusion No associated morbidity or mortality Arnautovic et al 45 8 Paraclinoid internal carotid artery Clip ligation with endovascular temporary balloon occlusion 6 patients considered ‘good’ outcome
1 patient stroke causing hemiplegia
1 patient deathHoh et al 50 ≤5 (does not differentiate giant from fusiform aneurysm) Paraclinoid internal carotid artery, basilar artery, middle cerebral artery and anterior cerebral artery Endovascular occlusion with either vascular bypass, clip ligation or both 2 patients GOS 5
2 patients GOS 4
1 patient deathPonce et al 48 9 Anterior communicating artery, basilar artery, posterior cerebral artery and cavernous internal carotid artery Vascular bypass and endovascular parent artery occlusion 3 patients no morbidity
1 patient hydrocephalus
3 patients epidural haematomas
1 patient ischaemic stroke
2 patients deathLawton et al 46 ≤15 (does not differentiate which giant aneurysms were treated by alternative means Does not specify location Vascular bypass and endovascular aneurysm occlusion or endovascular and surgical trapping 1 patient death GOS, Glasgow Outcome Score.
