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Skull Base 2011; 21(4): 233-242
DOI: 10.1055/s-0031-1280685
ORIGINAL ARTICLE

© Thieme Medical Publishers

Treatment Strategies for Complex Intracranial Aneurysms: Review of a 12-Year Experience at the University of Cincinnati

Norberto Andaluz1 , 2 , Mario Zuccarello1 , 3
  • 1Department of Neurosurgery, University of Cincinnati Neuroscience Institute and College of Medicine, Cincinnati, Ohio
  • 2Department of Veterans Affairs Medical Center, Cincinnati, Ohio
  • 3Mayfield Clinic, Cincinnati, Ohio
Further Information

Publication History

Publication Date:
21 June 2011 (online)

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ABSTRACT

Complex intracranial aneurysms (CIAs) include those classified as giant, those located in brain regions of technically difficult access, or that involve arterial trunks/branches, and/or have complicated wall structure. We reviewed retrospectively our management of such lesions in a 12-year period. From 1997 to 2009, 192 patients were admitted with CIAs (133 females, 59 males; average age 55 years); 128 presented with subarachnoid hemorrhage (SAH) and 64 with unruptured, symptomatic CIAs. The SAH group had 73 anterior- and 55 posterior-circulation aneurysms. Most frequent location was middle cerebral artery. Treatment strategies included clipping (65.6%), coiling/stenting (28.1%), bypass (3.1%), no treatment (3.1%). Coiling/stenting was exclusively used for posterior-circulation aneurysms. Outcomes were good (modified Rankin Scale [mRS] 0 to 2) in 54 patients (42.2%), fair (mRS = 3 to 4) in 38 (29.7%), and poor (mRS = 5 to 6) in 36 (28.1%). Among unruptured CIAs, there were 47 anterior- and 17 posterior-circulation aneurysms. Most frequent location was ophthalmic. Thirty (46.9%) were clipped, 19 (29.7%) coiled, 6 (9.4%) by-passed, 2 (3.1%) wrapped, and 7 (10.9%) had no treatment. Outcomes were good in 57 patients (89%) and fair in 7 (11%). Good outcomes were obtained in unruptured CIAs using a multidisciplinary approach. Ruptured CIAs carry a significantly worse prognosis than overall SAH patients.

KEYWORDS

Cerebral aneurysm - clipping - coiling - cerebral revascularization

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Norberto AndaluzM.D. 

c/o Editorial Office, Department of Neurosurgery, University of Cincinnati College of Medicine

ML 0515, Cincinnati, OH 45267-0515

Email: andalun@uc.edu