Surgical Decision-Making for Managing Complex Intracranial Aneurysms

被引:23
|
作者
Esposito, Giuseppe [1 ]
Regli, Luca [1 ]
机构
[1] Univ Zurich Hosp, Dept Neurosurg, CH-8091 Zurich, Switzerland
来源
关键词
Complex intracranial aneurysms; Extra-to-intracranial bypass; giant aneurysms; Reconstruction; Partial trapping; Trapping; Trapping variant; ARTERY ANEURYSMS; BYPASS; GIANT; SURGERY;
D O I
10.1007/978-3-319-02411-0_1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The treatment of complex intracranial aneurysms remains a therapeutic challenge. These lesions are frequently not amenable to selective clipping or coiling or other endo-vascular procedures and surgery still has a predominant role. We illustrate our "surgical decision making" for managing complex intracranial aneurysmal lesions. The best strategy is decided on the basis of pre-operative neuroradiological and intra-operative main determinants such as anatomical location, peri-aneurysmal angioanatomy (branch vessels, critical perforators), broad neck, intraluminal thrombosis, aneurysmal wall atherosclerotic plaques and calcifications, absence of collateral circulation, and previous treatment. The surgical strategy encompasses one of the following treatment possibilities: (1) Direct clip reconstruction; (2) Complete trapping ("classic" or "variant"); (3) Partial trapping (proximal "inflow" or distal "outflow" occlusion). Because the goal of any aneurysm treatment is both (1) aneurysm exclusion and (2) blood flow replacement, cerebral revascularization represents a major management option whenever definitive or temporary vessel occlusion is needed. Cerebral revascularization can therefore be used temporarily as a "protective" bypass, or definitively as a "flow replacement" bypass. Complete and partial trapping strategies are associated with flow "replacement" bypass surgery, to preserve blood flow into the territory supplied by the permanently trapped vessel. The construction of the "ideal" bypass depends on several factors, the most important of which are amount of flow needed, recipient vessel, donor vessel, and microanastomosis technique. The choice between "complete" or "partial" trapping depends on angioanatomical criteria as well. A complete trapping is always favored, as it has the advantage of immediate aneurysm exclusion. When perforating vessels arise from the aneurysmal segment or when the inspection of all the angioanatomy of the aneurysm is considered inadvisable and risky, "partial trapping" strategies are of interest. Partial trapping may consist either of proximal or distal occlusion. We discuss the rationale behind these treatment modalities and illustrate it with a case series of seven patients successfully treated for complex intracranial aneurysmal lesions (location: 1 ICA, 1 ACom, 3 MCA, 2 PICA).
引用
收藏
页码:3 / 11
页数:9
相关论文
共 50 条
  • [11] Surgical Management of Complex Intracranial Aneurysms
    Kim, Y. B.
    Kwon, Y. S.
    Huh, S. K.
    8TH ASIAN CONGRESS OF NEUROLOGICAL SURGEONS (ACNS 2010), 2010, : 77 - 84
  • [12] Interdisciplinary decision-making and treatment of intracranial aneurysms in the era of complementary microsurgical and endovascular techniques
    Marbacher, Serge
    Diepers, Michael
    Kahles, Timo
    Nedeltchev, Krassen
    Remonda, Luca
    Fandino, Javier
    SWISS MEDICAL WEEKLY, 2016, 146 : w14372
  • [13] Extracranial-intracranial bypass for aneurysms: Decision-making using intraoperative flow measurements
    Hanjani, Sepideh Amin
    Alaraj, Ali
    Charbel, Fady T.
    STROKE, 2007, 38 (02) : 593 - 593
  • [14] The Role and Reliability of Unruptured Intracranial Aneurysm Treatment Score in Decision-making in Surgical Indications for Unruptured Intracranial Aneurysms Based on the Results at a Japanese Single Center
    Yamashiro, Shigeo
    Uekawa, Ken
    Kaji, Masatomo
    Amadatsu, Toshihiro
    Matsuzaki, Hiroaki
    Murai, An
    Mukasa, Akitake
    Nishi, Toru
    NEUROLOGIA MEDICO-CHIRURGICA, 2025,
  • [15] Managing decision-making with certainty of threat
    Merlhiot, Gaetan
    Mermillod, Martial
    Le Pennec, Jean-Luc
    Mondillon, Laurie
    JOURNAL OF RISK RESEARCH, 2018, 21 (12) : 1551 - 1561
  • [16] RATIONAL DECISION-MAKING - MANAGING UNCERTAINTY
    LANCASTER, W
    LANCASTER, J
    JOURNAL OF NURSING ADMINISTRATION, 1982, 12 (09): : 23 - 28
  • [17] ETHICAL DECISION-MAKING IN MANAGING TRAUMA
    RATZAN, SC
    NEUROSURGERY CLINICS OF NORTH AMERICA, 1995, 6 (04) : 809 - +
  • [18] THE PROCEDURE FOR SURGICAL DECISION-MAKING
    LORENZ, W
    LANGENBECKS ARCHIV FUR CHIRURGIE, 1984, 364 : 403 - 405
  • [19] Tools for Surgical Decision-Making
    Miller, Samuel M.
    Kodadek, Lisa M.
    Morrison, Laura J.
    JOURNAL OF PALLIATIVE MEDICINE, 2024, 27 (09) : 1267 - 1269
  • [20] DECISION-MAKING IN SURGICAL PRACTICE
    CLARKE, JR
    WORLD JOURNAL OF SURGERY, 1989, 13 (03) : 245 - 251