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Microsurgical treatment of large and giant ICA aneurysms
EANS Academy. Spyrou A. Sep 27, 2019; 275953; EP01077
Abstract
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Aim: Despite recent advances in endovascular techniques, microsurgery remains an important option in treatment of large and giant ICA aneurysms. Surgical outcomes, complications and follow up results of consecutive series of 285 patients presented.
Methods: Retrospective study included 285 adult patients with single, large or giant aneurysm of ICA treated with microsurgery in Burdenko NSI from 2001-2018. Paraclinoid aneurysms comprised 159 (55.8%), supraclionoid - 77 (27%), fusiform - 12 (4.2%), ICA bifurcation - 26 (9.1%) of cases. Aneurysms manifested with hemorrhage in 182 cases (63.8%), but only 16 operated in acute stage (Hunt-Hess- I-V). Male to female ratio was 83 to 202. Mean age 43.7. Giant (>2.5 cm) aneurysms were found in 119 (41.5%), large (1.5- 2.5 cm) in 166 (58.5%).
Results: . In 245 (85.9%) cases aneurysms were clipped, 21 - trapped (12 with EC-IC bypasses), two - ICA was ligated, 17 were wrapped (all in 2001-2006). In 253 cases (88.8%) patients were discharged GOS 4-5, unfavorable outcomes (GOS 2-3) were found in 32 (11.2%). Mortality comprised 2.5%. Original anatomical classification of paraclinoid aneurysms (S. Eliava) presented.
Conclusion: Microsurgery for large and giant ICA aneurysm is an effective treatment option with high radicality that may considered in patients not qualified for endovascular repair.


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