Skip to main content

Management of giant intracranial aneurysms

Acta Neurochirurgica volume 116, pages 107–118 (1992)Cite this article

Summary

Based on an own material of 64 cases a survey is given on the management of giant intracranial aneurysms.

Essential investigations are as well CT and Magnetic Resonance Scanning as detailed angiographic studies.

With regard to the operative handling the following questions are discussed: approach; use of temporary vascular occlusion and related monitoring; preparation of the aneurysm neck for occlusion.

In cases without recent subarachnoid haemorrhage morbidity and mortality were less than 10%. It was 15% in cases where recent haemorrhage had occurred.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Acland R (1973) Thrombus formation in microvascular surgery: an experimental study of the effects of surgical trauma. Surgery 73: 766–771

    Google Scholar 

  2. Astrup J, Symon L, Branston NMet al (1977) Cortical evoked potential and extra-cellular K+ and H+ critical levels of brain ischaemia. Stroke 8: 51–57

    Google Scholar 

  3. Batjer HH, Samson DS (1990) Retrograde suction decompression of giant paraclinoidal aneurysms. J Neurosurg 73: 305–306

    Google Scholar 

  4. Branston NM, Symon L, Crockard HA (1976) Recovery of the cortical evoked response following temporary middle cerebral artery occlusion in baboons: Relation to local blood flow and PO2. Stroke 7: 151–157

    Google Scholar 

  5. Branston NM, Symon L, Crockard HA, Pasztor E (1974) Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusions in the baboon. Exp Neurol 45: 195–208

    Google Scholar 

  6. Branston NM, Symon L, Crockard HA (1976) Recovery of the cortical evoked response following temporary middle cerebral artery occlusion in baboons: Relation to local blood flow and PO2. Stroke 7: 151–157

    Google Scholar 

  7. Dennis C, Kabat H (1939) Behaviour of dogs after complete temporary arrest of the cephalic circulation. Proc Soc Exp Biol Med 40: 559–561

    Google Scholar 

  8. Dodson RF, Tagashire Y, Chu LWF (1976) Acute ultrastructural changes in the middle cerebral artery due to the injury and ischaemia of surgical clamping. Can J Neurol Sci 3: 23–27

    Google Scholar 

  9. Dujovny M, Kossovsky N, Laha RK, Leff L, Wackenhut N, Perlin A (1979) Temporary microvascular clips. Neurosurgery 5: 456–463

    Google Scholar 

  10. Dujovny M, Osgood CP, Barrionuevo PJ, Perlin A, Kossovsky N (1978) SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs. J Neurosurg 48: 42–48

    Google Scholar 

  11. Dujovny M, Wackenhut N, Kossovsky N, Gomes CW, Laha RK, Leff L, Nelson D (1979) Minimum vascular occlusive force. J Neurosurg 51: 662–668

    Google Scholar 

  12. Ebina K, Iwabuchi T, Suzuki S (1982) Histological change in permanently clipped or ligated cerebral arterial wall, Part II. Autopsy cases of aneurysmal neck clipping. Acta Neurochir (Wien) 66: 23–42

    Google Scholar 

  13. Gertz SD, Rennels ML, Forbes MS, Kawamura J, Sunaga T, Nelso E (1976) Endothelial cell damage by temporary arterial occlusion with surgical clips. Study of the clip site by scanning and transmission electron microscopy. J Neurosurg 45: 514–519

    Google Scholar 

  14. Gregorius FK, Rand RW (1975) Scanning electron microscopic observations of common carotid artery endothelium in the rat. II. Sutured arteries. Surg Neurol 4: 258–264

    Google Scholar 

  15. Grenell RG (1946) Central nervous system resistance. 1. The effects of temporary arrest of cerebral circulation for a period of two to ten minutes. J Neuropathol Exp Neurol 5: 131–154

    Google Scholar 

  16. Hargadine JR, Branston NM, Symon L (1980) Central conduction time in primate brain ischaemia: a study in baboons. Stroke 11: 637–642

    Google Scholar 

  17. Harris RJ, Symon L, Branston NMet al (1981) Changes in extracellular calcium activity in cerebral ischemia. J Cereb Blood Flow Metab 1: 203–209

    Google Scholar 

  18. Hume AL, Cant BR (1978) Conduction time in somatosensory pathways in man. Electroencephalogr Clin Neurophysiol 45: 361–375

    Google Scholar 

  19. Jabre A, Symon L (1987) Temporary vascular occlusion during aneurysm surgery. Surg Neurol 27: 47–63

    Google Scholar 

  20. Momma F, Wang AD, Symon L (1987) Effects of temporary arterial occlusion on somatosensory evoked responses in aneurysm surgery. Surg Neurol 27: 343–352

    Google Scholar 

  21. Osgood CP, Dujovny M, Faille RN (1976) Early scanning electron microscopic evaluation of microvascular manoeuvres. Angiology 27: 96–105

    Google Scholar 

  22. Pool JL (1961) Aneurysms of the anterior communicating artery, bifrontal craniotomy, and routine use of temporary clips. J Neurosurg 18: 98–112

    Google Scholar 

  23. Poole JCF, Cromwell SB, Benditt EP (1971) Behaviour of smooth muscle cells and formation of extracellular structures in the reaction of arterial wall to injury. Am J Pathol 62: 391–414

    Google Scholar 

  24. Rosenbaum TJ, Sundt TM Jr (1978) Interrelationship of aneurysm clips and vascular tissue. J Neurosurg 48: 929–934

    Google Scholar 

  25. Rosenstein J, Wang AD, Symon L, Suzuki M (1985) Relationship between hemispherical CBF, CCT, and clinical grade in aneurysmal subarachnoid hemorrhage. J Neurosurg 62: 25–30

    Google Scholar 

  26. Slayback JB, Bowen WW, Hinshaw DB (1976) Intimai injury from arterial clamps. Am J Surg 132: 183–188

    Google Scholar 

  27. Sugita K, Hiroti T, Iguchi I, Mizutani T (1976) Comparative study of the pressure of various aneurysm clips. J Neurosurg 44: 723–727

    Google Scholar 

  28. Suzuki J (1979) Prognosis of 1000 pure saccular aneurysms operated upon. In: Pia HW, Langmaid C, Zinski J (eds) Cerebral aneurysms: Advances in diagnosis and therapy. Springer, Berlin Heidelberg, pp 413–418

    Google Scholar 

  29. Symon L, Branston NM, Strong AJet al (1977) The concepts of thresholds of ischaemia in relation to brain structure and function. J Clin Pathol 30: 149–154

    Google Scholar 

  30. Symon L, Vajda J (1984) Surgical experience with giant intracranial aneurysms. J Neurosurg 61: 1009–1028

    Google Scholar 

  31. Thurston JB, Buncke JH, Chater NL (1976) A scanning electron microscopy study of micro-arterial damage and repair. Plast Reconstr Surg 57: 197–203

    Google Scholar 

  32. Weinberger LM, Gibbon MH, Gibbon JH Jr (1940) Temporary arrest of the circulation to the central nervous system. 2. Pathological effects. Arch Neurol Psychiatry 43: 961–986

    Google Scholar 

Download references

Author information

Affiliations

  1. Gough-Cooper Department Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK

    L. Symon

Authors
  1. L. Symon
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Symon, L. Management of giant intracranial aneurysms. Acta neurochir 116, 107–118 (1992). https://doi.org/10.1007/BF01540863

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01540863

Keywords

  • Giant aneurysm
  • management
  • diagnostic
  • operative technique
  • results