Summary
In a retrospective review about large and giant aneurysms of the literature and the own material (51 large and 19 giant aneurysms) the problems of distribution, diagnosis, and treatment are discussed. The present classification and interpretation are arbitrary and imprecise; size and form, site, origin, and projection have not been taken into consideration. A special analysis and a combined study of large and giant aneurysms are lacking. The own material discussed concerns distribution and classification as well as clinical and neuroradiological findings in the different locations of these aneurysms. The main locations are for large aneurysms ICA (17%), MCA (about 10%), and VBA (about 9%), and for giant aneurysms 3.5%, 3.6%, and 8.6% respectively. The relative distribution for giant aneurysms are ICA with about 50%, ACA with 20%, and VBA with 20% too. The management of giant aneurysms and to a lesser extent of large aneurysms as well is unsatisfactory. The results are discussed.
The development of CT-scanning and microsurgery with arterial bypass operations and intracranial artery sutures has improved the therapeutic possibilities tremendously. Some cases are briefly discussed. The prospective personal strategy in handling large and giant aneurysms by direct attack or a combined procedure with external-internal artery bypass operation and a direct occlusion and excision in a second stage have been described.
Because of the limited experience, a cooperative prospetive study of interpretation, classification, clinical data, course, and therapy of such aneurysms in a representative group of patients is necessary.
Zusammenfassung
In einem retrospektiven Überblick werden Verteilung, Diagnose und Therapie der großen Aneurysmen und Riesenaneurysmen an Hand der Literatur und des eigenen Krankengutes von 51 großen Aneurysmen und 19 Riesenaneurysmen untersucht. Die gebräuchliche Interpretation und Klassifizierung sind willkürlich und ungenau, da sie Größe und Form, Sitz, Ursprung und Projektion nicht berücksichtigen. Eine Analyse der großen Aneurysmen und ebenso eine gemeinsame Untersuchung beider Formen sind bisher nicht bekannt.
Das eigene Krankengut wird hinsichtlich Verteilung, Klassifikation, klinischer und neuroradiologischer Befunde in den verschiedenen Gefäßterritorien untersucht.
Hauptlokalisation der großen Aneurysmen sind A.carotis int. (17%), A.cerebri med. (ca. 10%) und Vertebrobasilarisgebiet (9%), der Riesenaneurysmen 3,5%, 3,6% und 8,6%. Relativ verteilen sich Riesenaneurysmen auf die A.carotis int. in 50% und in jeweils 20% auf das A.cerebri ant.- und Vertebrobasilaris-Gebiet.
Die Behandlung der Riesenaneurysmen und in geringerem Maße auch die der großen Aneurysmen ist bisher unbefriedigend. Die Ergebnisse werden erörtert.
Die Entwicklung der Computer-Tomographie und der Mikrochirurgie mit arteriellen Bypass-Operationen und direkter Naht der intrakraniellen Gefäße haben die diagnostischen und therapeutischen Möglichkeiten entscheidend verbessert. Einige der letzten eigenen Fälle werden kurz aufgeführt.
Das eigene Vorgehen in der Behandlung großer Aneurysmen und der Riesenaneurysmen durch direkte Primärversorgung oder ein kombiniertes Vorgehen mit Bypass-Operation und direkter Ausschaltung bzw. Exstirpation in einer Zweitoperation wird vorgestellt.
Wegen der geringen Zahl dieser Aneurysmen und der geringen persönlichen Erfahrung ist eine prospektive kooperative Untersuchung über Interpretation, Klassifikation, klinische Daten, Verlauf und Therapie mit einer repräsentativen Zahl von Fällen unerläßlich.
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Dedicated to Professor Dr. K. J. Zülch on the occasion of his 70th birthday.
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Pia, H.W. Large and giant aneurysms. Neurosurg. Rev. 3, 7–16 (1980). https://doi.org/10.1007/BF01644413
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DOI: https://doi.org/10.1007/BF01644413
Key words
- Large and giant aneurysms
- Interpretation and classification
- Microsurgical treatment
- Externalinternal carotid artery bypass operation