Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms

Abstract

Background

Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA.

Methods

Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study.

Results

Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated.

Conclusions

Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm.

Introduction

Unruptured giant intracranial aneurysms remain a challenge for the team of treating physicians. If left untreated, the risk of rupture resulting in the patient's death or disability is as high as 40% to 50% over a 5-year period [21]. Treatment, however, is complicated because of the giant size, partial thrombosis, calcification, and usually presence of a wide neck. Surgical options have been pioneered by CG Drake [6]. Since then, decompression of the aneurysm mass, complete exclusion from circulation, and clip ligation have been our favored treatment, if possible. Endovascular management with optional use of stenting is a newer and less invasive alternative. In light of the small number of very large and giant aneurysms (≥2 cm) and the recent evolution of stents, there are little data about treatment using all modalities available today. Various interventional treatment options are under debate [12], [18]. The goal of the present study is to investigate the outcome of stent and/or coil treatment of unruptured very large and giant intracranial aneurysms ≥2 cm starting at the time the neuroform stents became available.