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complex_intracranial_aneurysm

Complex intracranial aneurysm

Complex intracranial aneurysms present unique therapeutic challenges that require thorough surgical planning, individualized treatment strategies, and refined neurovascular techniques for successful outcome.

In addition to modern three-dimensional (3D) rotational angiography, computed tomography angiography (CTA) or magnetic resonance angiogram (MRA), a solid, tangible 3D model may improve anatomical comprehension and treatment planning. A 3D rapid prototyping (RP) technique based on multimodal imaging data was evaluated for use in planning of treatment for complex aneurysmal configurations.

Endovascular treatment

They may require stent-assisted coiling, either as primary stenting or combined with the balloon remodeling technique (BRT).

Primary BRT followed by stent assisted coiling may be associated with fewer residual aneurysms at 12 to 18 months as compared to stent-assisted coiling alone.

Bypass surgery

The revascularization technique has remained to be indispensable for complex intracranial aneurysms.

Regardless of the graft type, the middle cerebral artery pressure (MCAP) ratio (MCAPR) was associated with low-flow related ischemic complications (LRICs), which were related to late neurological worsening (NW) in patients with complex ICA aneurysms treated by EC-IC high-flow bypass graft 1).

Proper use of bypass surgery is imperative in preserving the parent artery and its major perforators. The internal maxillary artery, used as a donor in a bypass, is an effective method due to its shorter distance from the recipient vessels and relatively large diameter with resulting higher flow rate 2).

Case series

Six patients with complex aneurysms were selected for 3D RP based on CTA and 3D rotational angiography data. Images were segmented using image-processing software to create virtual 3D models. Three-dimensional rapid prototyping techniques transformed the imaging data into physical 3D models, which were used and evaluated for interdisciplinary treatment planning.

In all cases, the model provided a comprehensive 3D representation of relevant anatomical structures and improved understanding of related vessels. Based on the 3D model, primary bypass surgery with subsequent reconstruction of the aneurysm was then considered advantageous in all but one patient after simulation of multiple approaches.

Preoperative prediction of intraoperative anatomy using the 3D model was considered helpful for treatment planning. The use of 3D rapid prototyping may enhance understanding of complex configurations in selected large or giant aneurysms, especially those pretreated with clips or coils 3)

1)
Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Suzuki G, Takeda R, Tokuda S. Risk factors for low-flow related ischemic complications and neurological worsening in patients with complex internal carotid artery aneurysm treated by EC-IC high-flow bypass. World Neurosurg. 2015 Oct 9. pii: S1878-8750(15)01296-6. doi: 10.1016/j.wneu.2015.09.095. [Epub ahead of print] PubMed PMID: 26459703.
2)
Shi X, Qian H, Fang T, Zhang Y, Sun Y, Liu F. Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients. Neurosurg Rev. 2014 Aug 26. [Epub ahead of print] PubMed PMID: 25154436.
3)
Andereggen L, Gralla J, Andres RH, Weber S, Schroth G, Beck J, Widmer HR, Reinert M, Raabe A, Peterhans M. Stereolithographic models in the interdisciplinary planning of treatment for complex intracranial aneurysms. Acta Neurochir (Wien). 2016 Sep;158(9):1711-20. doi: 10.1007/s00701-016-2892-3. Epub 2016 Jul 14. PubMed PMID: 27416860.
complex_intracranial_aneurysm.txt · Last modified: 2016/09/09 11:49 (external edit)