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Surgical Strategies for Giant Intracranial Aneurysms

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Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage

Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 72))

Summary

Untreated giant intracranial aneurysms have a dismal natural history as a result of hemorrhage, cerebral compression, and thromboembolism. The poor prognosis of patients with giant aneurysms therefore warrants aggressive treatment. A surgical approach is chosen to maximize the operative exposure of the aneurysm and depends mainly on the aneurysm’s location. Once exposed, vascular control of the aneurysm is required not only to manage an intraoperative rupture, but also to collapse the aneurysm, to increase working space, and to improve visualization of the anatomy. Hypothermic circulatory arrest may be indicated in select patients with complex posterior circulation aneurysms. Direct clipping of giant aneurysms, with meticulous preservation of parent and branch arteries, is the preferred method of occlusion. Unclippable aneurysms require alternative techniques (e.g., trapping, parent artery occlusion, excision, and aneurysmorrhaphy) that compromise parent arteries and may require revascularization to restore adequate cerebral blood flow. Giant aneurysms are complex lesions that demand thorough surgical planning, individualized strategies, and a multidisciplinary effort in specialized neurovascular centers.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, California, USA

    M. T. Lawton

  2. Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, Arizona, USA

    Robert F. Spetzler M.D.

Authors
  1. M. T. Lawton
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  2. Robert F. Spetzler M.D.
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Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden

    Iver A. Langmoen M.D., Ph.D.

  2. Department of Neurosurgery, Rikshospitalet, The National Hospital, Oslo, Norway

    Tryggve Lundar

  3. Department of Neurological Surgery, Harborview Medical Center, Seattle, USA

    Rune Aaslid Ph.D.

  4. Department of Neurosurgery, Klinikum Großhadern, Munich, Germany

    Hans-J. Reulen M.D.

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© 1999 Springer-Verlag Wien

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Lawton, M.T., Spetzler, R.F. (1999). Surgical Strategies for Giant Intracranial Aneurysms. In: Langmoen, I.A., Lundar, T., Aaslid, R., Reulen, HJ. (eds) Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage. Acta Neurochirurgica Supplements, vol 72. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6377-1_12

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  • DOI: https://doi.org/10.1007/978-3-7091-6377-1_12

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-7309-1

  • Online ISBN: 978-3-7091-6377-1

  • eBook Packages: Springer Book Archive

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