Titlebook: Giant Intracranial Aneurysms; Therapeutic Approach Yves Keravel,Marc Sindou Book 1988 Springer-Verlag Berlin Heidelberg 1988 Surgery.Thromb

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Narrative

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Mechanisms of Formation: Hemodynamic Features,This chapter is a summary of hemodynamic studies undertaken to elucidate further the mechanisms of growth, thrombosis, and rupture of giant intracranial aneurysms. The role of turbulent flow and intra-aneurysmal pressure is reviewed in the literature and studied with glass models of giant aneurysms.

endarterectomy

Clinical Study,Since a clinical study of giant aneurysms has recently been published in the French journal . by Creissard [19], this chapter will merely deal with the main points regarding the symptomatology of the various anatomical and clinical types.

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maintenance

Direct Surgical Treatment by Neck Occlusion,Selective occlusion of the neck by direct approach is the ideal treatment of giant aneurysms, as it preserves normal blood flow in the parent artery. It also allows decompression of the mass by opening of the sac.

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Extracorporeal Circulation,The preceding review of the different techniques used in the direct surgical approach shows that a number of giant aneurysms can satisfactorily be managed using current techniques of anesthesiology (induced hypotension and moderate hypothermia with neuroanesthesiological protection) and by having recourse to temporary clamping of short duration.

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Intracranial Occlusion of the Parent Artery,When giant aneurysms cannot be occluded at the neck or if they rupture during surgery, proximal occlusion or trapping of their parent segment becomes the method of choice, provided that there is no great risk of ischemia in its distal territory.

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Extra-intracranial Bypass,Introduced in 1967 by Yasargil [64, 65] and Donaghy [13], the extra-intracranial bypass (EICB) can be useful before occlusion of the parent artery by reducing the risk of ischemia [50, 51] (Fig. 91).

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Tests for Tolerance of Therapeutic Occlusion,Evaluation of tolerance of occlusion is a precautionary measure to be taken prior to the management of any intracranial giant aneurysm, especially those located in the area perfused by the carotid artery.