TREATMENT OF LARGE AND GIANT FUSIFORM INTRACRANIAL ANEURYSMS WITH GUGLIELMI DETACHABLE COILS

Results in nine patients with large or giant fusiform intracranial ane urysms that were treated with Guglielmi detachable coils (GDCs) are re ported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic a nd located in an arterial feeder of an arteriovenous malformation. Fiv e aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preserva tion of the parent artery was attempted in three cases, and complete o cclusion of the aneurysm and the parent artery was performed in six pa tients. The tolerance to parent artery occlusion was assessed by angio graphy, balloon test occlusion, and amy tal testing. Six aneurysms wer e permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with S AH made an excellent clinical recovery. Three of the four patients pre senting with mass effect recovered completely and one remained unchang ed. The patient with an incidental aneurysm remained asymptomatic. The re were no permanent complications. In conclusion, GDCs were useful fo r the occlusion of large and giant intradural fusiform aneurysms. Occl usion of the aneurysm and the parent artery afforded the greatest oppo rtunity for a complete cure. Advantages of GDCs compared to balloons i nclude: occlusion of a shorter segment of normal artery, no traction o n the parent vessel, and safer and easier catheterization techniques.