GIANT SERPENTINE ANEURYSMS - RADIOGRAPHIC FEATURES AND ENDOVASCULAR TREATMENT

PURPOSE: To describe the characteristic CT, MR, and angiographic featu res of giant serpentine aneurysms and discuss their endovascular treat ment. METHODS: Thirteen patients with giant serpentine aneurysms were studied at our institution in the last 3 years. They all underwent CT and MR studies as well as cerebral angiography. More recently, some of the patients were studied with MR angiography. Seven patients had end ovascular occlusion of the giant serpentine aneurysms, 3 with N-butyl cyanoacrylate, 2 with Guglielmi detachable coils, and 2 with detachabl e balloons. RESULTS: Giant serpentine aneurysms mimic cerebral neoplas ms on CT and MR studies; they are often associated with mass effect an d adjacent edema, and they enhance with contrast medium. The cerebral angiogram shows a residual irregular lumen of the partially clotted an eurysm, which continues into normal branches supplying the distal arte rial territory. Six patients were treated successfully with an endovas cular approach consisting of complete and permanent occlusion of the p arent artery. CONCLUSION: Giant serpentine aneurysms form a subgroup o f large intracranial aneurysms that have specific CT, MR, and angiogra phic features, which should be recognized before their treatment. The endovascular treatment of the aneurysm consists of permanent occlusion of the parent artery.