G. Otsuka et al., Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils: successful reduction of mass effect - Report of two cases, J NEUROSURG, 94(5), 2001, pp. 836-840
Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant
aneurysms with persistent serpentine vascular channels. Surgical managemen
t of these rare lesions is difficult because of their large size, complex s
tructure, and unique hemodynamics. The authors report two cases of patients
harboring GSAs with mass effect. which were managed effectively with endov
ascular treatment. The first patient was a 48-year-old man who presented wi
th left homonymous hemianopsia caused by a GSA involving the terminal porti
on of the right internal carotid artery. The second patient, a 10-year-old
boy, presented with tetraparesis from compression or the cervicomedullary j
unction bq a GSA of the right vertebral artery. In each case, after confirm
ing collateral flow by temporarily occluding the proximal artery, the aneur
ysm was trapped by placement of Guglielmi detachable coils at the sites at
which the serpentine channels entered and exited the aneurysm. The midporti
on of each channel was isolated completely without packing, to maximize res
orption of the devascularized mass. Mass effect and clinical symptoms rapid
ly improved in both cas es, with no associated morbidity. We recommend endo
vascular trapping as a safe and effective therapeutic option for GSAs.