Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils: successful reduction of mass effect - Report of two cases

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.