title: Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up.
abstract: OBJECTIVE
  Giant/large peripheral cerebral aneurysms beyond the circle of Willis and middle cerebral artery (MCA) bifurcation are rare lesions, their etiopathogenesis is not completely elucidated, and their treatment is often difficult. We reviewed the etiopathologic findings available in the literature and report the results and long-term follow-up in 10 patients with a giant/large peripheral aneurysm treated by parent artery occlusion.
  
  
  METHODS
  Four aneurysms were on the MCA, 2 on the anterior cerebral artery, and 4 on the posterior cerebral artery (PCA). Two patients presented with bleeding. An occlusion test was performed in 7 patients. Occlusion of the parent artery was performed by using coils in 8 patients; and liquid coils and glue, in 2. Imaging follow-up was available from 1.5 to 4.5 years; and clinical outcome, from 1.5 to 7 years.
  
  
  RESULTS
  All aneurysms were excluded. One patient developed a partial homonymous hemianopsia after PCA occlusion. A transient deficit was observed in 2 other patients. In the partially thrombosed aneurysms, follow-up imaging showed shrinkage of the thrombosed compartment of the aneurysm and disappearance of the mass effect. No patient experienced progression of symptoms and/or bleeding during the follow-up period. At long-term follow-up, 6 patients presented with a modified Rankin Scale score of 0; 3, with score of 1; and 1, with score of 2.
  
  
  CONCLUSIONS
  The endovascular occlusion of the parent artery appears a relatively safe and efficacious technique in the treatment of these lesions. Long-term follow-up studies confirm persistent exclusion of the aneurysm and good clinical tolerance to the vessel occlusion.
authors.affiliation: Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris VI University School of Medicine, Paris, France. alessandra.biondi@psl.aphp.fr
authors.forename: A
authors.initials: A
authors.lastname: Biondi
authors.forename: B
authors.initials: B
authors.lastname: Jean
authors.forename: E
authors.initials: E
authors.lastname: Vivas
authors.forename: L
authors.initials: L
authors.lastname: Le Jean
authors.forename: A L
authors.initials: AL
authors.lastname: Boch
authors.forename: J
authors.initials: J
authors.lastname: Chiras
authors.forename: R
authors.initials: R
authors.lastname: Van Effenterre
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000098:blood supply; D002533:Cerebral Angiography; D002941:Circle of Willis / Q000000981:diagnostic imaging; D003097:Collateral Circulation / Q000502:physiology; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009460:Neurologic Examination; D011247:Pregnancy; D014057:Tomography, X-Ray Computed