Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms.
BACKGROUND
Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA.


METHODS
Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study.


RESULTS
Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated.


CONCLUSIONS
Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm.
Hauck
Erik Friedrich
EF
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. erik.hauck@utsouthwestern.edu
Welch
Babu Guai
BG
White
Jonathan Ari
JA
Replogle
Robert Edward
RE
Purdy
Phillip Douglas
PD
Pride
Lee Glenn
LG
Samson
Duke
D
D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002648:Child; D005123:Eye / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome