Management of Complex Wide Neck Intracranial Aneurysm

Background: About 5 % of the population has intracranial aneurysms, however the majority are asymptomatic and never discovered. Subarachnoid haemorrhage, the most frequent manifestation of aneurysm rupture, is a devastating medical disorder that frequently results in severe neurological impairment or death. The aim of this work was to evaluate the efficacy and safety of our procedures including microsurgical and endovascular techniques used for the management of complex wide neck intracranial aneurysms.

Methods: This prospective study was carried out on 50 patients with complex wide neck intra cranial aneurysms. All patients were subjected to neuroimaging (CT Brain, MRI brain, MRV, CT brain angiography and diagnostic angiography) and laboratory investigations (CBC, liver and kidney functions and complete coagulation profile).

Results: Remodelling technique was the most common technique used for ruptured aneurysms (14 %) followed by clipping (6%). Regarding 3months follow up, the group who had ruptured aneurysm had lower incidence of occlusion and higher incidence of recanalization. The relationship between technique used and outcome (mRS grade) was significant being better with Coilin + balloon technique followed by flow diversion then Coiling+ stent.

Conclusions: Endovascular techniques are better to deal with the complex anatomy of intracranial aneurysms. In case of ruptured aneurysm, the earlier the treatment, the better the outcome by preventing the hazards of rebleeding and safe management of vasospasm. CT Brain Angiography with 3D reconstruction proved to be a fast and reliable method for diagnosis and preoperative planning for cerebral aneurysms.