Retrospective Analysis Of The Treatment Of Large And Giant Intracranial Aneurysms

Objective:The treatment of large and giant intracranial aneurysms is facing great challenges.The purpose of this study was to evaluate the clinical efficacy of different treatments for large and giant aneurysms and to analyze the related factors affecting complications and prognosis.Methods:Review the clinical data of all patients with large and giant intracranial aneurysms in the past 10 years.A total of 90 patients with aneurysms,including 14 ruptured aneurysms,a total of 114 aneurysms;The size,location,type of aneurysm,surgical methods,degree of embolization,intraoperative and postoperative complications and follow-up results were analyzed retrospectively.A modified Rankin scale(MRS)was used to assess the prognosis.Result:Ninety patients were treated with six main methods:aneurysm embolization in 26 cases,intracranial bypass in 20 cases,aneurysm clipping in 12 cases,parental artery occlusion in 11 cases,flow diverter stent plasty in 15 cases,and wills graft stent application in 6 cases.There were 24 cases of postoperative complications.Analysis of influencing factors of intraoperative and postoperative complications showed that aneurysm site(p=0.015),aneurysm size(p=0.005 p=0.001),degree of embolization grading(p=0.021),and surgical method(p=0.000)had statistical significance for the occurrence of complications(p<0.05).Analysis of the influencing factors of MRS showed that different H&H grades(P=0.004),aneurysm size(p=0.021 p=0.001),and surgical methods(p=0.011)had statistical significance for the prognosis after discharge(p<0.05).Conclusion:The intraoperative and postoperative complications and discharge prognosis of large and giant intracranial aneurysms are mainly related to the degree of embolization at the aneurysm site of the surgical method,and different H&H grades are correlated.The operation risk of large and giant intracranial aneurysms is high,which should be further treated according to the individualChapter 2 The short-term efficacy of pipeline embolization device in the treatment of large and giant intracranial aneurysmsObjective:To investigate the short-term effect of the treatment of large and giant intracranial aneurysms with the pipeline embolization device.Methods:The clinical data of 19 patients with large and giant aneurysms treated with PED in our hospital in the past four years were reviewed.Result:There were a total of 20 aneurysms in 19 patients,among whom 4 patients were implanted with 2 PED and the rest were implanted with 1 PED.12 cases were treated with PrED alone,and 7 cases(including 2 cases of serpentine aneurysm)were treated with coils.All PED had been successfully put in place.Immediate intraoperative contrast showed obvious retention of contrast agent in the tumor lumen in all patients,and the artery of the tumor carrier was unobstructed without stenosis.Postoperative complications occurred in 3 patients,including one case had mild cerebral parenchymal hemorrhage with transient hemiplegia on the first day after surgery,and one case had perianeurysm blood oozing on the first day after surgery.Follow-up with DSA was conducted in 12 patients after the operation,and 9 cases of aneurysm were completely silent,2 cases of aneurysm volume significantly reduced(1 case of aneurysm with good effect),and 1 cases of treatment was ineffective.The mean follow-up time was 7.6 months.Conclusion:The application of PED in the treatment of large and giant intracranial aneurysm has a good effect,and the improper use of dual antagonism drugs is likely to cause serious complications.The treatment effect of PED and the perioperative medication still need further follow-up and exploration.