Giant Intracranial Aneurysms: Therapeutic Approaches

Anatomical Definition.- Mechanisms of Formation: Pathologic Features.- Macroscopic Findings.- Microscopic and Ultrastructural Findings.- Natural History of Giant Intracranial Aneurysms.- Mechanisms of Formation: Hemodynamic Features.- Review of the Literature.- Model Experiments.- Clinical Study.- Incidence and Distribution.- Topographic Types.- Giant Intracranial Aneurysms in Childhood.- Neuroradiological Features.- Plain Skull Radiographs.- Angiography.- Computed Tomography.- Magnetic Resonance Imaging.- Radionuclide Brain Scanning.- Direct Surgical Treatment by Neck Occlusion.- General Technical Considerations.- Direct Surgical Approaches According to Topographic Type.- Direct Surgical Treatment by Wrapping and Intravascular Thrombosis.- Wrapping.- Intravascular Thrombosis.- Extracorporeal Circulation.- Surgical Occlusion of the Carotid Axis (Cervical Common Carotid Artery and Cervical Internal Carotid Artery).- Effects of Carotid Occlusion.- Carotid Artery Occlusion in Giant Aneurysms.- Surgical Occlusion of the Vertebrobasilar Axis (Vertebral Artery and Basilar Trunk).- Hemodynamic Effects of Occlusion in the Vertebrobasilar System.- Results in the Treatment of Giant Aneurysms.- Intracranial Occlusion of the Parent Artery.- Proximal Occlusion.- Trapping.- Tolerance of Occlusion.- Implantable Vascular Occluder.- Extra-intracranial Bypass.- Methods.- Patency.- Applications in Giant Aneurysms.- Tests for the Tolerance of Therapeutic Occlusion.- Methods.- Selection of Patients.- Management by the Intravascular Approach.- Background.- Materials Used.- Methods.- Clinical Experience and Therapeutic Indications.- General Conclusions.