Department of Neurosurgery, Kepler University Hospital, Linz, Austria.
Johannes Kepler University (JKU) Linz, Linz, Austria.
Acta Neurochir Suppl. 2021;132:19-26. doi: 10.1007/978-3-030-63453-7_3.
Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery.
The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies.
In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity.
Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.
非常大的和巨大的动脉瘤是神经外科中最具挑战性的脑血管病变之一。
本文的目的是回顾目前关于治疗非常大的和巨大的动脉瘤的文献，并描述说明可能的治疗策略的代表性病例。
鉴于其不良的自然病史，需要采用多学科个体化方法进行积极的治疗，以实现动脉瘤的闭塞、占位效应的缓解和栓塞源的消除。有多种治疗方法可供选择，包括重建性（夹闭、弹簧圈栓塞、支架辅助弹簧圈栓塞、血流导向装置[FD]）和解构性技术（载瘤动脉闭塞[PAO]、PAO 联合旁路手术，以及血流改道策略），这些方法都可以在可接受的发病率下实现确定性治疗。
患有此类病变的患者应在具有所有开颅和血管内神经外科技术培训的多学科团队的高容量脑血管中心进行管理。
