Gmeiner Matthias, Gruber Andreas
Department of Neurosurgery, Kepler University Hospital, Linz, Austria
Johannes Kepler University (JKU) Linz, Linz, Austria
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.
超大和巨大动脉瘤是神经外科中最具挑战性的脑血管疾病之一。本文旨在综述当前关于超大和巨大动脉瘤治疗的文献，并描述说明可能治疗策略的代表性病例。鉴于其自然病史不佳，需要采用多专业个体化方法进行积极治疗，以实现动脉瘤闭塞、减轻占位效应和消除栓子来源。重建性技术（夹闭、栓塞、支架辅助栓塞、血流导向[FD]）和解构性技术（载瘤动脉闭塞[PAO]、PAO联合搭桥手术以及血流改道策略）均可用于实现具有可接受发病率的确定性治疗。患有此类病变的患者应由在开放和血管内神经外科所有技术方面受过培训的多学科团队在高容量脑血管中心进行管理。
