The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect.

Endovascular obliteration of intracranial aneurysms with preservation of the parent artery (endosaccular occlusion) has been advocated for patients who fail or are excluded from surgical clipping and cannot undergo Hunterian ligation therapy. To clarify the effect that endosaccular occlusion has on the presenting neurological signs, 26 patients with aneurysms and symptoms related to mass effect who underwent this therapy were followed for a mean of 60 months. Only patients with objective neurological deficits who had not suffered a hemorrhage were included in this series. Response to therapy was classified into one of three groups: "resolved," if the patient had complete resolution of presenting signs; "improved," if significant and sustained improvement was recorded in the neurological examinations, and "unchanged," if no change was observed. Thirteen patients (50%) were classified as resolved, 11 (42.3%) as improved, and two (7.7%) as unchanged. A comparison of patients classified as resolved with those who were improved revealed that the former group had less wall calcification (30% vs. 60%) and a shorter duration of symptoms. Patients with neurological sign resolution (62%) were more likely to have totally occluded aneurysms on late follow-up arteriograms than those who had improvement (28%) or were unchanged (0%). This study suggests that endosaccular embolization therapy can improve or alleviate presenting neurological signs unrelated to hemorrhage or distal embolization in the majority of cases.

[1]  H. Kikuchi,et al.  Selection and combination of various endovascular techniques in the treatment of giant aneurysms. , 1992, Journal of neurosurgery.

[2]  V. Macellari,et al.  Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. , 1991, Journal of neurosurgery.

[3]  R. Higashida,et al.  Intracranial aneurysms: interventional neurovascular treatment with detachable balloons--results in 215 cases. , 1991, Radiology.

[4]  R. Higashida,et al.  Endovascular coil embolization of unusual posterior inferior cerebellar artery aneurysms. , 1990, Neurosurgery.

[5]  Jimmy D Bell,et al.  Treatment of intracranial aneurysms with preservation of the parent vessel: results of percutaneous balloon embolization in 84 patients. , 1990, AJNR. American journal of neuroradiology.

[6]  Jimmy D Bell,et al.  Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. , 1990, Journal of neurosurgery.

[7]  R. Higashida,et al.  Aneurysms of the petrous portion of the internal carotid artery: results of treatment with endovascular or surgical occlusion. , 1990, AJNR. American journal of neuroradiology.

[8]  Jimmy D Bell,et al.  Endovascular treatment of intracranial aneurysms with a new silicone microballoon device: technical considerations and indications for therapy. , 1990, Radiology.

[9]  R. Higashida,et al.  Detachable balloon embolization therapy of posterior circulation intracranial aneurysms. , 1989, Journal of neurosurgery.

[10]  C. Strother,et al.  Thrombus formation and structure and the evolution of mass effect in intracranial aneurysms treated by balloon embolization: emphasis on MR findings. , 1989, AJNR. American journal of neuroradiology.

[11]  W. Hoyt,et al.  Treatment of a giant carotid ophthalmic artery aneurysm by intravascular balloon embolization therapy. , 1988, Surgical neurology.

[12]  R. Higashida,et al.  Cavernous carotid artery aneurysm associated with Marfan's syndrome: treatment by balloon embolization therapy. , 1988, Neurosurgery.

[13]  R. Higashida,et al.  Treatment of Intracranial Aneurysms by Balloon Embolization , 1987 .

[14]  M. Shigemori,et al.  [Follow-up study of inaccessible giant aneurysms of the intracranial internal carotid artery]. , 1987, No shinkei geka. Neurological surgery.

[15]  J. Raymond,et al.  Intracavernous aneurysms: treatment by proximal balloon occlusion of the internal carotid artery. , 1986, AJNR. American journal of neuroradiology.

[16]  R. Higashida,et al.  Intravascular balloon embolization of a carotid-ophthalmic artery aneurysm with preservation of the parent vessel. , 1986, AJNR. American journal of neuroradiology.

[17]  R. Heros,et al.  Giant intracranial aneurysms presenting with massive cerebral edema. , 1984, Neurosurgery.

[18]  I. Whittle,et al.  Giant intracranial aneurysms: diagnosis, management, and outcome. , 1984, Surgical neurology.

[19]  M. Kupersmith,et al.  Percutaneous transvascular treatment of giant carotid aneurysms , 1984, Neurology.

[20]  T. Koike,et al.  Computed tomographic demonstration of the effect of proximal parent artery ligation for giant intracranial aneurysms. , 1983, Surgical neurology.

[21]  N W Dorsch,et al.  Spontaneous thrombosis in giant intracranial aneurysms. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[22]  H. Handa,et al.  The fate of untreated symptomatic cerebral aneurysms: analysis of 26 patients with clinical course of more than five years. , 1982, Surgical neurology.

[23]  N. Kodama,et al.  [Sequential CT findings on giant aneurysms of the intracranial internal carotid artery after carotid ligation (author's transl)]. , 1982, Neurologia medico-chirurgica.

[24]  F. Servadei,et al.  Effect of common carotid ligation on giant aneurysms of the internal carotid artery: computerized tomography study. , 1981, Journal of neurosurgery.

[25]  G. Ferguson,et al.  Carotid-ophthalmic aneurysms: visual abnormalities in 32 patients and the results of treatment. , 1981, Surgical neurology.

[26]  S. Peerless,et al.  Giant unclippable aneurysms: treatment with detachable balloons. , 1981, AJNR. American journal of neuroradiology.

[27]  T. Sundt,et al.  Surgical approach to giant intracranial aneurysms. Operative experience with 80 cases. , 1979, Journal of neurosurgery.

[28]  Y. Hosobuchi.  Direct surgical treatment of giant intracranial aneurysms. , 1979, Journal of neurosurgery.

[29]  Sonntag Vk,et al.  Giant intracranial aneurysms: a review of 13 cases. , 1977, Surgical Neurology.

[30]  D. Carlson,et al.  Spontaneous thrombosis of a giant cerebral aneurysm in five days , 1976, Neurology.

[31]  C. Drake.  Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. , 1975, Journal of neurosurgery.

[32]  R. Scott,et al.  Spontaneous thrombosis in a giant middle cerebral artery aneurysm. Case report. , 1972, Journal of neurosurgery.

[33]  K. Mathai,et al.  Spontaneous cure of intracavernous aneurysm of the internal carotid artery in a 14-month-old child. Case report. , 1969, Journal of neurosurgery.

[34]  af BJORKESTEN,et al.  Changes in the size of intracranial arterial aneurysms. , 1962, Journal of neurosurgery.

[35]  S. Atlas,et al.  Partially thrombosed giant intracranial aneurysms: correlation of MR and pathologic findings. , 1987, Radiology.

[36]  D. Pelz,et al.  Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. , 1987, Journal of neurosurgery.

[37]  B. Weir.  Aneurysms affecting the nervous system , 1987 .

[38]  C. Drake,et al.  Extensive organization in a thrombosed giant intracranial aneurysm: case report. , 1985, Clinical neuropathology.

[39]  D. Graeb,et al.  Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. , 1984, Surgical neurology.

[40]  B. Stein,et al.  Giant intracranial aneurysms: a review of 13 cases. , 1977, Surgical neurology.