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Treatment Strategy:

 

Decision made to treat in view of young age and a giant aneurysm, substantial lifetime risk of rupture


Click to see enlarged image.



 

Treatment Strategy - Endovascular options:


Endovascular approach not chosen because:

  • Wide necked large aneurysm
  • Proximal on P1
  • Possibly a dissecting aneurysm.
  • Proximal occlusion not considered an option because aneurysm arising proximally on P1, risk of compromising perforators.


 

Treatment Strategy - Surgical options:


  • Proximal occlusion not considered as first option because
    • Risk of homonymous field defect
    • Proximal P1 perforators
  • Elected to undertake surgical exploration to determine nature of aneurysm, and feasibility of surgical clipping.


 

Surgical Procedure #1:  Exploration:


  • Underwent right pterional/orbitozygomatic craniotomy on 26/10/1998; aneurysm felt to be saccular in nature.
  • Felt to be clippable with hypothermic circulatory arrest.



 

Surgical Procedure #2:  Hypothermic Circ. Arrest:


  • URe-opened Rt OZ craniotomy, Aneurysm clipped under HCA (22 min standstill time).



 

Post-Operative Angiogram :

 

Note: Click to see enlarged images.


 

What to do?


What to do at this point?

Does she need long term F/U?