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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?