Giant fusiform aneurysm of the middle cerebral artery. Surgical treatment with multiple clipping: a case report
Introduction. Giant cerebral aneurysms (GCA) are defined by sizes above 2.5 cm. GCA clinically appear by the mass effect exerted on adjacent structures, and in other cases, by embolismal action of the mural thrombo or as a post rupture subarachnoid hemorrhage. Terapeutical options include: inducting mural thrombosis, inserting an intraneurysmatic balloon, setting a bypass and surgical clipping. The major characteristics of giant fusiform aneurysm (GFA), the lack of neck and the inclusion of main vessels, give surgical treatment a great complexity. Clinical case. 25 year old woman diagnosed of GFA of the middle cerebral artery, treated with direct surgical access with clipping and reconstruction of the vascular wall with fenestrated clips arranged in tandem. Conclusions. The lack of an accessible neck for clipping and exclusion of giant and fusiform intracranial aneurysms, forced practising bypass as a compulsory surgical alternative. Multiple clipping was a viable choice because of its simplicity and less surgical risk. This technique is not applicable to giant serpentine aneurysms as it is only feasible in cases of fusiform aneurysms with no intraluminal thrombosis. A satisfactory evolution of this case, keeping asintomatic after 18 months of the intervention guarantees its application in young patients with giant thrombosed aneurysms of low clinical repercussion
Caso clínico Paciente de 25 años con aneurisma gigante fusiforme de la arteria cerebral media, tratado con abordaje quirúrgico directo con clipaje y reconstrucción de la pared vascular con clips fenestrados dispuestos en serie.
Conclusiones En los aneurismas intracraneales gigantes y fusiformes, la ausencia de un cuello abordable para su clipaje y exclusión obligaba a la práctica de by-pass como técnica quirúrgica de elección. El clipaje múltiple se proponía como alternativa por su simplicidad y menor riesgo quirúrgico. Esta técnica sólo es viable en aneurismas fusiformes que no presenten trombosis intraluminal por lo que no es aplicable a los aneurismas gigantes serpinginosos. Su indicación en pacientes jóvenes con aneurismas gigantes no trombosados de escasa repercusión clínica está avalada por la evolución satisfactoria de esta paciente que permanece asintomática después de 18 meses desde la intervención
