The word aneurysm comes from the Latin word aneurysma, which means dilatation. Aneurysm is a persistent localized dilatation of the vessel wall, usually an artery. The true prevalence of intracranial aneurysms remains unknown, since most aneurysms remain undiagnosed until they rupture or produce neurological deficits. Aneurysms commonly arise at the branching site of major arteries. It also occurs at a turn or curve of the artery, and points in the direction blood flow.
This study was conducted on 40 patients. The majority of them were males and the age of studied cases ranged from 23-65 years . The majority of patients were in fifth decade. None of the patients had a family history of cerebral aneurysms. There were medical diseases associated in some patients as hypertension and diabetes mellitus. Smoking is also associated .
All patients in our study were symptomatic, 8 patients with unruptured aneurysms were fully conscious and presented with variable symptoms as visual field defects, 6th nerve palsy and 3rd nerve palsy. Thirty two patients with ruptured aneurysms were presented with headache in 32 patients, convulsions in 3 patients and vomiting in 7 patients, focal neurological deficits in 7 patients , and disturbed conscious level in all patients with variable GCS.
In all patients, multi-slice CT scan with thin cuts was very useful in the diagnosis of the type and site of hemorrhage. In patients with ruptured aneurysms (CTA) was done in the acute phase of hemorrhage. In patients with unruptured aneurysms (MRI, MRA) of the brain were also used. Conventional angiography (DSA) is considered the gold standard for the visualization of such lesions.
In this study, all aneurysms were arranged according to neck size into 2 groups with small necked group with neck size > 4mm, which contains 32 aneurysms in 30 patients and other wide necked group with neck size 1.
In our 40 patients, endovascular coiling was selected as the primary modality of treatment. Endovascular intervention is preferred in early 3 days or after 12 days to avoid cerebral vasospasm. our patients in the study are selected according to H&H grades with all patients were done with H&H grade I, II, III, and patients with grade IV were managed conservative till improvement of H&H grade. All patients were operated upon in the neuroangiography suite. All received general anesthesia. The standard transfemoral approach was used in all patients. Coiling was done using single microcatheter in 36 aneurysms , double catheter technique in four aneurysms and balloon assisted in 2 aneurysms.
Coiling process was done with respect of the parent artery and neck size of aneurysm and aspect ratio. Degree of angiographic occlusion of cerebral aneurysms were assessed according to modified Raymond classification. In small necked group, class I was achieved in 22 aneurysms, Class II was achieved in 8 aneurysms, Class IIIa was achieved in one aneurysm and class IIIb in one aneurysm . For wide necked group, Class I was achieved in 4 aneurysms, Class II was achieved in 2 aneurysms, Class IIIa was achieved in 3 aneurysms, Class IIIb was achieved in one aneurysm.
The immediate angiographic outcome was affected by neck size and angio-architecture of the aneurysms where most small aneurysms and aneurysms with AR >1.5 applicable for complete occlusion. In wide necked aneurysms and aneurysms with AR |
