Combined Endovascular and Microsurgical Management of Giant and Complex Unruptured Aneurysms

Francisco A. Ponce, M.D.; Felipe C. Albuquerque, M.D.; Cameron G. Mcdougall, M.D.; Patrick P. Han, M.D.; Joseph M. Zabramski, M.D.; Robert F. Spetzler, M.D.


Neurosurg Focus. 2004;17(5) 

In This Article


Certain complex aneurysms may be treated optimally by combining endovascular and surgical techniques. Cavernous ICA aneurysms are classic examples, wherein treatment consists of an extracranial-intracranial bypass and endovascular parent-vessel occlusion. A similar strategy may be indicated for complex PCA aneurysms. In this case an OA-PCA bypass is performed, and the PCA is occluded endovascularly at the location of the aneurysm.

Finally, flow-redirection techniques may alter the hemodynamics of aneurysms that are not amenable to removal from the circulation. This treatment may be indicated for giant dolichoectatic lesions of the posterior circulation. Al though the surgical and endovascular procedures emphasized in this combined paradigm are associated with well-known complications, the high-risk nature of the primary lesion mandates an aggressive approach. The risks of this combined treatment strategy are likely lower than those associated with the natural history of this subset of aneurysms.