Giant serpentine aneurysms: multidisciplinary management. Report of four cases and review of the literature

Abstract

Sixty-five cases of intracranial giant serpentine aneurysms (GSAs), including 61 cases reported in the literature and four additional cases presented in this study were reviewed. The clinical presentation, possible causes, natural history, and especially management of GSAs are discussed with emphasis on the need for aggressive intervention and multidisciplinary management.

Figure 1

Precontrast (A) and postcontrast (B) CT scanning. An oval mass 2.5 cm × 3.0 cm of high density is located in the Sylvian fissure with uneven enhancement on the postcontrast CT (B).

Figure 2

A) Precontrast CT scanning showed a huge mass 3 cm × 5 cm of increased heterogeneous attenuation beside right side of the sella with egg-like calcification of the wall. B, C) MR scanning demonstrated a mass with mixed heterogeneous signals compatible with thrombus of variable ages, mass effect, and flow void within the lesion. D) MRA demonstrated a snake-like vascular channel within the lesion. E) Anteroposterior view and F) lateral view the right internal carotid artery injection showed an irregular tortuousc ectatic vascular channel arising from the petrosal segment of the right internal carotid artery and involving the Ml, Al, and the posterior communicating artery of the right side. G, H) Lateral angiograms of the right external carotid artery after bypass procedure demonstrated patency of the STA-MCA bypass and increased flow through the anastomosis after detachable balloon occlusion of the right internal carotid artery (H).

Figure 2

A) Precontrast CT scanning showed a huge mass 3 cm × 5 cm of increased heterogeneous attenuation beside right side of the sella with egg-like calcification of the wall. B, C) MR scanning demonstrated a mass with mixed heterogeneous signals compatible with thrombus of variable ages, mass effect, and flow void within the lesion. D) MRA demonstrated a snake-like vascular channel within the lesion. E) Anteroposterior view and F) lateral view the right internal carotid artery injection showed an irregular tortuousc ectatic vascular channel arising from the petrosal segment of the right internal carotid artery and involving the Ml, Al, and the posterior communicating artery of the right side. G, H) Lateral angiograms of the right external carotid artery after bypass procedure demonstrated patency of the STA-MCA bypass and increased flow through the anastomosis after detachable balloon occlusion of the right internal carotid artery (H).

Figure 3

Incidence of neurologic symptoms and signs, based on 51 cases in the table 1.

Figure 4

Protocol used for decision-marking of multidisciplinary management on GSA.