الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 229 |  |  |
| | | from | 229 | | |
Abstract
Complex intracranial aneurysms constitute a poorly defined group of technically demanding lesions that are usually associated with worse outcomes because of the therapeutic difficulties posed by their own nature and the need for increased skill and use of resources.
Ruptured CIAs carried a worse prognosis than overall SAH patients.
Multi-disciplinary neurovascular discussion for each individual case is crucial for deciding the best management strategy of these complex lesions.
In our personal experience and practice, certain modalities can be used for specific complex aneurysms. In most cases, simple coiling and clipping techniques are not enough to manage these complex pathologies. Difficulty to achieve this leads us to think about more complicated and complex techniques to manage this type of aneurysms. For example, blister aneurysms are better to be managed by clip/wrap technique due to the marked difficulty to approach these lesions with coils. Giant aneurysms with wide neck can be managed by flow diverter devices with or without concomitant coiling. Absence of collateral circulation with difficult access by different catheters are usually managed by bypass techniques.
The concept of complex intracranial aneurysms with the criteria described by Hanel and Spetzler in 2008 must be emphasized and regularly reviewed for any modifications in order to set up a clear and concrete treatment algorithm for the management dilemma.
CIAs managed surgically showed less recurrence rate than those treated by different endovascular techniques.
CIAs treated by endovascular modalities showed much lower length of hospital stay and better modified Rankin scale after 6 months.
Complications rate and mortality rate were nearly similar in both groups and were usually related to the initial poor presentation with hight WFNS grade upon the initial ictus.
There is a growing necessity towards studies with longer term of follow up especially for endovascular techniques involving flow diversion devices. This will increase the accuracy of the assessment of the obliteration and recurrence rates.
There is evident gap of knowledge due to the lack of well-designed RCTs of the various treatments used for management of CIAs. Many of the treatments have significant potential complications, as well as major resource implications.
Proper training programmes for neurosurgeons to master all the surgical techniques to deal with “simple aneurysms” in order to be able to deal with more complex ones.
Endovascular techniques are rapidly evolving and needs continuous training and up to date knowledge about all the proposed strategies for the management of these complex pathology.
In the absence of more definitive studies, there is insufficient evidence to recommend or reject any treatment modality for CIAs. Therefore, a well-designed, multi-center prospective study is needed in order to provide confirmative data regarding the safety and efficacy of every treatment modality.
Future studies will require prospective analysis of outcomes, standardized surgical and endovascular techniques with standardization of reported results. Meaningful results will probably require a multi-center effort.