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Flow Alteration Concept of Intracranial Aneurysms Not Amenable to Direct Aneurysmal Obliteration. Report of Three Cases and Literature Review

We report three cases treated with the same concept for intracranial aneurysms not amenable to direct aneurysmal obliteration. Our treatment strategy is to reduce the hemodynamic burden of aneurysms and avoid ischemic complications of perforating arteries. It consists of isolation of several branches from the parent artery of the aneurysm with bypasses and endovascular techniques. Three treated cases comprised two partially thrombosed unruptured aneurysms and one ruptured dissecting aneurysm. Although the three cases involved different disease entities, they were treated under the same treatment concept, and the patients obtained good results. In the two partially thrombosed aneurysms, almost complete or virtually complete thrombosis had been achieved, and significant shrinkage of the aneurysm was observed. Our strategy prevented aneurysmal rupture in all cases, and is considered effective in promoting thrombosis of the aneurysm. All the demonstrated cases also showed shrinkage of the aneurysm. Further study on this treatment concept is necessary to confirm its clinical efficacy and safety.