Hello!

My name is George and I am from Greece. The topic of this thread is Fusiform aneurysm and probable Endovascular Treatment. It's well known that fusiform aneurysms are rather rare and quite difficut to decide the appropriate treatment method
So, if anybody wishes to contribute to the conversation it would have been so helpful.
As a starting point, you can find below the diagnosis script from my angiography test in Switzerland last December:

Diagnosis:Giant (30mm) M1-unruptured fusiform aneurysm on the left side.
Therapy: Complete selective cerebral angiography and balloon-occlusion test of the left M1-segment in a case with a giant M1-aneurysm on the left side (under general anaesthesia).
Personal History:Intermittent head and neck pain since summer 2008
Car accident in 1995
Obstructive Sleep Apnea Syndrome
Medication:None
Allergies:No known drug allergies
Physical Examination:Right pupil discretely larger than the left one. Pupils reactive to light. Other cranial nerves, motor and sensory exam, reflexes and coordination unremarkable.
Therapy:As a patint, I was found by imaging to have a mostly asymptomatic but giant non-thrombosed aneurysm of the left M1-segment. There is no associated perianeurysmal edema and no evidence of abnormal wall enhancement.
Based on these findings a selective angiographic investigation including functional balloon-occlusion test of the M1-segment on left side is planned.
Selective cerebral angiography confirms the presence of a giant, non-thrombosed, fusiform aneurysm arising from the left middle and distal M1-segment, distal to the origin of the left lenticulo-striate artery and the anterior temporal artery. It incorporates the MCA-bifurcation.
There is decreased anterograde flow in the M2-M3 territories on the left side and already visible activated retrograde lepto-meningeal collaterals from A5 and P5. However, these collaterals do not retrogradly reach the MCA-bifurcation area, indicating that they are not fully developed.
Subsequently a micro-balloon is passed through M1-segment and through the aneurysm and positioned at the exit side of the aneurysm, where it is inflated. During occlusion of the proximal M2-segment cerebral angiography shows more prominent visualization of the retrograde lepto-meningeal collaterals, described above now reaching the area of the MCA-bifurcation but nevertheless, being still insufficient for permanent occlusion of the M2-segment.
The test is repeated by occluding the M1-segment proximal to the origin of the aneurysm giving similar results. Selective external carotid angiography shows a normal calibre and normal configuration of the left superficial temporal artery.
This investigation revealed and confirmed the presence of a non-thrombosed giant M1-aneurysm on the left side with ongoing retrograde lepto-meningeal collateral development.
The medical team proposed a repeat balloon-occlusion test in approx. 6 months in order to evaluate the progression of the retrograde lepto-meningeal collateral development and decide about the endovascular treatment.

Hope that the above picture isn't so disappointing

Waiting for your fusiform data experience
Best regards
George

Hi George,
Welcome to this group and sorry you have an aneurysm
I would like to give you some input and maybe offer some support, but I'm not exactly sure what you are asking??
Ruthie

Hello Ruthie,

Many thanks for your sincere concern.
Let me write my question in a more simplified form: as giant fusiform aneurysms are rare and quite complicated cases in order Docs choose the appropriate, per case, treatment option, I would have been obliged to any member of this community who wishes to communicate any knowledge about my case as it is described in my first message (i.e. a giant unruptured fusiform aneurysm in MCA is treated mainly with balloon occlusion only or usually together with EC-IC bypass?)

Thank you
George

Kali mera, George.
The short answer is; I don't know!
My situation is similar, but not identical, to yours. My aneurysm was, when last measured, just 2mm too small to be classed as "giant". It's not fusiform either but is on the right carotid artery, very close to where several other vessels branch off it.

Proposed treatment, after consultation with neurosurgeon & consultant neuroradiologist (both well-respected in their fields):
Neuroradiologist to try to occlude the aneurysm by coiling, with a stent across the wide neck of the aneurysm, after doing a balloon occlusion test to make sure that not too much damage will occur.

If this fails, craniotomy with clipping and bypass.

I do not know if this will help at all, but hope it does. You have a lot to worry you, I think!
I'll PM you with the names of my neurosurgeon & neuroradiologist do you can check up on them
καλές υγείες,

Dear Beth,

First I wish to know how do you speak greek?

Then, I will grateful to you if you can tell me names of well specialized docs in this field. I know one in King's College Hospital.

Many thanx
Heorge

I'm afraid I can't really help you there, George; I only know of my own! It doesn't seem to be particularly easy to track down this information on the internet, either, but you could try here: http://www.privatehealth.co.uk/hospi.../neurosurgery/
You could perhaps "Complete the hospital treatment enquiry form" - please note that the other links on that page are rather unhelpful! Alternatively, I've managed to find a list of all of the UK Neurological Units here: http://www.sbns.org.uk/rcsed/RCSEdDo...ersion=Staging
although finding the names of neurosurgeons/neuroradiologists from there may take a little detective work! I do know that Frenchay Hospital (Bristol) has a good reputation...
Good luck!

Many,many thanks Beth!

I've also just remembered the name of the biggest private Healthcare providers in the UK... Spire Healthcare, who are allied with BUPA.

Would highly recommend Neuroradiologist Dr N Deasay & Mr Tolias