Surgical treatment of image disguised thrombosed giant cerebral aneurysms (TGCAs): A single center experience

Abstract

Introduction: Thrombosed giant cerebral aneurysms (TGCAs) are extremely rare. Even complete intraluminal thrombosis is uncommon and occurs especially in 13–20% of TGCAs cases. TGCAs can atypically present as other cerebral space-occupying (SOL) mass lesion. They could be misdiagnosed on digital subtraction angiography (DSA) or other diagnostic tools. Treatment of such aneurysms could be challenging as their diagnosis as well. Objective: We aim to report such extremely rare occurrence aneurysms and share our clinical experience with their treatment and diagnosis. Material and methods: Our institution’s databases were retrospectively reviewed from April 2019 to July 2021. We included all patients who were suspected to have TGCAs and another cerebral SOL were considered as possible differential diagnosis and was confirmed only on intraoperative exploration and postoperative histopathological examination. Results: Six patients harboring 6 TGCAs met our inclusion criteria. All underwent surgical treatment, and the diagnosis was confirmed by postoperative histopathological examination. All patients had favorable functional outcome (mRS 0–2) Conclusions: TGCAs could be disguise or hidden on conventional diagnostic tools, even DSA. Surgical exploration with preparation for aneurysmal surgical techniques would be the only suitable treatment option and to confirm diagnosis as well.

Keywords

• Thrombosed giant aneurysm
• Cerebral
• Surgical exploration