Wide-necked intracranial aneurysm

Wide-necked intracranial aneurysms refer to a specific type of aneurysm located within the brain, where the neck of the aneurysm (the portion connecting the aneurysm sac to the artery wall) is wide in diameter. These aneurysms present certain challenges for treatment, particularly in endovascular procedures such as coiling, due to the difficulty in securing the aneurysm with standard devices.

Aneurysm neck > 4 mm in diameter or aneurysm dome to neck ratio < 2 are typically classified as wide-neck ¹⁾.

### Key Characteristics: - Wide Neck: The neck is broader compared to the dome of the aneurysm, making it difficult to isolate the aneurysm from the parent vessel using conventional techniques. - Risk of Rupture: Like all intracranial aneurysms, they pose a risk of rupture, which can lead to subarachnoid hemorrhage (SAH), a serious and potentially life-threatening condition. - Location: These aneurysms are often found at bifurcations of arteries within the brain, which increases the complexity of treatment.

Wide-necked intracranial aneurysm treatment.

### Treatment Approaches: 1. Endovascular Coiling: A common method for treating intracranial aneurysms, but wide-necked aneurysms require special techniques such as:

1. Stent-assisted coiling: A stent is placed across the neck to help secure the coils within the aneurysm sac and prevent coil prolapse into the parent vessel.
2. Balloon-assisted coiling: A balloon is inflated across the neck to assist with coil placement and to help stabilize the aneurysm.
3. Flow diversion: In some cases, a flow-diverting stent may be used to reroute blood flow away from the aneurysm, promoting aneurysm occlusion over time.

2. Surgical Clipping: In some cases, particularly when the aneurysm is difficult to treat endovascularly, surgical clipping may be considered. This involves placing a clip at the neck of the aneurysm to prevent blood flow into the aneurysm sac.

3. Hybrid Techniques: Occasionally, a combination of endovascular and surgical methods may be required, depending on the aneurysm’s size, location, and the patient's anatomy.

The management of wide-necked intracranial aneurysms requires careful consideration of the patient's overall health, aneurysm characteristics, and the available treatment options.