| Guidelines for the managment of intracranial aneurysms at Dalcross Hospital |
| This page is intended for the use of Nursing staff and Medical staff at Dalcross Hospitals in Sydney. |
| Clipping versus coiling of unruptured aneurysms |
Surgery is considered the first choice for:
-Middle cerebral artery location.
-Size greater than 14 mm.
-Multiple aneurysms where a single exposure can allow all aneurysms to be repaired.
-Aneurysms downstream from occluded artery.
-Patient age less than 55 years.
-Need for ongoing antiplatelet or anticoagulant therapy.
-If diagnositic DSA is unnecessary or undesirable.
GDC coiling is considered the first choice for:
-Patient age greater than 65 years and the aneurysm is less than 15 mm in size with a neck-to-fundus ration of 1:2 and the neck is less than 4 mm in size.
-Heavily calcified neck identified on CT scan.
-Posteriorly projecting basilar and posteriorly projecting ACoA aneurysms.
|
| Clipping versus coiling of ruptured aneurysms |
Surgery is considered the first choice for:
-Life threatening intracerebral haemorrhage with rapidly declining neurological state.
-Middle cerberal artery location.
-Size greater than 14 mm.
-Multiple aneurysms where a single exposure can allow all aneurysms to be repaired.
-Aneurysms downstream from occluded artery.
-Need for ongoing antiplatelet or anticoagulant therapy.
-If diagnositic DSA is unnecessary or undesirable.
GDC coiling is considered the first choice for:
-Single non-MCA aneurysm less than 15 mm in size with a neck-to-fundus ration of 1:2 and the neck less than 4 mm in size.
-Heavily calcified neck identified on CT scan.
-GCS <13 with ventriculomegaly (after EVD).
-Poor neurological state in the absence of mass lesions.
-Greater than 80 years of age
|
|
