A case of giant aneurysm combined with embolization and intervention in neurosurgery was a complete success Recently, the deputy chief physician of neurosurgery department of our hospital successfully completed a case of giant aneurysm combined with embolization and intervention with the full cooperation of the whole department. The patient has successfully passed the postoperative observation period. One day in October, a 72-year-old woman came to the neurosurgery clinic because of progressive vision loss in her right eye, which had been unsuccessfully treated for many years. By chance, a cranial MR examination found that the patient had a 2.8-cm space occupation next to the right cavernous sinus, so she came to our hospital for medical treatment. Dr. Wan Jieqing, deputy chief of neurosurgery department, immediately suspected that this was a huge aneurysm with his years of professional sensitivity, and his judgment was confirmed after completing various examinations. Usually, the size of intracranial aneurysm is between 4-7mm, larger than 1cm is large aneurysm, and larger than 2.5cm is called giant aneurysm. Giant aneurysms are very difficult to treat with either surgical clipping or traditional interventional embolization, and the mortality rate is very high. Currently, the most advanced interventional therapy in foreign countries is to make up for these two deficiencies through the combined use of dense mesh stents and spring coils, while the use of dense mesh stents in China is still in the clinical research stage. Dr. Wan proposed a bold treatment plan: first fill the spring coil into the tumor, and then use the embolic agent to completely fill the remaining space in the tumor. This treatment method is like “steel + concrete” in construction, which can ensure the safety of the patients, but also ensure that the tumor is completely embolized, and can save half of the cost. After serious discussion in the department, Prof. Jiang, the head of the department, finally supported the implementation of this new plan, and Dr. Wang, the chief physician, “escorted” the patient during the interventional procedure in case of any mishap. On October 17th, in the DSA room on the first basement level of Building 9, the interventional procedure was carried out as scheduled. With the catheter in place, Dr. Wan accurately placed the first spring coil into the aneurysm and knitted it into a uniform “cocoon”. Immediately afterward, the second and third spring coils were also placed one by one, gradually weaving the “cocoon” more and more densely. According to past experience, at least 10-15 spring coils were needed to completely fill the aneurysm, but as the number of spring coils increased, many compartments were formed within the aneurysm, making it difficult for the spring coils to enter the remaining small cavities, which was the main culprit for the aneurysm’s recurrence. At this point, Dr. Wan quickly inflated the blocking balloon and started injecting the special embolic agent into the aneurysm. This step is the most dangerous part of the entire procedure. If the embolic agent overflows into the aneurysm, the aneurysm will either rupture and bleed or embolize the distal vessels. Moreover, each time the internal carotid artery is blocked, it must be within the safe time window, otherwise accidents can easily occur. Viewers who have watched the Hong Kong TV series “Kindness” still remember the scene in which the female protagonist became a vegetable after her internal carotid artery was blocked for more than 30 minutes during cerebrovascular surgery, right? In reality, if the patient’s cerebrovascular traffic is more developed, coupled with anesthesia or hypothermia, blocking for 30 minutes or even longer is also possible. But the patient was 72 years old, and her fragile cerebral vessels could not withstand such a toss. With the slow injection of 5 ONYX embolic agents, the cocoon inside the aneurysm gradually became thicker and thicker, and the last of the embolic agents closed the entrance of the aneurysm completely along the border of the blocking balloon. The aneurysm should have been densely packed, but can the embolic agent stay inside the aneurysm and not be carried by the blood flow to the distant normal vessels under the rush of blood? The moment the balloon was released, everyone was extremely nervous. When the radiographer pressed the contrast button and everyone saw the black blood vessels snaking up and showing the “tree of life” without any obstruction, there was a round of applause in the contrast room. The operation was a complete success. After anesthesia resuscitation, the patient’s limbs moved normally, his speech was clear, and he passed the postoperative observation period smoothly. 5 days later, the patient and his family embarked on the train to go home with the joy of regaining a new life. Although it will take another 6 months of endothelial repair before the patient can be called completely cured, everyone is full of expectation and confidence for this day.