Surgical Approach to Giant Aneurysms of the Anterior Circulation
Part of the
Acta Neurochirurgica Supplementum 42
book series (NEUROCHIRURGICA, volume 42)
The surgical approach to cerebral giant aneurysms is still a source of great concern. We describe our experience with giant aneurysms of the anterior circulation and discuss the different surgical techniques adopted.
During the period January 1972–December 1985, a total of 33 patients were operated upon at the Istituto Neurologico “C. Besta” of Milan for a giant aneurysm of the anterior circulation. Nineteen cases had suffered subarachnoid haemorrhage before admission; in 14 cases the hospitalization was due to evidence of mass effect on the surrounding neurovascular structures. All aneurysms were directly approached: in 24 cases the neck was occluded by a suitable clip, in 4 cases intramural thrombosis was attempted, in 3 cases the aneurysms were definitively trapped and in one case aneurysmorrhaphy was performed after resection of the sac.
Operative mortality was 12%. Long-term follow-up shows good results whenever exclusion of the aneurysm from cerebral circulation had been achieved, either after removal of the sac or not; on the contrary, only fair or poor results were evident when other surgical techniques were adopted, either electively or out of necessity.
The importance of intraoperative protection and monitoring of brain function is stressed.
KeywordsDelayed Cerebral Ischaemia Anterior Circulation Parent Vessel Giant Aneurysm Anterior Clinoid Process
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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© Springer-Verlag/Wien 1988