Surgical Management of Giant Intracranial Aneurysms

Abstract

Giant intracranial aneurysms represent one of the most problematic lesions of vascular neurosurgery because of their complex anatomy and the variety of treatment modalities often required. Since 1969, a total of 263 aneurysms measuring at least 25 mm have been operated upon by our department. These represent nearly 20% of our total group of 1418 aneurysms treated. Of these, 193 were unruptured and presented with symptoms of mass effect; 70 of the aneurysms presented with subarachnoid hemorrhage. Forty aneurysms were in the posterior circulation and 223 were in the anterior circulation. A variety of surgical techniques were required: proximal ligation in 26 patients, simple trapping in 15 patients, direct clipping in 92 patients, direct clipping and thrombectomy in 16 patients, superficial temporal to middle cerebral artery bypass and proximal ligation in 33 patients, superficial to middle cerebral artery and saphenous vein bypass graft in four patients, saphenous vein bypass graft and clipping in six patients, saphenous vein bypass graft and trapping in nine patients, saphenous vein bypass graft and proximal ligation in 12 patients, and direct repair with vessel reconstruction in 13 patients. The results show excellent or good outcome in 198 patients, poor outcome in 15 patients and death in 50 patients. The results will be analysed with respect to aneurysm location and patient preoperative grade.