Direct surgical treatment of giant intracranial aneurysms

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Abstract
Operations were performed on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30-60 yr. Patients presented were subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2) and CSF rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5) and the middle cerebral artery (2). Eight of 40 patients had 1 or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1) and aneurysmorrhaphy (1). After as much as 8 yr of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; 2 patients (5%) had a poor recovery. There were 6 surgical mortalities (15%). Giant aneurysms can be treated with fair results if the surgeon selects the technique best suited to the particular aneurysm. Neck occlusion, trapping and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.