Treatment of Giant Intracranial Aneurysms: a Review Based on Experience from 286 Cases

Abstract

Aneurysms are classified as giant when their largest diameter is equal to or greater than 25?mm, which represents approximately 5?7% of intracranial aneurysms. Severe disease with poor natural history presents with 68% mortality in two years and 85% in five years for untreated cases. Thus, in the majority of cases, the patients require treatment, despite the risks of therapeutic options. We discuss the epidemiology, natural history, diagnosis, and treatment of giant aneurysms based on the experience of 286 operations and literature data.

Treatment of giant intracranial aneurysms: long-term outcomes in surgical versus endovascular management

“…In literature, few studies of GIAs compare the outcomes of the two different treatment strategies; in some collections [ 11 , 23 , 28 – 30 ], it is argued that a different rate of complications and obliteration rates among reconstructive techniques for each strategy. On other hand, designing treatment strategies for GIAs is difficult as evidence of large clinical trials is lacking [ 31 – 33 ].…”

“…According to the current epidemiology [ 31 , 32 ], we found GIAs located more frequently in the anterior circulation. Here we have recognized that, regardless of treatment modality, there is a significant difference in outcome concerning the aneurysm site, where localizations such as MCA, AcoA, and the supraclinoid portion carotid artery pose a lower risk of mortality.…”

“…Patient factors (age, comorbidity, clinical condition) [ 36 ], pathological factors (aneurysm location, morphology) [ 31 ], and team experience [ 5 ] play a crucial role in the decision-making for GIAs.…”

“…In some cases, temporary trapping, thrombectomy, or clip reconstruction may be required, especially with wide-necked aneurysms [ 25 , 26 , 38 ]. Based on our experience, the most critical surgical factor for the technical decision is the characteristics of the neck: in the case of an absent or small channel (defined as < 4 mm [ 39 , 40 ]) or in surgical cases of fusiform aneurysms, the first alternative technique taken into consideration is the bypass (that can be high-flow extracranial-intracranial bypass, low-flow bypass with superficial temporal artery or reimplantation/reanastomosis [ 31 , 41 ], based on BOT).…”