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

Abstract

Aneurysms with a major diameter > 25 mm are defined as giant intracranial aneurysms (GIAs). Different clinical, pathological, and radiological factors were revealed as playing a role in choosing the best strategy between surgical and endovascular approaches. Despite the improvement of both techniques, the efficacy and safety of these different management are still debated. We evaluated the differences in clinical and radiological outcomes of GIAs treated with surgical and endovascular techniques in a large retrospective mono-centric study. We compared aneurysm location, clinical, morphological features, treatment outcome, and complications on the ground of treatment technique. The final cohort consisted of 162 patients. All the patients were assigned on the ground of the type of eligible treatment: surgical (118 patients) and endovascular procedure (44 patients). The different treatment strategies were made through a multidisciplinary selection whereas clinical parameters, location, and morphologic features of the aneurysm were considered. The surgical group manifested a greater reduction in performance levels and neurological status in the post-operative phases than the endovascular group (p < 0.01) with a higher incidence of complications (p = 0.012) in contrast to a lower recurrence rate (p > 0.01). There is no significant difference in post-operative mortality and survival between surgical and endovascular groups. The surgical group manifested a higher incidence of complications after treatment. The endovascular group has a better post-operative outcome, but a higher risk of recurrence and the necessity of further treatment.

A 5-Year Follow-Up after Endovascular Treatment of 402 Intracranial Aneurysms—A Single-Centre Experience

“…On the other hand, the meta-analysis by Dengler et al shows similar results for both neurosurgical and endovascular types of treatment for giant aneurysms [61]. The study by Santoro et al showed similar results but a higher percentage of periprocedural complications in the neurosurgical group compared to the endovascular treatment group [62], so further research on the relationship between aneurysm size and treatment choice is needed to draw more accurate conclusions.…”

Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report

“…Giant intracranial aneurysms present a significant risk of rupture, with mortality rates ranging from 65% to 100% within 1 to 5 years following rupture. [ 1 , 2 ] While both neurosurgical clipping and endovascular coiling have demonstrated effectiveness in treatment, [ 3 ] the choice between them is influenced by certain factors. For ruptured cerebral aneurysms, microsurgical clipping is often preferred due to limitations associated with antiplatelet agents.…”

Flow Diverter Stenting for Symptomatic Intracranial Internal Carotid Artery Aneurysms: Clinical Outcomes and Factors for Symptom Improvement

“…Surgical procedures, including parent artery occlusion with/without bypass and direct clipping, have been performed in the past, but these procedures require great skill and reportedly have high morbidity rates. 1 - 3 ) Coil embolization is associated with a residual mass effect. 4 ) In comparison, flow diverter (FD) stenting is expected to improve symptoms without a mass effect by promoting spontaneous thrombosis through the flow diversion effect.…”