Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms.

BACKGROUND Compared with smaller aneurysms, giant intracranial aneurysms (GICAs) have a poorer prognosis and require more meticulous surgical planning and techniques to exclude them from the circulation. GICAs continue to challenge the limits of neurosurgical techniques. A series of 170 patients with GICAs were reviewed for understanding the clinical characteristics, surgical treatment and outcomes of patients with GICAs. METHODS Collected data of 170 consecutive patients with GICAs from January 1995 to July 2007 were analyzed. The clinical characteristics in this study included age, sex, intracranial aneurysms size, the first presentations, locations and Hunt & Hess grade. Surgical methods included direct clipping of the aneurysm neck, parent artery reconstruction, proximal artery ligation, trapping and wrapping. Surgical results were evaluated postoperatively by the Glasgow Outcome Scale (GOS). RESULTS GICAs were more commonly diagnosed at age 30 to 50 years with a mean age of 39.3 years and without obvious gender preponderance in our study (88 male and 82 female patients). The size of the GICAs ranged from 2.5 cm to 8.0 cm (mean, 2.9 cm). Hemorrhage (41%), mass effect (34%) and headache (12%) were the first 3 most common presentations. Regarding the Hunt & Hess classification, at admission there were 100 cases in grade 0, 24 in grade 1, 21 in grade 2, 16 in grade 3, 8 in grade 4 and 1 in grade 5. There were 84 cases of GICAs treated by direct neck-clipping, 47 by parent artery reconstruction, 19 by proximal artery occlusion (with 4 combined with revascularization), 18 by trapping and 2 by wrapping. The follow-up study (ranging from 6 to 115 months, mean 32 months) showed good results in 108 cases, moderate disability in 26 and severe disability in 15 according to GOS. Six cases died. CONCLUSIONS Surgical treatment is an effective treatment for GICAs. Surgical strategies should be made carefully and individually. Doppler ultrasonography, neuroendoscope and intraoperative angiography are useful to perfect surgical results.