Giant intracranial aneurysms: evolution of management in a contemporary surgical series

Document Type

Article

Abstract

BACKGROUND: Many significant microsurgical series of patients with giant aneurysms predate changes in practice during the endovascular era. OBJECTIVE: A contemporary surgical experience is presented to examine changes in management relative to earlier reports, to establish the role of open microsurgery in the management strategy, and to quantify results for comparison with evolving endovascular therapies. METHODS: During a 13-year period, 140 patients with 141 giant aneurysms were treated surgically. One hundred aneurysms (71%) were located in the anterior circulation, and 41 aneurysms were located in the posterior circulation. RESULTS: One hundred eight aneurysms (77%) were completely occluded, 14 aneurysms (10%) had minimal residual aneurysm, and 16 aneurysms (11%) were incompletely occluded with reversed or diminished flow. Three patients with calcified aneurysms were coiled after unsuccessful clipping attempts. Eighteen patients died in the perioperative period (surgical mortality, 13%). Bypass-related complications resulted from bypass occlusion (7 patients), aneurysm hemorrhage due to incomplete aneurysm occlusion (4 patients), or aneurysm thrombosis with perforator or branch artery occlusion (4 patients). Thirteen patients were worse at late follow-up (permanent neurological morbidity, 9%; mean length of follow-up, 23 ± 1.9 months). Overall, good outcomes (Glasgow Outcome Score 5 or 4) were observed in 114 patients (81%), and 109 patients (78%) were improved or unchanged after therapy. CONCLUSION: A heavy reliance on bypass techniques plus indirect giant aneurysm occlusion distinguishes this contemporary surgical experience from earlier ones, and obviates the need for hypothermic circulatory arrest. Experienced neurosurgeons can achieve excellent results with surgery as the "first-line" management approach and endovascular techniques as adjuncts to surgery.

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; Cerebral Revascularization (methods); Chi-Square Distribution; Child; Child, Preschool; Embolization, Therapeutic (methods); Female; Glasgow Coma Scale; Humans; Infant; Intracranial Aneurysm (surgery); Kaplan-Meier Estimate; Longitudinal Studies; Male; Microsurgery (methods); Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult

Publication Date

7-8-2011

Publication Title

Neurosurgery

E-ISSN

1524-4040

Volume

69

Issue

6

First Page

1261

Last Page

70; discussion 1270

PubMed ID

21734614

Digital Object Identifier (DOI)

10.1227/NEU.0b013e31822bb8a6

This document is currently not available here.

Share

COinS