Analysis of our experience in the management of giant intracranial aneurysms
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Abstract
Introduction: Giant aneurysms are rare, their natural history is unfavorable, and their treatment is complex and full of controversies. We present our recent experience in the management of this pathology and an analysis of possible therapeutic strategies. Methods: We present a retrospective observational study of twelve giant intracranial aneurysm diagnosed from June 2020 to June 2023. The following data were analyzed: age, symptoms, aneurysm size, presence of thrombosis or calcifications, type of treatment performed, complications, clinical and radiological outcomes and need for further treatments. The surgical technique is explained. Results: Seven giant aneurysms were operated using microsurgery. Five other giant aneurysms were identified: two aneurysms treated with flowdiversion, another ruptured aneurysm that rebleeded before duramater opening and was not clipped and another three that were observed. One of them was located in the posterior circulation (8,3%). Three aneurysms were diagnosed due to rupture (25%), seven due to mass effect (58,3%) and two incidentally (16,7%). Overall mortality was 33%. All of five patients with unruptured aneurysms treated by surgery presented very good clinical outcomes (mrS 0-1 at follow-up). Conclusions: Microsurgery is safe and effective for the treatment of giant anterior circulation aneurysms with mass effect. Adequate radiological follow-up is essential to assess endovascular treatment in case of aneurysmal remnant or regrowth. We consider this strategy the technique of choice for the treatment of giant anterior circulation aneurysms.
Conclusions: Microsurgery is safe and effective for the treatment of giant anterior circulation aneurysms with mass effect. Adequate radiological follow-up is essential to assess endovascular treatment in case of aneurysmal remnant or regrowth. We consider this strategy the technique of choice for the treatment of giant anterior circulation aneurysms.
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Intracranial aneurysm, Giant intracranial aneurysm, Clipping, Flowdiversion
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