Management and prognosis of intracranial giant aneurysms. A report on 58 cases

Abstract

Between 1975 and 1989, 58 patients, 32 females and 26 males, mean age 50 years, with intracranial giant aneurysms with a diameter more than 2.5 cm were treated at our clinic. 48% of the patients presented with subarachnoidal hemorrhage. The most of the other 30 patients presented with cranial nerve dysfunctions. The most common site of the aneurysm was the internal carotid artery (25 cases, 43%), followed by the anterior cerebral artery (14%), and the vertebro-basilar region (11 cases, 19%). In 14 patients direct surgery was not performed because of the poor general condition of the patient, the high risks, or non-consent. In seven patients (12%) the aneurysm had been misdiagnosed as meningeoma, pituitary-adenoma, craniopharyngeoma or glioblastoma. 47% of all patients were discharged as "independent" and 19% died. Patients without SAH had better chance of survival: 7% of patients without SAH died and 29% of patients with hemorrhage. 50% of patients without hemorrhage were discharged as "independent" but only 18% of patients with SAH. Because of the high incidence of hemorrhage and the better prognosis for patients without hemorrhage, we recommend routine surgical treatment of patients with giant aneurysms.

Traumatic Aneurysm Involving the Posterior Communicating Artery

“…Aneurysms often go undetected for years, allowing hemosiderin to settle inside the vessel wall. Aneurysm remodeling can last years and, in rare cases, even result in macroscopic structural alterations, such as in large or giant aneurysms [22,23]. Drugs such as cocaine and methamphetamine predispose patients to rapid aneurysm formation and rupture arising from a sudden increase in blood pressure [24][25][26][27].…”

The Orbitopterional Approach for Large and Giant Middle Cerebral Artery Aneurysms: A Report of Two Cases and Literature Review

“…The available therapeutic options include surgery, endovascular therapy, or a combination of both. [6][7][8][9][10] In the present article, the authors report on two cases of complex MCA aneurysms with previous subarachnoidal hemorrhages that were treated by surgical clipping using the orbitopterional approach. We discuss the various methods of treatment of these complex aneurysms with an emphasis on the possible surgical approaches and the advantages of an orbital osteotomy.…”

"Dificuldades no tratamento microcirúrgico dos aneurismas gigantes e complexos da circulação anterior do polígono de Willis: proposta de escala técnica prognóstica"

“…Ausman, em 1990, publicou seus resultados com 62 casos de aneurismas gigantes operados nos quais obteve 84% de resultados bons e excelentes, 11% de morbidade e mortalidade de 5% (70) . (72) .…”