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Giant and Very Large Intracranial Aneurysms: Surgical Strategies and Special Issues

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Trends in the Management of Cerebrovascular Diseases

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 129))

Abstract

Giant intracranial aneurysms (GIAs) and very large intracranial aneurysms (VLAs) have a poor natural history because of a high incidence of bleeding and strokes. These lesions always represent a great challenge for neurosurgeons and interventional neuroradiologists because of some peculiar intrinsic features such as size, angioarchitecture, wide neck, mass effect, intraluminal thrombosis, atherosclerotic changes, involvement of branches and perforators, and a frequent need to perform revascularization procedures. The results of a cumulative surgical series of 75 VLAs and GIAs are reported. Thirty-three aneurysms were unruptured. Sixty aneurysms underwent direct surgical treatment consisting of 56 direct clippings, 3 trappings w/o revascularization, and 1 wrapping. Fifteen aneurysms were treated by means of extracranial to intracranial (EC-IC) high-flow bypass. An mRS score ranging between 0 and 2 was observed in 54 patients, whereas an mRS of 3 was seen in 5 patients. Four patients had a severe disability (mRS 4–5) and six patients died. Aneurysm’s fragmentation, with stacking and seating clips, thrombectomy, and aneurysmorrhaphy were the techniques most frequently employed. Revascularization options involving EC-IC high-flow bypass were used in cases not amenable for direct treatment. Some technical tips and special issues related to the surgical management of these complex lesions are discussed.

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Conflict of Interest Statement

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, San Salvatore City Hospital, L’Aquila, Italy

    Sabino Luzzi M.D., Alessandro Ricci M.D. & Renato Galzio M.D.

  2. Department of Life, Health and Environmental Sciences (MESVA), University of L’Aquila, L’Aquila, Italy

    Massimo Gallieni M.D., Mattia Del Maestro M.D. & Renato Galzio M.D.

  3. Department of Anesthesiology, San Salvatore City Hospital, L’Aquila, Italy

    Donatella Trovarelli M.D.

Authors
  1. Sabino Luzzi M.D.
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  2. Massimo Gallieni M.D.
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  3. Mattia Del Maestro M.D.
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  4. Donatella Trovarelli M.D.
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  5. Alessandro Ricci M.D.
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  6. Renato Galzio M.D.
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Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Giuseppe Esposito

  2. Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Luca Regli

  3. Department of Neurosurgery, Asahi Uni Murakami Memorial Hospital, Gifu, Japan

    Yasuhiko Kaku

  4. Department of Neurosurgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan

    Tetsuya Tsukahara

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Luzzi, S., Gallieni, M., Del Maestro, M., Trovarelli, D., Ricci, A., Galzio, R. (2018). Giant and Very Large Intracranial Aneurysms: Surgical Strategies and Special Issues. In: Esposito, G., Regli, L., Kaku, Y., Tsukahara, T. (eds) Trends in the Management of Cerebrovascular Diseases. Acta Neurochirurgica Supplement, vol 129. Springer, Cham. https://doi.org/10.1007/978-3-319-73739-3_4

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  • DOI: https://doi.org/10.1007/978-3-319-73739-3_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-73738-6

  • Online ISBN: 978-3-319-73739-3

  • eBook Packages: MedicineMedicine (R0)

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