Skip to main content
SpringerLink
Log in

Giant Intracranial Aneurysms

  • Protocol
  • First Online:
Cerebrovascular Disorders

Part of the book series: Neuromethods ((NM,volume 170))

  • 650 Accesses

Abstract

Intracranial aneurysms are classified as giant when their largest diameter is equal to or greater than 25 mm; they represent approximately 5–7% of intracranial aneurysms. Giant intracranial aneurysms carry a poor natural history with a 68% mortality in 2 years and a 85% in 5 years for untreated cases. The clinical presentation, natural history, location, therapeutic challenges, and treatment strategy are considerably different from smaller intracranial aneurysms and thus warrant special attention.

This chapter will summarize the types of giant intracranial aneurysms, their pathophysiology, review clinical presentations and diagnostic evaluation. Different management strategies for giant intracranial aneurysms are also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Protocol
USD 49.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Krings T, Alvarez H, Reinacher P, Ozanne A, Baccin C, Gandolfo C, Zhao W-Y, Reinges M, Lasjaunias P (2007) Growth and rupture mechanism of partially thrombosed aneurysms. Interv Neuroradiol 13(2):117–126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Parkinson RJ, Eddleman CS, Batjer HH, Bendok BR (2006) Giant intracranial aneurysms: endovascular challenges. Neurosurgery 59(5):S3–S103

    Google Scholar 

  3. Choi IS, David C (2003) Giant intracranial aneurysms: development, clinical presentation and treatment. Eur J Radiol 46(3):178–194

    Article  PubMed  Google Scholar 

  4. Drake C (1979) Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg 26:12

    Article  CAS  PubMed  Google Scholar 

  5. Wiebers DO, Investigators ISoUIA (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110

    Article  PubMed  Google Scholar 

  6. Barrow D, Alleyne C (1994) Natural history of giant intracranial aneurysms and indications for intervention. Clin Neurosurg 42:214–244

    Google Scholar 

  7. Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Huston J III, McClelland RL, Christianson TJ (2005) The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis 20(4):270–279

    Article  PubMed  Google Scholar 

  8. Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Nakatomi H, Huston J III, McClelland R, Christianson TJ (2004) Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J Neurosurg 101(1):82–87

    Article  PubMed  Google Scholar 

  9. Lonjon M, Pennes F, Sedat J, Bataille B (2015) Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms. Neurochirurgie 61(6):361–365

    Article  CAS  PubMed  Google Scholar 

  10. Krings T, Mandell DM, Kiehl T-R, Geibprasert S, Tymianski M, Alvarez H, Hans F-J (2011) Intracranial aneurysms: from vessel wall pathology to therapeutic approach. Nat Rev Neurol 7(10):547–559

    Article  CAS  PubMed  Google Scholar 

  11. Little JR, St Louis P, Weinstein M, Dohn DF (1981) Giant fusiform aneurysm of the cerebral arteries. Stroke 12(2):183–188

    Article  CAS  PubMed  Google Scholar 

  12. Nakatomi H, Segawa H, Kurata A, Shiokawa Y, Nagata K, Kamiyama H, Ueki K, Kirino T (2000) Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms insight on the mechanism of growth. Stroke 31(4):896–900

    Article  CAS  PubMed  Google Scholar 

  13. Christiano LD, Gupta G, Prestigiacomo CJ, Gandhi CD (2009) Giant serpentine aneurysms. Neurosurg Focus 26(5):E5

    Article  PubMed  Google Scholar 

  14. Segal HD, McLaurin RL (1977) Giant serpentine aneurysm: report of two cases. J Neurosurg 46(1):115–120

    Article  CAS  PubMed  Google Scholar 

  15. Pia H, Zierski J (1982) Giant cerebral aneurysms. Neurosurg Rev 5(4):117–148

    Article  CAS  PubMed  Google Scholar 

  16. Lawton M, Spetzler R (1998) Surgical strategies for giant intracranial aneurysms. Neurosurg Clin N Am 9(4):725–742

    Article  CAS  PubMed  Google Scholar 

  17. Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84(2):185–193

    Article  CAS  PubMed  Google Scholar 

  18. Resta M, Gentile M, Di Cuonzo F, Vinjau E, Brindicci D, Carella A (1984) Clinical-angiographic correlations in 132 patients with megadolichovertebrobasilar anomaly. Neuroradiology 26(3):213–216

    Article  CAS  PubMed  Google Scholar 

  19. Pinto RS, Kricheff II, Butler AR, Murali R (1979) Correlation of computed tomographic, angiographic, and neuropathological changes in Giant cerebral aneurysms 1. Radiology 132(1):85–92

    Article  CAS  PubMed  Google Scholar 

  20. Dengler J, Maldaner N, Gläsker S, Endres M, Wagner M, Malzahn U, Heuschmann PU, Vajkoczy P, Group GIAS (2016) Outcome of surgical or endovascular treatment of Giant intracranial aneurysms, with emphasis on age, aneurysm location, and Unruptured Aneuryms-a systematic review and meta-analysis. Cerebrovasc Dis 41(3-4):187–198

    Article  PubMed  Google Scholar 

  21. Hanel RA, Spetzler RF (2008) Surgical treatment of complex intracranial aneurysms. Neurosurgery 62(6):SHC1289–SHC1299

    Article  Google Scholar 

  22. de Sousa AA, de Sousa Filho JL, Dellaretti Filho MA (2015) Treatment of Giant intracranial aneurysms: a review based on experience from 286 cases. Arq Bras Neurocir 34(04):295–303

    Article  Google Scholar 

  23. Lemole GM, Henn J, Spetzler RF, Riina HA (2000) Surgical management of giant aneurysms. Oper Tech Neurosurg 3(4):239–254

    Article  Google Scholar 

  24. Chen S, Kato Y, Subramanian B, Kumar A, Watabe T, Imizu S, Oda J, Oguri D, Sano H (2011) Retrograde suction decompression assisted clipping of large and giant cerebral aneurysms: our experience. Minim Invasive Neurosurg 54(01):1–4

    Article  CAS  PubMed  Google Scholar 

  25. Eliava SSFYM, Yakovlev SB, Shekhtman OD, Kheireddin AS, Sazonov IA, Sazonova OB, Okishev DN (2010) Results of microsurgical treatment of large and giant ICA aneurysms using the retrograde suction decompression (RSD) technique: series of 92 patients. World Neurosurg 73:683–687

    Article  PubMed  Google Scholar 

  26. van Doormaal TPC, van der Zwan A, Verweij BH, Regli L, Tulleken CAF (2010) Giant aneurysm clipping under protection of an excimer laser–assisted non-occlusive anastomosis bypass. Neurosurgery 66(3):439–447. https://doi.org/10.1227/01.neu.0000364998.95710.73

    Article  PubMed  Google Scholar 

  27. Cantore G, Santoro A, Guidetti G, Delfinis CP, Colonnese C, Passacantilli E (2008) Surgical treatment of giant intracranial aneurysms: current viewpoint. Neurosurgery 63(4):279–290

    PubMed  Google Scholar 

  28. Hauck EF, Wohlfeld B, Welch BG, White JA, Samson D (2008) Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study: clinical article. J Neurosurg 109(6):1012–1018

    Article  PubMed  Google Scholar 

  29. Sharma BS, Gupta A, Ahmad FU, Suri A, Mehta VS (2008) Surgical management of giant intracranial aneurysms. Clin Neurol Neurosurg 110(7):674–681

    Article  PubMed  Google Scholar 

  30. Kato Y, Sano H, Imizu S, Yoneda M, Viral M, Nagata J, Kanno T (2003) Surgical strategies for treatment of giant or large intracranial aneurysms: our experience with 139 cases. Minim Invasive Neurosurg 46(06):339–343

    Article  CAS  PubMed  Google Scholar 

  31. Piepgras DG, Khurana VG, Whisnant JP (1998) Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment. J Neurosurg 88(3):430–435

    Article  CAS  PubMed  Google Scholar 

  32. Drake CG, Peerless SJ (1997) Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg 87(2):141–162

    Article  CAS  PubMed  Google Scholar 

  33. Briganti F, Cirillo S, Caranci F, Esposito F, Maiuri F (2002) Development of" de novo" aneurysms following endovascular procedures. Neuroradiology 44(7):604–609

    Article  CAS  PubMed  Google Scholar 

  34. Sluzewski M, Menovsky T, Van Rooij WJ, Wijnalda D (2003) Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. Am J Neuroradiol 24(2):257–262

    PubMed  PubMed Central  Google Scholar 

  35. Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45(4):793

    Article  CAS  PubMed  Google Scholar 

  36. Chalouhi N, Tjoumakaris S, Gonzalez L, Dumont A, Starke R, Hasan D, Wu C, Singhal S, Moukarzel L, Rosenwasser R (2014) Coiling of large and giant aneurysms: complications and long-term results of 334 cases. Am J Neuroradiol 35(3):546–552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF (2013) Endovascular treatment of intracranial aneurysms with flow diverters a meta-analysis. Stroke 44(2):442–447

    Article  PubMed  Google Scholar 

  38. Nimer Adeeb CG, Shallwani H, Shakir HJ, Foreman P, Moore J, Dmytriw A, Alturki A, Siddiqui A, Levy E, Snyder K, Harrigan M, Ogilvy C, Thomas A (2016) Pipeline Embolization Device in treatment of unruptured large and giant aneurysms. World Neurosurg 105:232–237

    Article  Google Scholar 

  39. Strauss I, Maimon S (2016) Silk flow diverter in the treatment of complex intracranial aneurysms: a single-center experience with 60 patients. Acta Neurochir 158(2):247–254

    Article  PubMed  Google Scholar 

  40. Zhou Y, Yang P, Fang Y, Xu Y, Hong B, Zhao W, Li Q, Zhao R, Huang Q, Liu J (2014) A novel flow-diverting device (Tubridge) for the treatment of 28 large or giant intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 35(12):2326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. El-Chalouhi N, Jabbour PM, Tjoumakaris SI, Starke RM, Dumont AS, Liu H, Rosenwasser R, El Moursi S, Gonzalez LF (2014) Treatment of large and giant intracranial aneurysms: cost comparison of flow diversion and traditional embolization strategies. World Neurosurg 82(5):696–701

    Article  PubMed  Google Scholar 

  42. Chalouhi N, Tjoumakaris S, Starke RM, Gonzalez LF, Randazzo C, Hasan D, McMahon JF, Singhal S, Moukarzel LA, Dumont AS (2013) Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke 44(8):2150–2154

    Article  PubMed  Google Scholar 

  43. Zhang Y, Zhou Y, Yang P, Liu J, Xu Y, Hong B, Zhao W, Chen Q, Huang Q-H (2015) Comparison of the flow diverter and stent-assisted coiling in large and giant aneurysms: safety and efficacy based on a propensity score-matched analysis. Eur Radiol 26:2369–2377

    Article  PubMed  Google Scholar 

  44. Derrey S, Penchet G, Thines L, Lonjon M, David P, Bataille B, Emery E, Lubrano V, Laguarrigue J, Bresson D (2015) French collaborative group series on giant intracranial aneurysms: current management. Neurochirurgie 61(6):371–377

    Article  CAS  PubMed  Google Scholar 

  45. Huang L, Cao W, Ge L, Lu G, Wan J, Zhang L, Gu W, Zhang X, Geng D (2015) Endovascular management of giant middle cerebral artery aneurysms. Int J Clin Exp Med 8(5):7517

    PubMed  PubMed Central  Google Scholar 

  46. Gao X, Liang G, Li Z, Wei X, Cao P (2012) A single-Centre experience and follow-up of patients with endovascular coiling of large and giant intracranial aneurysms with parent artery preservation. J Clin Neurosci 19(3):364–369

    Article  PubMed  Google Scholar 

  47. Hauck EF, Welch BG, White JA, Replogle RE, Purdy PD, Pride LG, Samson D (2009) Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol 71(1):19–24

    Article  PubMed  Google Scholar 

  48. Jahromi BS, Mocco J, Bang JA, Gologorsky Y, Siddiqui AH, Horowitz MB, Hopkins LN, Levy EI (2008) Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms. Neurosurgery 63(4):662–675

    Article  PubMed  Google Scholar 

  49. Standhardt H, Boecher-Schwarz H, Gruber A, Benesch T, Knosp E, Bavinzski G (2008) Endovascular treatment of Unruptured intracranial aneurysms with Guglielmi detachable coils short-and long-term results of a single-Centre series. Stroke 39(3):899–904

    Article  PubMed  Google Scholar 

  50. Li M-H, Li Y-D, Fang C, Gu B-X, Cheng Y-S, Wang Y-L, Gao B-L, Zhao J-G, Wang J, Li M (2007) Endovascular treatment of giant or very large intracranial aneurysms with different modalities: an analysis of 20 cases. Neuroradiology 49(10):819–828

    Article  PubMed  Google Scholar 

  51. Hanel R, Bonafe A, Fischer S, Diaz O, Kallmes D, Barnwell S, Woo H (2015) O-020 treatment of giant intracranial aneurysms with pipeline: aspire (aneurysm study of pipeline in an observational registry) results. J NeuroInterventional Surg 7(Suppl 1):A11

    Article  Google Scholar 

  52. Berge J, Biondi A, Machi P, Brunel H, Pierot L, Gabrillargues J, Kadziolka K, Barreau X, Dousset V, Bonafé A (2012) Flow-diverter silk stent for the treatment of intracranial aneurysms: 1-year follow-up in a multicenter study. Am J Neuroradiol 33(6):1150–1155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E (2012) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Neuroradiology 54(10):1145–1152

    Article  PubMed  Google Scholar 

  54. Lubicz B, Collignon L, Raphaeli G, Pruvo J-P, Bruneau M, De Witte O, Leclerc X (2010) Flow-diverter stent for the endovascular treatment of intracranial aneurysms a prospective study in 29 patients with 34 aneurysms. Stroke 41(10):2247–2253

    Article  PubMed  Google Scholar 

  55. Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64(4):632–643

    Article  PubMed  Google Scholar 

  56. Familiari P, Maldaner N, Kursumovic A, Rath SA, Vajkoczy P, Raco A, Dengler J (2015) Cost comparison of surgical and endovascular treatment of unruptured giant intracranial aneurysms. Neurosurgery 77(5):733–743

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Endovascular and Operative Neurovascular Surgery, BIDMC Neurosurgery & Brain Aneurysm Institute, Harvard Medical School, Boston, MA, USA

    Abdulrahman Y. Alturki

  2. Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia

    Abdulrahman Y. Alturki

  3. Neurosurgery, Harvard Medical School, BIDMC Brain Aneurysm Institute, Neurointerventional Fellowship, Boston, MA, USA

    Ajith Thomas

  4. Neurosurgery, Harvard Medical School, BIDMC Brain Aneurysm Institute, Endovascular and Operative Neurovascular Surgery, Boston, MA, USA

    Christopher S. Ogilvy

Authors
  1. Abdulrahman Y. Alturki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajith Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher S. Ogilvy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher S. Ogilvy .

Editor information

Editors and Affiliations

  1. Associate Chair of Neurology for Research, New York Medical College, Associate Professor of Neurology, Neurosurgery and Radiology, New York Medical College, Director of the Neuroendovascular Surgery Fellowship, Neuroendovascular Surgery (Interventional Neurologist) Attending Medical Director of Neurocritical Care, Westchester Medical Center at New York Medical College, New York, USA

    Fawaz Al-Mufti, MD

  2. Division of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Division of Neurointerventional Radiology, Ascension St. Vincent Medical Center, Department of Neurosurgery, Marian College of Osteopathic Medicine, Indianapolis, IN, USA

    Krishna Amuluru MD

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Science+Business Media, LLC, part of Springer Nature

About this protocol

Check for updates. Verify currency and authenticity via CrossMark

Cite this protocol

Alturki, A.Y., Thomas, A., Ogilvy, C.S. (2021). Giant Intracranial Aneurysms. In: Al-Mufti, MD, F., Amuluru MD, K. (eds) Cerebrovascular Disorders. Neuromethods, vol 170. Humana, New York, NY. https://doi.org/10.1007/978-1-0716-1530-0_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-0716-1530-0_10

  • Published:

  • Publisher Name: Humana, New York, NY

  • Print ISBN: 978-1-0716-1529-4

  • Online ISBN: 978-1-0716-1530-0

  • eBook Packages: Springer Protocols

Publish with us

Policies and ethics

Search

Navigation