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Giant cerebral aneurysms

A Review of Clinical Picture, Diagnosis and Management with Illustrative Cases

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Summary

A review of the literature regarding the clinical aspects, diagnosis and management of giant aneurysms and examples from the series of 30 cases of these lesions draw attention to the following aspects: – clinical presentation:

a large proportion of aneurysms, measuring more than 2.5 cm in diameter presents with signs and symptoms suggesting a tumorous lesion. Cranial nerve palsies are a frequent sign. However, approximately 60 per cent of cases present with subarachnoid haemorrhage on admission or with history of SAH in the past.

In contrast to smaller aneurysms giant aneurysms involve mainly the ICA and the VB system and less frequently the ACA complex.

– radiology:

Giant aneurysms have fairly characteristic CT appearance but must be differentiated from some basal tumours like meningioma, neurinoma, pituitary adenoma, germinoma. Angiography remains the main diagnostic tool. Subdivision of giant aneurysms into five types plus fusiform aneurysm based on the degree of thrombosis and degree of opacification on angiogram is justified in view of its implications for the management. Serpentine type of giant aneurysm is a particular form of a partially thrombosed lesion and it is not limited to the MCA. Giant partially thrombosed aneurysms may act as a source of emboli.

– management:

Surgical treatment still remains a formidable task. Direct clipping of the neck is often impossible. In the majority of cases temporary occlusion of the parent vessel proximally and distally to the lesion is necessary at the time of operation of permanent occlusion of the parent vessel, and remains the only possibility. In such cases a bypass operation should be considered and should be done at the same time as staged occlusion. There is good evidence that a bypass is also of value in patients in whom only the extracranial ICA is ligated.

– morbidity and mortality are higher than in other types of aneurysms. Prognosis in non-treated, nonthrombosed or partially thrombosed giant aneurysms particularly of the vertebro-basilar system is extremely poor.

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Pia, H.W., Zierski, J. Giant cerebral aneurysms. Neurosurg. Rev. 5, 117–148 (1982). https://doi.org/10.1007/BF01742676

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