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Neurol India. 2018 Nov-Dec;66(6):1741-1757. doi: 10.4103/0028-3886.246291.

Surgery for very large and giant intracranial aneurysms: Results and complications.

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Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
Department of Radiology, University of Washington, Seattle, Washington, USA.
Department of Pathology, University of Washington, Seattle, Washington, USA.



Results of and the complications encountered during surgery for very large and giant intracranial aneurysms are illustrated.


To analyze a consecutive series of patients with very large and giant aneurysms treated with microsurgery.


This retrospective study included seventy six very large and giant aneurysms which were managed by clipping and bypass technique. Sixty two (82%) aneurysms were located in anterior circulation, and 14 (18%) aneurysms were located in posterior circulation. The bypasses performed included local bypasses, extra-intracranial bypasses, double bypasses and combination techniques of external carotid-internal carotid (EC-IC) bypass and local bypasses.


73 patients with 76 aneurysms were treated over 13 years. There were 44 very large and 32 giant aneurysms. Twenty-four patients presented with subarachnoid hemorrhage [SAH] (32%) while forty nine patients with 52 aneurysms (68%) were unruptured. These 73 patients underwent 63 bypass procedures with aneurysm occlusion and 13 clipping procedures. Out of 62 anterior circulation aneurysms, bypass surgery was performed in 49 patients while 13 underwent clipping. In posterior circulation aneurysms, all patients were treated with bypass procedures with proximal occlusion or trapping. In the ruptured group, 16 (67%) patients had postoperative modified Rankin Scale (mRs) 0-2, six patients (25%) had mRs 3-5, and two patients (8.4%) died. In the unruptured group, 45 patients (87%) had mRs 0-2, 3 patients (6%) had mRs 3-5, and four patients (7.6%) died.


In this large series of very large and giant aneurysms treated with microsurgical clipping and bypasses, excellent results were obtained in the long term, in regards to aneurysm occlusion, functional status, and graft patency. Our experience will be very useful to other neurosurgeons who treat these complex lesions.


Aneurysm clipping; bypass surgery; complication; internal carotid artery; large and giant intracranial aneurysms; outcome; revascularization; ruptured aneurysm; subarachnoid hemorrhage; unruptured aneurysm; vertebral artery

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