Twenty-two cases of giant cerebral aneurysms were reviewed in terms of incidence, location, symptomatology and the results of surgical treatment. Surgical outcome of direct operation and carotid ligation was compared in 16 of the 22 patients. The incidence of giant aneurysms was 4.6% among 476 cerebral aneurysms. The patients were six men and 16 women, with a mean age of 57 years. There were 15 aneurysms of the internal carotid artery (68%), three of the anterior communicating artery, two of the basilar artery and two of the middle cerebral artery.
Subarachnoid hemorrhage had occurred in six (50%)of the 12 patients with a nonthrombosed aneurysm, and in two (25%) of the eight patients with a partially thrombosed aneurysm. The overall incidence of subarachnoid hemorrhage was 41%, and the incidence of rebleeding was four (44%) out of nine.Cerebral ischemic episodes were noted in five (23%) of the 22 patients.
The results of surgery were as follow: there were five excellent cases, one good case and one deceased case out of the patients treated by carotid ligation or trapping and three excellent cases and three deceased cases in the patients treated by clipping. Six patients treated by carotid ligation or trapping had no subsequent neurological deficit in the follow-up period, which ranged from one to 10 years with a mean of 6.5 years. Overall mortality was five of the 12 patients with a nonthrombosed aneurysm and two of the eight patients with a partially or completely thrombosed aneurysm.
