The natural history of the intracranial giant aneurysms is not well known. To determine the natural course of the intracranial giant aneurysms, a long term follow-up study was carried ont in a consecutive series of 25 patients with intracranial giant aneurysms who had been followed without surgery. Symptoms and signs directly or indirectly attributable to the intracranial mass effect accounted for presentation in 14 (56%) patients. Three patients (12%) were asymptomatic. Eight patients (32%) presented subarachnoid hemorrhage (SAH). The locations and forms of aneurysms were as follows: extradural (cavernous) internal carotid artery (ICA) in 6 cases; intradural (including ICA, middle cerebral artery and vertebro-basilar artery) saccular form in 17; intradural fusiform in 2.
Subarachnoid hemorrhage was recorded frequently from giant intradural saccular aneurysms. The rupture from giant extradural ICA aneurysms, completely thrombosed giant aneurysms and giant intradural fusiform aneurysms was not recorded. In 50%of partially thrombosed intradural saccular aneurysms, SAH was recorded. Subarachnoid hemorrhage was frequently associated with a poor clinical grading and a high mortality.
In the cases of extradural ICA aneurysms, no dead case was recorded but there was no improvement of mass signs.
The mortality rate in 28 cases was 64%and the major morbidity rate was 20%.
From the results of the presented study, we emphasized that surgical treatment must be recommended whenever possible for cases of giant intradural saccular aneurysms.
