Abstract
We analyze surgical results of 32 consecutive patients with intradural giant aneurysms. Using temporary clipping of parent artery, dome decompression by needle aspiration, and multiple clipping, 28 of 32 aneurysms were clipped. Proximal artery occlusion was performed for 2 vertebral aneurysms, and dome coating was done for 1 basilar aneurysm and 1 vertebral aneurysm. Surgical outcome was excellent in 17 patients, good in 7, fair in 3, poor in 1, with 4 death. The location of aneurysm had the biggest influence on the surgical outcome, and aneurysms located in the posterior cranial fossa tended to have poor results. The preoperative grade also influenced the results of ruptured cases. Another factor affecting the results was premature rupture during aneurysmal manipulation.
Five internal carotid artery aneurysms, 3 middle cerebral artery aneurysms, 1 basilar tip aneurysm, and 2 vertebral artery aneurysms harbored intra-aneurysmal thrombi. The thrombosed aneurysms of the internal carotid artery were successfully clipped, but some of those in the middle cerebral and basilar arteries showed poor outcome.
In conclusion, we recommend direct surgery for intradural giant aneurysm in the anterior circle of Willis, even for thrombosed aneurysms. For cases with giant basilar artery aneurysm, especially thrombosed one, strong brain protection with deep hypothermia, barbiturate administration, etc. should be considered during surgical intervention.
