To elucidate clinical characteristics of ruptured large aneurysm whose diameter ranges from 15 to 24mm, surgical procedures and surgical outcomes of cases with large aneurysms were compared with those with small or giant aneurysms. This study included 827 small aneurysm cases, 62 large aneurysm cases and 16 giant aneurysm cases. Surgical procedures required were significantly different among those groups. Frequency of temporary clip usage, multiple clipping, and cervical carotid artery exposure in the carotid artery aneurysm was related to the size of aneurysms. Surgical outcome of good presurgical clinical grades was poorer in the large aneurysm group than in the small aneurysm group.
This difference appeared to be based on surgical procedures resulting in vascular damage in large aneurysm cases. We should note that some techniques required in giant aneurysm surgery are also necessary for some large aneurysm cases, especially in cases of internal carotid artery aneurysms or vertebrobasilar artery aneurysms. Sophisticated surgical techniques, including skull base approaches, or alternative procedures like endovascular treatment should be considered even for large aneurysm cases to improve surgical results, especially in good clinical grade patients.
