Clipping of large and giant aneurysms of anterior circulation.

AIM

Surgical outcome for giant intracranial aneurysms (GIA) is suboptimal. Reasons for higher complication rates in large and GIA surgery are the occlusion of perforators or parent arteries during aneurysm clipping, or prolonged temporary occlusion of main arteries. In this article, results of clipping of large and GIAs of anterior circulation are presented.

MATERIAL AND METHODS

Ten patients with large or GIAs in the anterior circulation were treated by clipping (10/19, 52%). The most common location was the middle cerebral artery (MCA, 5/10), followed by the anterior cerebral artery (ACA, 3/10), and internal carotid artery (ICA, 2/10). Five aneurysms were large (17-20 mm), five were giant (27-53 mm).

RESULTS

Uneventful aneurysm clipping was performed in eight, and cure was obtained in nine patients. Mortality and morbidity figures were 10% (1/10), and 0% (0/10), respectively. Mean follow up time is 2.8 years (range 1-10 years).

CONCLUSION

Clipping is still the most common surgical method of dealing with these lesions. Clipping of all large and giant aneurysms of anterior circulation was achieved in our patients with 10% mortality and 0% morbidity rates. These rates are similar to figures reported in previous series. Clipping of large and giant aneurysms is still the best definitive treatment, and is applicable in majority of the patients.