[Direct surgical treatment of giant intracranial aneurysms (author's transl)].

This report discusses the surgical techniques employed in the 27 cases of giant aneurysm of the brain in which direct operations were performed at the Department of Neurosurgery of Tohoku University from 1961 to 1979. The report also provides a review of the operative results and long-term result of these cases. The conclusions are as follows: 1) Whenever possible, direct operation was implemented in all cases with the exception of infraclinoid ones. The propriety of the neck treatment greatly affected the mortality of the operation. 2) In most cases, there are more difficulties involved in radical surgery on giant aneurysms than on ordinary aneurysms. Temporary occlusion of the afferent and or efferent arteries under the administration of 800 to 1000 microliters 20% mannitol is thought to be a safe and effective method for procedures such as treatment of the aneurysmal neck. 3) In the case of a giant aneurysm of the internal carotid artery, STA-MCA anastomosis was performed before the ligation of the internal carotid artery and this method gave better results than direct operation.