• World Neurosurg · Feb 2020

    Review Case Reports

    THE LONGEST ANGIOGRAPHIC AND CLINICAL FOLLOW-UP OF MICROSURGICALLY TREATED GIANT INTRACRANIAL ANEURYSMS: EXPERIENCE WITH 70 CASES.

    • Servet İnci, Atilla Akbay, and Tulay Aslan.
    • Department of Neurosurgery, Hacettepe University School of Medicine, Ankara, Turkey. Electronic address: sinci@hacettepe.edu.tr.
    • World Neurosurg. 2020 Feb 1; 134: e412-e421.

    BackgroundGiant intracranial aneurysms (GIAs), if left untreated, have an extremely poor natural history. Despite many reports about the surgical treatment of GIAs, their long-term clinical and angiographic results are unclear. To our knowledge, this study reports the longest clinical and angiographic follow-up of microsurgically treated GIAs in the English literature.MethodsBetween January 1997 and December 2017, 70 patients with giant anterior circulation aneurysms treated using microsurgery were retrospectively reviewed. The applied microsurgical techniques and especially long-term clinical and angiographic follow-up data were evaluated.ResultsThe mean aneurysm size was 29.2 mm (range, 25-58 mm). The aneurysm neck was occluded in 61 patients (87.2%). Nine aneurysms were clipped using an aneurysm clip compression technique. In 8 patients (11.4%), the aneurysm neck was found smaller at surgery than expected according to angiographic findings. Postoperative angiograms showed complete occlusion in 52 of 61 patients (85.2%). The treatment results at discharge were excellent-good (modified Rankin Scale score ≤2) in 75.3% of the patients. The overall mortality was 7.6%. At long-term clinical follow-up (mean, 105.2 months), 48 patients (78.6%) showed excellent-good outcome. At late angiographic follow-up (mean, 98.0 months), no recurrence was seen in patients with complete aneurysm closure.ConclusionsMost giant anterior circulation aneurysms can be successfully clipped, with acceptable morbidity and mortality. Some giant aneurysms have a smaller neck than expected. The aneurysm clip compression technique is useful in clipping of GIAs. This longest clinical and angiographic follow-up in the literature shows that clip ligation has excellent durability in GIAs, also.Copyright © 2019 Elsevier Inc. All rights reserved.

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