Intracranial Giant Aneurysms

Kim, Hyung Dong

Abstract

Intracranial giant aneurysms(GANs), approximately 5% of all intracranial aneurysms, represent a subgroup of diverse intracranial artery aneurysms(ANs) with a maximum sac diameter reaching or exceeding 25 mm. This size has been used arbitrarily to define this clinicopathological entity because smaller lesions have been shown to differ significantly with regard to the rate of rupture, the incidence of presentation with mass effect, and, most importantly, the difficulty of surgical treatment. And GANs also are a unique biological entity. The goals of therapy may include protection from hemorrhage, prevention and treatment of thromboembolic complications and relief of symptomatic mass effect. The treatment of all GANs has benefited from advances in angiography and imaging, endovascular techniques, intraoperative angiography, and collaborative advances in anesthetic technique, brain resuscitation and protection, critical care and rehabilitation. GANs present formidable surgical challenges due to their size, management strategies, brain protection and proximal control. Therefore dynamic and multidisciplinary strategy of therapy is optimally executed by a clinical team dedicated to interaction and collaboration, these clinical team should include diagnostic and interventional neuroradiology expertise and a technical competence geared toward realistic and individualized therapeutic options. The author reviewed the literature for clinical manifestation, diagnostic evaluation, therapeutic stategies including the method of brain protection of GANs.