Long Term Outcome of Intracranial Giant Aneurysms: Analysis of 51 Cases

Kim, Myoung Soo; Han, Dae Hee; Oh, Chang Wan

Abstract

OBJECTIVE
The present study is conducted to clarify the long-term outcome of intracranial giant aneurysm(IGA) and to elucidate optimal treatment strategy.
METHODS
The authors analyzed respectively clinical records and radiological images of 51 patients with IGA treated from 1981 to 2000. Ten patients underwent conservative treatment. Twenty-nine patients underwent surgical procedure and twelve patients underwent endovascular treatment.
RESULTS
The patients' ages ranged from 5 to 75 years, with a peak incidence in the sixth decade. The male to female ratio was 1:2.4. Twenty-seven cases presented with mass effect, and twenty-one cases manifested with subarachnoid hemorrhage(SAH). The incidence of rebleeding among twenty-one patients that presented with SAH was 16.4% within 7 dyas after first bleeding. Five of ten patients that underwent conservative treatment died. Permanent balloon occlusion after successful temporary carotid occlusion was performed in eight cases of unclippable internal carotid aneurysm. Seven of them demonstrated both clinical and angiographic tolerance. The clinical outcome for the aneurysmal neck clipping was good in 10, poor in one, death in three, and follow up loss in one patient. The clinical outcome of fourteen patients that underwent other surgical treatment was good in eight, poor in one, death in four, and follow up loss in one patient.
CONCLUSION
High mortality rate has been observed with conservative management. Immediate obliteration of aneurysm is mandatory in intracranial giant aneurysm unless medical risks are prohibitive.