Microsurgical management of giant intracranial aneurysms: a single surgeon experience from Louisiana State University, Shreveport.

BACKGROUND: Surgical management of giant aneurysms is challenging because of multiple factors: aneurysm size, wide neck, thrombosis, and calcification. The risk of ischemic complications is higher when compared with smaller aneurysms. We present our surgical experience of clipping these difficult aneurysms.
METHODS: A total of 59 giant intracranial aneurysms underwent surgical clipping by a single surgeon over the last 2 decades. The case records of these patients were retrospectively reviewed to evaluate the operative outcome. The study was approved by the Institutional Review Board of the Louisiana State University Health Sciences Center, Shreveport, in compliance with Health Insurance Portability and Accountability Act regulations.
RESULTS: The mean age in our series was 50.57 years (range 19 to 77 years). There was a female preponderance (female-male ratio 2.47:1). Headache was the most common form of presentation (62.7%, n = 37), followed by cranial nerve deficits (32.2%, n = 19) and seizures (13.5%, n = 8). Subarachnoid hemorrhage was seen in 38.9% (n = 23). Eleven patients had posterior circulation aneurysm. At admission, 47.8% (n = 11) of the patients were in good grade (grade I and II). Multiple aneurysms were noted in 18.64% (n = 11) of cases, but none of the patients harbored more than 1 giant aneurysm. Mortality rate was 10.1% (n = 6). The majority of patients (71.9%) experienced a good outcome (Glasgow Outcome Scale score [GOS] 4 and 5) at the last follow-up. Binary logistic regression analysis was performed to find predictors of poor outcome. Poor clinical grade, ruptured aneurysm, and posterior location predicted independently for poor outcome.
CONCLUSIONS: Giant aneurysms impose a relatively higher risk of mortality and morbidity to patients. With proper case selection and appropriate surgical strategy, it is possible to achieve a favorable outcome in most cases.