[Series of 17 cases of giant intracranial aneurysms. Long-term surgical follow-up and hemodynamic effects of arterial occlusions].

The authors report their experience of 17 cases of giant intracranial aneurysms some of them with particular forms and localisations: Giant serpentine aneurysms in 17.6%, carotid cavernous, carotid, Willis Circle and vertebral branches. 8 cases were operated, 2 by direct neck occlusion and 6 others by carotid or vertebral interruption. For the nine non operated cases 5 were in a very bad clinical condition and 4 had refused the operation. Aneurysmal neck occlusion gave uneventful results lasting more than 4 and 10 years. Carotid or vertebral branches occlusion showed 16.6% mortality. In one case, the post operative death happened after 8 days of well tolerated carotid occlusion and in spite of a functional extra-intra-cranial anastomosis. Very good surgical outcome was seen in the other cases for over 3 and 22 years. Arterial occlusion in giant aneurysm surgery can bring multiple complications as in one case iatrogenic aneurysmal formation like in experimental Hassler and Hashimoto's descriptions. Curiously in the same way can be explained the ruptured intra cranial aneurysmal formation in some ischemic cerebral disease like Moyamoya syndrome or Takayashu disease.