Giant aneurysms: surgical treatment.

We have reviewed our experience with the surgical management of giant aneurysms of the cerebral circulation. Patients with aneurysms at the base of the skull, below the subarachnoid space, were treated by proximal ligation and arterial bypass with trapping intracranially if necessary. Patients harboring giant aneurysms located on arteries within the subarachnoid space were treated by direct attack on the aneurysm aided by hypothermia and elective circulatory arrest. Elective circulatory arrest allows the surgeon more control in dissecting out and obliterating giant aneurysms. We were able to exclude these lesions from the circulation without sacrificing the parent artery. There was no mortality and morbidity seems acceptably low.