A 7-year retrospective single-center study on treatment strategy and clinical outcome of giant intracranial aneurysm

Background

A giant intracranial aneurysm (GIA) measures ≥ 25 mm and is a rare, challenging condition to treat with a poor prognosis. Selecting the appropriate treatment approach, whether surgical, endovascular, or a combination of both, is crucial for achieving favorable outcomes. However, the unique characteristics of each GIA imply that no single treatment option can be considered optimal universally. This study aimed to evaluate the treatment strategies and clinical outcomes at our center.

Methods

This retrospective, single-center study conducted between 2012 and 2018, included 20 patients with GIA. We comprehensively reviewed demography, aneurysm characteristics, clinical and radiography data, treatment strategies, and angiography and clinical outcomes.

Results

The average maximum GIA was 29.4 mm (excluding serpentine). Twelve aneurysms were located in the internal carotid artery (ICA); three, anterior cerebral artery; and five, middle cerebral artery. Morphologically, 18 saccular and 2 serpentine aneurysms were observed. Among them, 14 were symptomatic, with 8 presenting with subarachnoid hemorrhage, of which, 5 (62.5 %) were accompanied by intracerebral hemorrhage. Cranial nerve–related symptoms were observed in five ICA aneurysms, and two involved a carotid cavernous fistula. Five patients had multiple aneurysms accompanied by GIA. The treatment modalities varied; eight patients initially underwent surgical treatment. Regarding the number of treatment steps, 14 patients required one step, 4 required two steps, and 2 required three steps. In eight patients, parent artery occlusion (with or without bypass surgery) was the final treatment approach. After 1 year, 70 % of patients achieved a favorable outcome, as indicated by a modified Rankin Scale score ≤ 2.

Conclusions

Patient-specific treatments are crucial for improving clinical outcomes. Advancements in endovascular treatment have been made owing to the development of new devices. Parent artery occlusion with vascular bypass was a reliable treatment option.