Treatment and results of partially thrombosed giant aneurysms

Partially thrombosed giant aneurysms are one of the most difficult diseases to treat in the neurosurgical field. Of 1675 aneurysms surgical treated at our institution by July 1997, we have encountered 18 cases of partially thrombosed giant aneurysms (three vertebral artery, four basilar artery, four internal carotid artery, five middle cerebral artery, and two anterior communicating artery aneurysms). Nine aneurysms were clipped: two were removed with anastomosis, two were treated interventionally, and five cases were treated conservatively because of serpentine and fusiform type aneurysms in I.C. bifurcation. These conservatively treated patients died due to infarction. When surgery is selected to treat thrombosed giant aneurysms, the approach is the most important in securing the neck. If the neck is big enough to clip, arterial reconstruction is the method of choice. Three-dimensional computerized tomography angiography is useful in planning the strategy for surgery. The reconstruction must be done to include enough sized artery because of the thick wall. If the aneurysm neck is too small to reconstruct, resection with anastomosis in order to prevent occlusion due to rethrombosis should be performed. These operative procedures will be shown on video.