THE LONGEST ANGIOGRAPHIC AND CLINICAL FOLLOW-UP OF MICROSURGICALLY TREATED GIANT INTRACRANIAL ANEURYSMS: EXPERIENCE WITH 70 CASES

Abstract Background Giant intracranial aneurysms (GIAs), if left untreated, have an extremely poor natural history. Objective Despite many reports about the surgical treatment of GIAs, their long-term clinical and angiographic results are unclear. To our knowledge, this study reports the longest clinical and angiographic follow-up of microsurgically treated GIAs in the English literature. Methods Between January 1997 and December 2017, 70 patients with giant anterior circulation aneurysms treated using microsurgery were retrospectively reviewed. The applied microsurgical techniques and especially long-term clinical and angiographic follow-up data were evaluated. Results The mean aneurysm size was 29.2 mm (range, 25-58 mm). The aneurysm neck was occluded in 61 patients (87.2%). Nine aneurysms were clipped using "Aneurysm Clip Compression" technique. In 8 patients (11.4%), the aneurysm neck was found smaller at surgery than expected according to angiographic findings.Postoperative angiograms showed complete occlusion in 52 of 61 patients (85.2%). The treatment results at discharge were excellent-good (mRS score ≤2) in 75.3% of the patients. The overall mortality was 7.6%. At long term clinical follow-up (mean 105.2 months), 48 patients (78.6%) showed excellent-good outcome. At late angiographic follow-up (mean 98.0 months), no recurrence was seen in patients with complete aneurysm closure. Conclusions Most giant anterior circulation aneurysms can be successfully clipped with acceptable morbidity and mortality. Some giant aneurysms have smaller neck than expected. The "Aneurysm Clip Compression" technique is useful in clipping of GIAs. Finally, this longest clinical and angiographic follow-up in the literature demonstrates that clip ligation has excellent durability in GIAs, also.