title: French collaborative group series on giant intracranial aneurysms: Current management.
abstract: OBJECTIVE
  Giant intracranial aneurysms represent a major therapeutic challenge for each surgical team. The aim of our study was to extensively review the French contemporary experience in treating giant intracranial aneurysms in order to assess the current management.
  
  
  METHODS
  This retrospective multicenter study concerned consecutive patients treated for giant intracranial aneurysms (2004-2008) in different French university hospitals (Bordeaux, Caen, Clermont-Ferrand, Lille, Lyon, Nice, Paris-Lariboisière, Rouen et Toulouse). Different variables were analyzed: the diagnostic circumstances, the initial clinical status based on the WFNS scale, aneurysmal features and exclusion procedure. At 6 months, the outcome was evaluated according to the modified Rankin Scale (mRS): favorable (mRS 0-2) and unfavorable (mRS 3-6). A multivariate logistic regression model included all the independent variables with P<0.25 in the univariate analysis (P<0.05).
  
  
  RESULTS
  A total of 79 patients with a mean age of 51.5 ± 1.6 years (median: 52 years; range: 16-79) were divided into two groups, with the ruptured group (n=26, 32.9%) significantly younger (P<0.05, Student's-t-test) than the unruptured group (n=53, 67.1%). After SAH, the initial clinical status was good in 12 patients (46.2%), and in the unruptured group, the predominant diagnosis circumstance was a pseudo-tumor syndrome occurring in 22 (41.5%). The first procedure of aneurysm treatment in the global population was endovascular in 42 patients (53.1%), microsurgical in 29 (36.7%) and conservative in 8 (10.2). An immediate neurological deterioration was reported in 38 patients (48.1%) after endovascular treatment in 19 (45.2% of endovascular procedures), after miscrosurgical in 15 (51.7% of microsurgical procedures) and after conservative in 4 (the half). At 6 months, the outcome was favorable in 45 patients (57%) and after multivariate analysis, the predictive factors of favorable outcome after management of giant cerebral aneurysm were the initial good clinical status in cases of SAH (P<0.002), the endovascular treatment (P<0.005), and the absence of neurological deterioration (P<0.006). The endovascular procedure was obtained as a predictive factor because of the low risk efficacy of indirect procedures, in particular a parent vessel occlusion.
  
  
  CONCLUSIONS
  The overall favorable outcome rate concerned 57% of patients at 6 months despite 53.8% of poor initial clinical status in cases of rupture. The predictive factors for favorable outcome were good clinical status, endovascular treatment and the absence of postoperative neurological deterioration. Endovascular treatment should be integrated into the therapeutic armenmatarium against giant cerebral aneurysms but the durability of exclusion should be taken into account during the multidisciplinary discussion by the neurovascular team.
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Derrey
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Penchet
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Thines
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Lonjon
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: David
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Bataille
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Emery
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Lubrano
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Laguarrigue
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Pelissou
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Irthum
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lejeune
authors.affiliation: Department of Neurosurgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France. Electronic address: Francois.Proust@chu-rouen.fr.
authors.forename: F
authors.initials: F
authors.lastname: Proust
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005602:France; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anévrisme cérébral géant; Coiling endovasculaire; Endovascular coiling; Giant cerebral aneurysm; Management; Microsurgical clipping; Outcome; Predictive factors; Pseudo-tumor syndrome; Syndrome pseudo-tumeur; Traitement microchirurgical