title: Selective microsurgical treatment of giant intracranial aneurysms.
abstract: Giant intracranial aneurysms are defined as greater than 25mm in diameter. They share the same surgical challenges and strategies as so-called complex aneurysms, sometimes smaller in size but presenting with similar complex anatomy. The surgical difficulties arise from the size of the sack, the presence of intraluminal thrombus, the thickness of the arterial wall, and the complexity of arterial branching on the neck. Preoperative imaging gathers complementary information from magnetic resonance imaging, computed tomographic angiography, and rotational catheter-based angiography with three-dimensional reconstruction including balloon-test occlusion. The therapeutic decision-making needs a multidisciplinary approach including endovascular, neurosurgical and anesthesiological expertises. The microsurgical treatment needs a step-by-step preoperative planning with anticipation of possible pitfalls and alternative strategies. Classical principles of aneurysm surgery have to be tailored to face the difficulties arising from the size of the sack and from the arterial wall calcifications.
authors.affiliation: Department of Neurosurgery, Lille University Hospital, 59000 Lille, France. Electronic address: jp-lejeune@chru-lille.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lejeune
authors.affiliation: Department of Neurosurgery, Besançon University Hospital, 25000 Besançon, France.
authors.forename: L
authors.initials: L
authors.lastname: Thines
authors.affiliation: Department of Neurosurgery, Strasbourg University Hospital, 67000 Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
authors.affiliation: Department of Anesthesiology, Lille University Hospital, 59000 Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Riegel
authors.affiliation: Department of Cardiac and Vascular Surgery, Lille University Hospital, 59000 Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Koussa
authors.affiliation: Department of Anesthesiology, Lille University Hospital, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Decoene
mesh_terms: D002533:Cerebral Angiography / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008866:Microsurgery / Q000379:methods; D018579:Patient Selection; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: Anévrismes complexes; Anévrismes géants; Complex aneurysms; Giant aneurysms; Microsurgery; Traitement microchirurgical