Surgical approach and treatment outcomes for the rare giant aneurysms: 3 Cases

Abstract

Aim: Giant aneurysms are used to describe aneurysms over 25 mm.They are rarely seen cases within all aneurysms and usually present with rupture at an early age or mass effect at an older age. We aimed to describe the methods that can be applied in the diagnosis and treatment of giant aneurysms and the points to be considered. Materials and Methods: Three patients, two males and one female, who were admitted to our clinic between 2015-2016 with different clinical findings and whose giant aneurysms were detected in their examinations, were discussed. Computed Tomography (CT), Digital Subtraction Angiography (DSA), Magnetic Resonance Imaging (MRI) were performed on the patients.Subarachnoid hemorrhage (SAH) presence, the size of the aneurysms, whether they were thrombosed or calcific, their localizations, compression occurred in neural structures of the patients were evaluated. Results: One patient applied to the emergency department due to SAH.One patient had frontal lobe findings and one patient had headache.Giant aneurysms including left M1 in the level of the right middle cerebral artery (MCA) bifurcation in 2 of the patients and in the level of left internal carotid artery bifurcation in one of the patients.2 patients underwent operations and one was led to endovascular treatment. Conclusion: Aneurysms may grow as big as to cause compression effect before being ruptured. Performing MRI,CT,DSA in the patients with giant aneurysms are critical in terms of leading the treatment.In particular, DSA investigation to be performed in detail is very valuable in terms of leading the patient to surgical and endovascular treatment and determining the strategy of the surgery and the endovascular treatment to be applied.