Surgical Treatment and Outcome of Giant Intracranial Aneurysm in KCMH from 2005 - 2010

บทคัดย่อ

Background: The natural history of giant intracranial aneurysms is generally morbid. Mortality and morbidity associated with giant aneurysms is also higher than for smaller aneurysms. The reported experiences of surgery for giant intracranial aneurysm is slightly limited in Thailand institutes and South-East Asia.
Objectives: The objective of this investigation was to study the clinical presentation, diagnosis, treatment, and outcome of patients with giant intracranial aneurysm in King Chulalongkorn Memorial Hospital (KCMH).
Materials and Methods: We retrospectively analyzed data collected between 2005 - 2010 about patientûs demographic, management, and outcome.
Results: Giant intracranial aneurysm was found in 12 patients during a 6 year period. The 2 males and 10 females range in age from 16 to 74 years (mean: 53.6 years). The ICA and MCA were the most frequently involved arteries. Compression of adjacent intracranial structures was the usual course of symptoms, and only 2 patients experienced subarachnoid hemorrhage. No patient present with ischemic stroke. Proximal parent vessel occlusion or trapping and bypass were dominant among the treatment methods. Excellent and good outcome occurred in 50% and 25% of patient with aneurysm in the anterior circulation, respectively. Fifty percent of patient with posterior circulation aneurysm had poor outcome. Two patients in this series died from bleeding before treatment.
Conclusions: In this series, the anterior circulation, especially ICA, is the most frequently involved artery. Mass effect from the aneurysm is the most common clinical presentation followed by features of SAH. Various neurosurgical techniques were used for proper case. With proper case selection, optimal radiological evaluation and appropriate surgical strategy, it is possible to achieve a favorable outcome in 70% of case.