[Natural history of giant intracranial aneurysms]

The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32%) presented subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission and a high mortality. Subarachnoid hemorrhage was most often recorded from the giant aneurysm at the supraclinoid portion of the internal carotid artery and the vertebro-basilar artery, but the rupture from the intracavernous giant aneurysm, completely thrombosed giant aneurysm and the fusiform type of giant aneurysm was rare. The mortality rate in 28 cases for the above follow up period was 46% (13 in 28 cases) and major morbidity occurred in 11% (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients.