Giant intracranial aneurysms in children and adolescents

10 giant intracranial aneurysms in children were treated consecutively in Neurosurgical Department of Atatürk University, Erzurum, Turkey between 1985-1989. A total of 60 aneurysms of normal size were operated on in the same period. Of the ten cases 6 were male and 4 were female. All the patients were under 17-years old. In 6 cases, the onset of symptoms was sudden subarachnoid hemorrhage, in 3 cases presenting symptoms were insidious imitating a intracranial mass, and in one case, clinical manifestation was epileptic seizure. Among 6 cases with subarachnoid hemorrhage, 3 were in IV grade according to Hunt-Hess scale, 2 were in III grade and one in II grade. Angiographic localisation of the aneurysms was in the middle cerebral artery in 9 cases and in the anterior communicating artery in one case. During the operation, blood pressure was not lowered. All the patients were operated on with normal blood pressure without hypotension. In 4 cases, intramural thrombosis was detected. The necks of aneurysms were occluded by suitable clips. The aneurysms were excised in 4 cases after clipping. One patient died in the early postoperative period, and 9 cases remained alive and were free of symptoms after the operation for one to 4 years. We conclude that especially giant aneurysms in children should be treated surgically without exercising hypotension during operation.