CEREBRAL-ARTERY RECONSTRUCTION IN THE TREATMENT OF LARGE AND GIANT INTRACRANIAL ANEURYSMS

From 1978 to 1988, 14 giant intracranial aneurysms (more than 2.4 cm i n diameter) and one large aneurysm (1.5 cm in diameter) were treated b y extracranial / intracranial (EC / IC) bypass or cerebral artery reco nstruction. Of the aneurysms, 10 were located at the intracavernous ca rotid artery (CCA). One of the 10 anourysms was posttraumatic and loca ted at both the carotid-ophthalmic artery segment and the bifurcation of the internal carotid artery (ICA). Three were seen st the middle ce rebral artery (MCA) trunk. The aneurysms were demonstrated by angiogra phy and CT scanning. They were treated with trapping of the aneurysm a nd superficial temporal artery (STA) / middle cerebral artery (STA-MCA ) bypass with / without a graft (6 cases), cervical ICA ligation and S TA-MCA bypass with / without a graft (6) aneurysm excision with an end -to-end anastomosis of the MCA and a STA-MCA bypass with a graft (1), proximal MCA occlusion and STA-MCA bypass with a graft (1), and aneury sm neck clipping following a STA-MCA bypass with a graft (1). The pati ents showed marked improvement after operation except one whose neurol ogical deficit was aggravated temporarily. Postoperative angiography r evealed that the anastomoses were patent in all cases. No surgical mor tality or any delayed ischemic complications were noted after follow-u p for 5.6 years. We believe that cerebral artery reconstruction or EC / IC bypass is still effective in the treatment of large and giant int racranial aneurysms.