SURGICAL STRATEGIES FOR GIANT INTRACRANIAL ANEURYSMS

Management strategies for giant intracranial aneurysms are presented. Safe treatment of these lesions requires a complete diagnostic evaluat ion preoperatively, selection of the optimal surgical approach, early vascular control of the aneurysm, and careful clipping technique, impo rtant intraoperative adjuncts, such as skull-base surgical approaches, endovascular methods, and hypothermic circulatory arrest greatly faci litate the treatment of these lesions. Some giant aneurysms cannot be clipped directly and require alternative techniques, such as proximal parent artery occlusion, excision, or aneurysmorrhaphy. Bypass techniq ues are an important aspect of these alternative treatments. Giant ane urysms are the vascular neurosurgeon's greatest challenge, and well-de signed surgical strategies are critical to their successful treatment.