Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: A 7-year, single-center experience

OBJECTIVE: To evaluate whether the objectives of surgical treatment, i.e., prevention of aneurysmal rebleeding, relief of aneurysmal mass effect, and prevention of embolic complications, are met by endosaccular coiling treatm ent applied to giant and very large wide-necked aneurysms. METHODS: Thirty patients with 31 giant or very large aneurysms were conside red to show unacceptable risk/benefit ratios for open surgery and were trea ted using the Guglielmi detachable coil (GDC) method between 1992 and 1998. RESULTS: With endosaccular GDC treatment, 73.3% of the population experienc ed excellent to good recoveries (Glasgow Outcome Scale scores of 4 or 5), w ith a 13.3% procedure-related morbidity rate and a 6.7% procedure-related m ortality rate. Two hemorrhaging episodes occurred after GDC treatment (annu al bleeding rate, 2.5%; 2 hemorrhaging episodes/79.2 patient-yr). Symptoms related to aneurysmal mass effect were improved for 45.5% of the patients p resenting with signs of neural compression. Among 23 patients with 24 aneur ysms who were available for angiographic follow-up assessment, complete or nearly complete occlusion was observed for 17 aneurysms (71%; angiographic follow-up period, 24.3 +/- 19.6 mo, mean +/- standard deviation). A single total embolization served as definitive treatment for only 12.5% of the gia nt aneurysms and 31% of the very large aneurysms. CONCLUSION: Endosaccular GDC treatment of giant and very large aneurysms wa s accomplished with procedure-related morbidity and mortality rates compara ble to those for open surgery performed by experts. However, because coil s tability was unsatisfactory, we suggest that the CDC method should currentl y be reserved for individuals who are considered poor candidates for open s urgery.