Clinical presentation and management of giant anterior communicating artery region aneurysms

Object. The authors reviewed their 20-year experience with giant anterior c ommunicating artery aneurysms to correlate aneurysm size with clinical pres entation and to analyze treatment methods. Methods. In 18 patients, visual and cognitive impairment were quantitated a nd clinical outcome was categorized according to the Rankin scale. Statisti cal analysis was performed using Fisher's exact test. Conclusions. At least 3.5 cm of aneurysm mass effect was required to produc e dementia in the patient (p = 0.0004). Dementia was usually caused by dire ct brain compression by the aneurysm rather than by hydrocephalus. Optic ap paratus compression occurred with smaller aneurysms (2.7-3.2 cm) when they pointed inferiorly. Aneurysm neck clipping was possible in half of the cases. Special technique s, including temporary clipping, evacuation of intraluminal thrombus, tande m and/or fenestrated clipping, and clip reconstruction were often required. Occlusion of or injury to the anterior cerebral artery (ACA) was the main cause of poor outcome or death. Proximal ACA occlusion, even of dominant A, segments with small or no contr alateral A. artery, was an effective treatment alternative and was well tol erated as a result of excellent leptomeningeal collateral circulation.