Bypass-surgery and coil-embolisation in the treatment of cerebral giant aneurysms

Objective. Operative clipping is the most effective method in the treatment of cerebral giant aneurysms. But about 50% of all giant aneurysms are trea table this way. We want to report about eight patients with giant cerebral aneurysms, which were in our opinion "unclippable" without causing ischaemi a in depending brain areas. Methods. We describe eight cases of giant aneurysms of the pericallosal art ery (n = 1), the middle cerebral artery (n = 3), the basilar tip (n = 3) an d of the upper part of the basilar artery (n = 1). One patient with an aneu rysm of the pericallosal artery was treated with an extra-intracranial saph enous vein bypass saphenous bypass, in three cases of middle cerebral arter y aneurysms an extra-intracranial bypass was also done combined with a rese ction of the aneurysm. The four patients suffering from an aneurysm of the basilar artery got an extra intracranial bypass too followed by an occlusio n of the aneurysm with GD-Coils. Results. There was no peri-operative mortality and no severe peri- or posto perative complication. The neurological symptoms of all patients were uncha nged after the operation. An angiographic controll showed a complete oblite ration of the aneurysm and a free running bypass in all cases. Conclusion. Bypass surgery and combined bypass surgery and coil embolisatio n are effective methods in the treatment of giant cerebral aneurysms, which can not be treated by clipping alone.