Introduction: The rupture of giant aneurysm (GIA) is supposed to be related to higher risk of poor outcome due to surgical management failure. Additionally, factors influencing the outcome and quality of life many years after subarachnoid hemorrhage in GIAs were not finally investigated.
Methods: 242 patients were operated in ten years period on ruptured ICA aneurysm, including 36 GIAs. Neck clipping, extracranial to intracranial by-pass and wrapping were used for GIA securing. Temporary balloon occlusion, retrograde suction or other accessory techniques were applied in most of clipped GIAs. Series of 206 patients, who survived SAH and were discharged, were included to short-term outcome analysis. The quality of life was assessed in 146 patients, mean follow-up was 6.5 years. Glasgow Outcome Scale, modified Rankin Scale and quality of life SF-36 scale were used in the study. Demographic data, GCS, WFNS, Hunt-Hess and Fisher grade, preoperative neurologic deficit and recognition of delayed cerebral ischemia (DCI) were used in the analysis. The methods of survival and short and long-term outcome prediction consisted of logistic regression, receiver operating characteristic curves and population attributable risk comparisons.
Results: The survival rate, percentages of poor outcome and low long-term quality of life did not differ significantly between giant and smaller ICA aneurysms. Mortality was related with poor clinical condition in Hunt-Hess scale and DCI. Unfavorable outcome was determined by older age, while morbidity by presence of postoperative neurological deficit in multivariate analyses. Clinical signs of vasospasm (DCI), Fisher and Hunt-Hess grade influenced both unfavorable outcome and morbidity. There were no significant factors connected with the quality of life many years after the surgery.
Conclusions: Giant aneurysm rupture does not preclude good clinical result. Factors influencing unfavorable outcome differ from these determining morbidity. Hunt-Hess scale is a dominant component of morbidity and short-term outcome prediction.
Patient Care: Better understanding of surgical approach for giant internal carotid artery aneurysms as an alternative option to endovascular treatment; the important role of initial patient’s condition and clinical vasospasm in poor outcome prediction and minor influence of the aneurysm size on treatment result.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of surgical management in giant internal carotid artery aneurysms in endovascular era. 2) Discuss, in small groups: which internal carotid artery aneurysms should be treated surgically, which accessory technique may occur the best help for giant aneurysm safe securing and what is the future role of surgery for giant aneurysms. 3) Identify an effective treatment for giant aneurysm located in specific segment of internal carotid artery.