Surgical Nuances for Giant Cerebral Aneurysms

Giant cerebral aneurysms can cause various neurological deficits owing to compression of the brain parenchyma and cranial nerves. In addition, the risk of rupture in giant aneurysms is extremely high, but the risks associated with surgery are significantly higher than those of ordinary aneurysms. Even the results of endovascular treatment, which have progressed remarkably in recent years, still require improvement. Some giant cerebral aneurysms are untreatable and cannot be surgically repaired. However, it is also true that most giant aneurysms can be successfully treated if neurosurgeons properly understand the pathophysiology of the aneurysm, preserve the flow of the parent artery or reconstruct the flow distal to the aneurysm using the bypass, and save the perforating arteries adjacent to the aneurysm. In this section, we focus on direct surgery to obliterate giant cerebral aneurysms and present the details of the surgical techniques.