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. 2022 Dec;45(6):3759-3770.
doi: 10.1007/s10143-022-01884-3. Epub 2022 Oct 21.

Treatment of giant intracranial aneurysms: long-term outcomes in surgical versus endovascular management

Antonio Santoro  1 , Daniele Armocida  2 , Francesco Paglia  1 , Marta Iacobucci  3 , Luigi Valentino Berra  1 , Luca D'Angelo  1 , Carlo Cirelli  3 , Giulio Guidetti  3 , Francesco Biraschi  3 , Giampaolo Cantore  1
Affiliations

Treatment of giant intracranial aneurysms: long-term outcomes in surgical versus endovascular management

Antonio Santoro et al. Neurosurg Rev. 2022 Dec.

Abstract

Aneurysms with a major diameter > 25 mm are defined as giant intracranial aneurysms (GIAs). Different clinical, pathological, and radiological factors were revealed as playing a role in choosing the best strategy between surgical and endovascular approaches. Despite the improvement of both techniques, the efficacy and safety of these different management are still debated. We evaluated the differences in clinical and radiological outcomes of GIAs treated with surgical and endovascular techniques in a large retrospective mono-centric study. We compared aneurysm location, clinical, morphological features, treatment outcome, and complications on the ground of treatment technique. The final cohort consisted of 162 patients. All the patients were assigned on the ground of the type of eligible treatment: surgical (118 patients) and endovascular procedure (44 patients). The different treatment strategies were made through a multidisciplinary selection whereas clinical parameters, location, and morphologic features of the aneurysm were considered. The surgical group manifested a greater reduction in performance levels and neurological status in the post-operative phases than the endovascular group (p < 0.01) with a higher incidence of complications (p = 0.012) in contrast to a lower recurrence rate (p > 0.01). There is no significant difference in post-operative mortality and survival between surgical and endovascular groups. The surgical group manifested a higher incidence of complications after treatment. The endovascular group has a better post-operative outcome, but a higher risk of recurrence and the necessity of further treatment.

Keywords: Brain aneurysm; Coiling; Endovascular; Giant intracranial aneurysm; Neurosurgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The bar graph of the ANOVA study shows the outcome difference on the ground of GIA’s aneurysm site. The bars show the percentages of cases in which a better clinical outcome was obtained, showing a significant difference in patients in which the GIA was localized at the MCA, the bifurcation of ICA, and at the AcoA complex
Fig. 2
Fig. 2
Bar chart with chi-square analysis shows a not significant difference in overall survival between the two groups (part A) and a substantial difference in complications in the surgical group after the 30th day (part B)
Fig. 3
Fig. 3
A chi-square analysis demonstrates a valuable difference in the percentage of recurrence of the aneurysm after one year in the endovascular group
Fig. 4
Fig. 4
The algorithm summarizes the criteria chosen to select the best treatment for the GIAs proposed in this study
See this image and copyright information in PMC

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