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Abstract

The natural history of large (20–25 mm) and giant (> 25 mm) intracranial aneurysms is still undefined. Most frequently giant aneurysms present with haemorrhage (45% of cases) or symptoms of expanding mass lesion (39% of cases), rarely with ischemic deficits (5% of cases) or epilepsy (2% of cases).

Endoluminar thrombosis is present in 48% of large and 73% of giant aneurysms (according to the Italian Cooperative Study of 1988) and constitutes a dynamic process, with possible evolution to: a) sudden mass effect, b) progressive enlargement of the aneurysm, or c) complete spontaneous occlusion; moreover, endoluminar thrombosis does not prevent haemorrhage.

According to the ISUIA Study (1998), the risk of haemorrhage for intact aneurysms is highest for aneurysms larger than 25 mm, especially if located on the posterior communicating artery or in the posterior circulation. From a more recent and still preliminary analysis of the ISUIA Study, the five-year haemorrhage rate is roughly 40% for giant anterior circulation and 50% for giant posterior circulation aneurysms.

Keywords

aneurysm natural history subarachnoid haemorrhage

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References

Artmann

: Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysms. Review of the literature. Surg Neurol 21: 391–401, 1984.

Battaglia

: Italian Cooperative Study on Giant Intracranial Aneurysms: 1. Study design and clinical data. Acta Neurochir (suppl 42): 49–52, 1988.

Drake

: Giant intracranial aneurysms: Experience with surgical treatment in 174 patients. Clin Neurosurg 26: 12–96, 1979.

Gerber

: Complete spontaneous thrombosis of giant intracerebral aneurysm. Neuroradiol 36: 316–317, 1994.

Heros

Kolluri

: Giant intracranial aneurysms presenting with massive cerebral edema. Neurosurgery 15: 572–577, 1984.

Katayama

: Growth of totally thrombosed giant aneurysm within the posterior cranial fossa. Neuroradiology 33: 168–170, 1991.

Khurana

: Ruptured giant intracranial aneurysms. Part 1: A study of rebleeding. J Neurosurg 88: 425–429, 1998.

Morley

Barr

HWK

: Giant intracranial aneurysms: Diagnosis, course and management. Clin Neurosurg 16: 73–94, 1969.

Nagahiro

: Thrombosed growing giant aneurysms of the vertebral artery: Growth mechanism and management. J Neurosurg 82: 796–801, 1995.

10.

Pasqualin

: Italian Cooperative Study on Giant Intracranial Aneurysms 4. Results of treatment. Acta Neurochir (suppl 42): 65–70, 1988.

11.

Pia

Zierski

: Giant cerebral aneurysm. Neurosurg Rev 5: 117–148, 1982.

12.

Pozzati

: Effect of common carotid ligation of giant aneurysms of the internal carotid artery: Computerized tomography study. J Neurosurg 55: 527–531, 1981.

13.

Rosta

: Italian Cooperative Study on Giant Intracranial Aneurysms: 2. Radiological data. Acta Neurochir (supp 42): 53–59, 1988.

14.

Schubiger

: Growth-mechanism of giant intracranial aneurysms: Demonstration by CT and MR imaging. Neuroradiology 29: 266–271, 1987.

15.

Sindou

Keravel

: Les aneurisms géants intracraniens: Approches thérapeutiques. Neurochirurgie 30 (suppl 1): 24–26, 1984.

16.

Strenger

: Neurological deficits following therapeutic collapse of intracavernous carotid aneurysms. J Neurosurg 25: 215–218, 1966.

17.

Sutherland

: Platelet interaction within giant aneurysm. J Neurosurg 56: 53–61, 1982.

18.

The International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms. Risk of rupture and risks of surgical intervention. N England J Med 339: 1725–1733, 1998.

19.

Whittle

: Spontaneous thrombosis in giant intracranial aneurysm. J Neurol Neurosurg Psychiatry 45: 1040–1047, 1982.

20.

Wiebers

: Personal Communication.

Storia naturale degli aneurismi “large-giant”

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