Giant aneurysm frequently presents with clinical features due to mass effect as well as subarachnoid hemorrhage. Also, direct surgery is difficult because of risk of premature rupture, possible injury to perforating artery, and poor visualization
of
neck of aneurysm. Protection of the brain, prevention of premature rupture, and complete clipping of the aneurysm are essential in the surgery of giant aneurysm.
In order to protect the normal brain during surgery, many drugs that reduce the cerebral metabolic rates of oxygen consumption(CMRO2) and functional neuronal electrical activity are used. Hypothermia not only reduce neuronal electrical activity
but
also
reduce CMRO2.
Proximal and/or distal artery ligation, exclusion of aneurysm from circulation by open or endovascular technique, or combined method may be sued in the treatment of giant aneurysm.
Direct surgical clipping and excision of aneurysm under deep hypothermic circulatory arrest is one of the most beneficial treatment modality in giant aneurysm.
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