Summary
A review of the literature regarding the clinical aspects, diagnosis and management of giant aneurysms and examples from the series of 30 cases of these lesions draw attention to the following aspects: – clinical presentation:
a large proportion of aneurysms, measuring more than 2.5 cm in diameter presents with signs and symptoms suggesting a tumorous lesion. Cranial nerve palsies are a frequent sign. However, approximately 60 per cent of cases present with subarachnoid haemorrhage on admission or with history of SAH in the past.
In contrast to smaller aneurysms giant aneurysms involve mainly the ICA and the VB system and less frequently the ACA complex.
– radiology:
Giant aneurysms have fairly characteristic CT appearance but must be differentiated from some basal tumours like meningioma, neurinoma, pituitary adenoma, germinoma. Angiography remains the main diagnostic tool. Subdivision of giant aneurysms into five types plus fusiform aneurysm based on the degree of thrombosis and degree of opacification on angiogram is justified in view of its implications for the management. Serpentine type of giant aneurysm is a particular form of a partially thrombosed lesion and it is not limited to the MCA. Giant partially thrombosed aneurysms may act as a source of emboli.
– management:
Surgical treatment still remains a formidable task. Direct clipping of the neck is often impossible. In the majority of cases temporary occlusion of the parent vessel proximally and distally to the lesion is necessary at the time of operation of permanent occlusion of the parent vessel, and remains the only possibility. In such cases a bypass operation should be considered and should be done at the same time as staged occlusion. There is good evidence that a bypass is also of value in patients in whom only the extracranial ICA is ligated.
– morbidity and mortality are higher than in other types of aneurysms. Prognosis in non-treated, nonthrombosed or partially thrombosed giant aneurysms particularly of the vertebro-basilar system is extremely poor.
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References
Aarabi, B., J. Chambers: Giant thrombosed aneurysm associated with an arteriovenous malformation. J. Neurosurg. 49 (1978) 278–282.
Alajouanine, T., J. Le Beau, R. Houdart: La symptomatologie tumorale des volumineux anévrysmes des artères vertebrales et basilaires. Rev. Neurol. 80 (1948) 321–337.
Alksnie, J. F., R. W. Smith: Iron-acrylic compound for stereotaxic aneurysm thrombosis. J. Neurosurg. 47 (1977) 137–141.
Allcock, J., P. C. Conhaun: Angiography study of the growth of intracranial aneurysms. J. Neurosurg. 45 (1976) 617–621.
Amacher, L. A., C. G. Drake: Cerebral artery aneurysms in infancy, childhood and adolescence. Child's Brain 1 (1975) 72–80.
Ammerman, B. J., D. R. Smith: Giant fusiform middle cerebral aneurysm. Successful treatment utilizing microvascular bypass. Surg. Neurol. 7 (1977) 255–257.
Antunes, J. L., J. W. Corell: Cerebral emboli from intracranial aneurysms. Surg. Neurol. 6 (1976) 7–10.
Barr, H. W. K., W. Blackwood, S. D. Meadows: Intracavernous carotid aneurysm. Brain 94 (1971) 607–622.
Bauer, B.: Personal communication 1981.
Beck, D. W., D. J. Boarini, N. F. Kassell: Surgical treatment of giant aneurysm of vertebrobasilar junction. Surg. Neurol. 12 (1979) 283–285.
Berson, E., M. I. Freeman, A. J. Gay: Visual field defects in giant suprasellar aneurysms of internal carotid. Arch. Ophthalmology 76 (1966) 52–58.
Bhushman, C., F. I. Hodges, J. Posey: Successful surgical treatment of giant aneurysm of the basilar artery. Case report. J. Neurosurg. 49 (1978) 124–128.
Björkesten, A. G., M. Troupp: Changes in the size of intracranial aneurysms. J. Neurosurg. 19 (1962) 583–588.
Black, S. P. W., W. J. German: Observations on the relationship between the volume and the size of the orifice of experimental aneurysms. J. Neurosurg. 10 (1953) 984–990.
Bohl, J., A. Fenshe, H. J. Reulen, E. Schindler: Giant aneurysm of the vertebral artery causing compression of the lower medulla oblongata. J. Neurol. 214 (1977) 289–293.
Bramwell, R.: Two enormous intracranial aneurysms. Edinburgh Med. J. 32 (1887) 911–922.
Bull, L. J.: Massive aneurysms at the base of the brain. Brain 92 (1969) 535–570.
Byrd, S. E., J. R. Bentson, J. Winter, G. H. Wilson, P. W. Joyce, L. O'Connor: Giant intracranial aneurysms simulating brain neoplasm on computed tomography. J. Comp. Assist. Tomogr. 2 (1978) 303–307.
Cambria, S., E. Cardia, E. Macri: Anévrysme géant de l'artère sylvienne chez un enfant de 4 ans. Exérèse guérison. Neurochirurgie 22 (1976) 85–90.
Cantu, R. C., M. Lemay: A large middle cerebral aneurysm presenting as a bizzare vascular malformation. Brit. J. Radiol. 39 (1966) 317–319.
Carlson, D., D. Thomson: Spontaneous thrombosis of a giant cerebral aneurysm in five days. Neurology 26 (1976) 334–336.
Constans, J. P., A. Visot, D. Fredy, P. Dorland: Anévrysme géant du tronc basilaire révélé par une névralgie faciale essentielle. Neurochirurgie 22 (1976) 493–502.
Creissard, P.: Les anévrysmes géants. Table Ronde de la Réunion de la Société française de Neurochirurgie. Neurochirurgie 26 (1980) 309–331.
Cuatico, W., A. W. Cook, V. Tysnenko, R. Khatib: Massive enlargement of intracranial aneurysms following carotid ligation. Arch. Neurol. 17 (1967) 609–613.
Dandy, W. E.: Results following ligation of the internal carotid artery. Arch. Surg. 45 (1942) 521–533.
Dandy, W. E.: Intracranial arterial aneurysms. Comstock, Ithaca, N. Y. 1944.
Debrun, G., A. Fox, C. Drake, S. Peerless, J. Girvin, G. Ferguson: Giant unclippable aneurysms: treatment with detachable balloons. Am. J. Neurorad. 2 (1981) 167–173.
Debrun, G., F. Lacour, J. P. Caron, M. Hurth, J. Comoy, Y. Kerevel: Detachable ballon and calibrated leak balloon techniques in the treatment of cerebral vascular lesions. J. Neurosurg. 49 (1978) 635–649.
Drake, C. G.: Giant intracranial aneurysms. Experience with surgical treatment in 174 patients. Clin. Neurosurg. 26 (1979) 12–95.
Drake, C. G.: Progress in cerebrovascular disease: Management of cerebral aneurysms. Stroke 12 (1981) 273–283.
Driesen, W.: Über zwei ungewöhnliche Operationsbefunde bei raumfordernden intrasellären Prozessen. Zbl. Neurochir. 19 (1959) 28–35.
Du Boulay, G. M.: Some observations on the natural history of intracranial aneurysms. Brit. J. Radiol. 38 (1965) 721–757.
Duft, T. A., H. H. Gossmann: Giant aneurysm of the internal carotid artery simulating posterior fossa tumour in a 13 year old girl. Neurochirurgia (Stuttg.) 18 (1975) 190–193.
Dvořak, M., E. Klaus: Schwierigkeiten in der Röntgendiagnostik und in der Behandlung von großen intrakraniellen sakkulären Aneurysmen. Acta Neurochir. 15 (1966) 182–193.
Farlan, A. L., I. R. Little, D. F. Dohn: Arterial occlusion following anastomosis of the superficial temporal artery to middle cerebral artery. Stroke 11 (1980) 91–94.
Fearnsides, E. C.: Intracranial aneurysms. Brain 39 (1916) 244–296.
Ferguson, G. G.: Physical factors in the initiation, growth and rupture of human intracranial aneurysms. J. Neurosurg. 37 (1972) 666–677.
Ferguson, G. G., C. G. Drake, S. J. Peerless: Extracranial-intracranial arterial bypass in the treatment of giant intracranial aneurysms. Stroke 8 (1977) 11.
Finney, L. H., T. S. Roberts, R. E. Anderson: Giant intracranial aneurysm associated with Marfan's syndrome. Case report. J. Neurosurg. 45 (1976) 342–347.
Fodstad, H., B. Lilliequist, S. Wirell, P. E. Nillsson, L. Boquist, A. Abdoul-Rahman: Giant serpentine intracranial aneurysm after carotid ligation. Case report. J. Neurosurg. 49 (1978) 903–909.
Fox, J. L.: Multiple giant aneurysms. Surg. Neurol. 13 (1979) 147–151.
Gallaher, G. P., J. F. Porsey, M. Stefannini, J. M. Looney: Large intracranial aneurysms producing panhypopituitarism and frontal lobe syndrome. Neurology 6 (1956) 829–837.
Garcia Bengochea, F., F. M. Delandy: Bilateral giant carotid ophthalmic aneurysm. Case report. J. Neurosurg. 47 (1975) 589–592.
Gelber, B. R., T. M. Sundt Jr.: Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass. J. Neurosurg. 52 (1980) 1–10.
Gerhard, I., G. Schmitzbauer: Hirnbasisarterienveränderungen bei Marfan-Syndrom und idiopathische Medianecrose. Acta Neuropath. 36 (1973) 176–184.
Golding, R., R. C. Peatfield, H. H. Shawdon: Computer tomographic features of giant intracranial aneurysms. Clin. Radiol. 31 (1980) 41–48.
Guillain, G., D. Schmitte, J. Bertrand: Anévrysme du tronc basilaire ayant déterminé la symptomatologie d'une tumeur de l'angle ponto-cérébelleux. Rev. Neurol. 1 (1930) 795–802.
Gupta, S. K., O. P. Gupta, M. M. Singh, D. N. Varma, R. Kesharwani: Giant aneurysm of the internal carotid in the carotid canal. J. Laryng. Otol. 93 (1979) 299–305.
Handa, J., I. Matsuda, H. Handa: Association of brain tumor and intracranial aneurysms. Surg. Neurol. 6 (1976) 25–29.
Handa, J., Y. Nakano, H. Aii, H. Handa: Computed tomography with giant intracranial aneurysms. Surg. Neurol. 9 (1978) 257–263.
Harrison, T. E. C. Kunkle: Internal carotid aneurysm arising in carotid canal. Arch. Neurol. 8 (1963) 328–331.
Heiskanen, O., P. Nikki: Large intracranial aneurysms. Acta Neurol. Scand. 38 (1962) 195–208.
Hoff, J., D. Winestock, W. F. Hoyt: Giant suprasellar aneurysm associated with optic stalk agenesis and unilateral anophthalmos. Case report. J. Neurosurg. 43 (1975) 495–498.
Hosobuchi, Y.: Direct surgical treatment of giant intracranial aneurysms. J. Neurosurg. 51 (1979) 743–756.
Howe, J. F., A. B. Harris, G. W. Sypert: Giant aneurysm of the middle cerebral artery. Surg. Neurol. 6 (1976) 231–233.
Huber, P., R. Rivoir: Die Zirkulation in und distal von sehr großen Aneurysmen. Fortschr. Röntgenstr. Nuklearmed. 114 (1971) 457–463.
Ito, H., T. Shima, S. Yamamoto: Giant anterior communicating artery aneurysm. Neurol. Surg. (Tokyo) 3 (1975) 171–176 (In Japanese).
Iwabuchi, T., T. Kudo, M. Hatanaka, N. Oda, S. Maeda: Vein graft bypass in treatment of giant aneurysm. J. Neurosurg. 12 (1979) 403–405.
Jane, J. A.: A large aneurysm of the posterior inferior cerebellar artery in a one-year-old child. J. Neurosurg. 18 (1961) 245–247.
Janetta, P. J., W. N. Hanafee, W. Weidner: Pneumoencephalographic findings suggesting aneurysm of the vertebro-basilar junction. Differentiation of cases simulating mass lesions. J. Neurosurg. 34 (1966) 530–535.
Jefferson, G.: Compression of the chiasma, optic nerves and optic tracts by intracranial aneurysms. Brain 60 (1937) 444–487.
Jefferson, G.: Further concerning compression of the optic pathways by intracranial aneurysms. Clin. Neurosurg. 1 (1955) 55–103.
Jellinger, K.: Pathology and aetiology of intracranial aneurysms. In: Pia, H. W., C. Langmaid, J. Zierski: Cerebral Aneurysms, pp. 5–19. Springer, Berlin—Heidelberg—New York 1979.
Johnsen, S. D., G. Okamoto, J. Kooiker: Fusiform basilar artery aneurysm in a child. Neurology (Minneap.) 27 (1977) 334–336.
Johnston, I.: Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms. Case report. J. Neurosurg. 51 (1979) 98–102.
Jones, J. N., H. J. Schwarz: Two cases of giant intracerebral aneurysms simulating neoplasm on CT scan. J. Neurol. 215 (1977) 49–57.
Judice, D., E. S. Connolly: Foramen magnum syndrome caused by a giant aneurysm of the PICA. J. Neurosurg. 48 (1978) 439–441.
Katakura, R., T. Yoshimoto, J. Suzuki: Giant basilar aneurysm. A case report. In: Suzuki, J.: Cerebral Aneurysms, pp. 704–707. Neuron Publ. Comp., Tokyo 1979.
Kempe, L.: Vertebral artery aneurysms; operative treatment. In: Pia, H. W., C. Langmaid, J. Zierski: Cerebral Aneurysms. Springer, Berlin—Heidelberg—New York, 1979
Kinley, G. J., D. S. Leighninger: Aneurysm of anomalous ophthalmic artery presenting in the sphenoid sinus and simulating an aneurysm of the internal carotid artery on routine angiography. J. Neurosurg. 9 (1952) 544–547.
Kodama, N., T. Sato, J. Suzuki: Homonymous hemianopsia caused by chiasmal compression due to intracranial aneurysm. In: Suzuki, J.: Cerebral Aneurysms, pp. 123–131. Neuron Publ. Comp., Tokyo 1979.
Kondo, T., H. Higashi, T. Murakami, T. Goto, T. Sugawara, T. Tsubokawa, N. Morigasu: A case of giant aneurysm at the posterior cerebral artery. No Shinkei Geka 6 (1978) 907–911 (In Japenese).
Kraus, H.: Ein besonders großes intracranielles Aneurysma der Arteria carotis interna. Wien Z. Nervenheilk. 5 (1952) 23–25.
Kraus, H.: Zwei besondere intracranielle Aneurysmen. Acta Neurochir. 12 (1964) 80–87.
Little, J. R., P. St. Louis, M. Weinstein, D. F. Dohn: Giant fusiform aneurysm of cerebral arteries. Stroke 12 (1981) 183–188.
Locksley, H. B.: Report of the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations based on 6.368 cases in the cooperative study. J. Neurosurg. 23 (1966) 321–368.
Lukin, R. R., A. A. Chaombers, R. McLaurin, J. Tew Jr.: Thrombosed giant middle cerebral aneurysms. Neuroradiology 10 (1975) 125–129.
Maxwell, R., S. N. Chou: Aneurysmal tumors of the basifrontal region. J. Neurosurg. 46 (1977) 438–445.
Mehdorn, H. M., N. L. Chater, J. L. Townsend: Giant aneurysm and cerebral ischaemia. Surg. Neurol. 13 (1980) 49–57.
Michel, W. F.: Posterior fossa aneurysms simulating tumours. J. Neurol. Neurosurg. Psychiat. 37 (1974) 218–223.
Miller, J. D., K. Jaward, B. Jenett: Safety of carotid ligation and its role in the management of intracranial aneurysms. J. Neurol. Neurosurg. Psych. 40 (1977) 64–72.
Morantz, R. A., F. R. Kirchner, P. Kishore: Aneurysms of the petrous portion of the internal carotid artery. Surg. Neurol. 6 (1976) 313–318.
Morley, T. P., H. W. S. Barr: Giant intracranial aneurysms, diagnosis, course and management. Clin. Neurosurg. 18 (1969) 73–94.
Mullan, S., E. F. Duda, N. J. Patronas: Some examples of balloon technology in neurosurgery. J. Neurosurg. 52 (1980) 321–329.
Nadjimi, M., M. Ratzka, M. Wodarz: Giant aneurysms in CT and angiography. Neuroradiology 16 (1979) 284–286.
Nakashara, A., T. Asakura, H. Kanabatake, K. Inone, K. Kitamura: A giant aneurysm of the internal carotid artery treated by intracranial direct surgery with a special reference to the anatomical relationship between the cavernous sinus and the internal carotid artery. Neurol. Surg. (Tokyo) 3 (1976) 783–789 (In Japanese).
Nishioka, H.: Report on the cooperative study of intracranial aneurysms and subarachnoid haemorrhage. Section VIII. Part I. – Results of treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J. Neurosurg. 25 (1966) 660–682.
Norlen, G., H. Olivecrona: The treatment of aneurysms of the circle of Willis. J. Neurosurg. 10 (1953) 404–415.
Nukui, H., S. Imai, A. Fukamachi, T. Aiba: Bilaterally symetrical giant aneurysms of the internal carotid artery within the cavernous sinus associated with an aneurysm of the basilar artery. Neurol. Surg. (Tokyo) 5 (1977) 479–484 (In Japanese).
Nyström, S. H. M.: Factors related to growth, rupture and spontaneous healing of cerebral aneurysms. In: Pia, H. W., C. Langmaid, J. Zierski: Cerebral Aneurysms, pp. 20–27. Springer, Berlin—Heidelberg—New York, 1979.
Obrador, S., G. Dierssen, J. Rodriguez-Hernandes: Giant aneurysm of the posterior cerebral artery. J. Neurosurg. 26 (1967) 413–416.
O'Connor, P. S., J. L. Smith, B. M. Yates: Crossed external carotid ligation for giant aneurysms. Surg. Neurol. 9 (1978) 382–385.
Odom, G. L., G. T. Tindall: Carotid ligation in the treatment of certain intracranial aneurysms. Clin. Neurosurg. 15 (1968) 100–116.
Odom, G. L., B. Woodhall, G. T. Tindall, R. Jackson: Changes in distal intravascular pressure and size of intracranial aneurysms following common carotid ligation. J. Neurosurg. 19 (1962) 41–50.
Oldershaw, J. B., M. C. Voris: Internal carotid ligation. A follow-up study. Neurology 16 (1966) 937–938.
Onuda, T., J. Suzuki: Surgical treatment of giant intracranial aneurysms. J. Neurosurg. 51 (1979) 33–36.
O'Neill, M., T. Hope, G. Thompson: Giant intracranial aneurysms diagnosis with special reference to computerised tomography. Clin. Radiol. 31 (1980) 27–39.
Parkinson, D., K. K. Jain, J. B. Johnston: Saccular aneurysm of the ophthalmic artery; report of an unusual case. Canad. J. Surg. 4 (1961) 229–232.
Peerless, J.: Discussion remark at the International Microsurgical Symposium. Frankfurt, July 1981, 9–11.
Peerless, S. J., G. G. Ferguson, C. G. Drake: Extra/intracranial bypass in the treatment of giant intracranial aneurysms. Neurosurg. Rev. 5 (1982) 77–81.
Pia, H. W.: Classification and treatment of aneurysms of the vertebro-basilar system. Neurologia med.-chir. (Tokyo) 19 (1979) 375–394.
Pia, H. W.: Large and giant aneurysms. Neurosurg. Rev. 3 (1980) 7–16.
Pia, H. W., J. Zierski: Giant cerebral aneurysms. Problems in treatment. In: Pia, H. W., C. Langmaid, J. Zierski: Cerebral Aneurysms, pp. 336–342, Springer, Berlin—Heidelberg—New York, 1979.
Pianetti, G., Jr., R. S. Barros, G. Cabral, Jr., F. D. Carneiro, E. H. Lamar: Aneurisma gigante da arteria cerebral media. Relato de un caso. Arq. Neuropsiquiatr. 36 (1978) 155–159.
Pinto, R. S., I. I. Krichef, A. R. Butler, R. Murali: Correlation of computed tomographic, angiographic and neuropathological changes in giant cerebral anerysms. Radiology 132 (1979) 85–92.
Polis, Z., J. Brzeziński, M. Chodak-Gajewicz: Giant intracranial aneurysm. Case report. J. Neurosurg. 39 (1973) 408–411.
Pribram, H. F., J. D. Hudson, R. L. Joyut: Posterior fossa aneurysms presenting as mass lesions. Am. J. Roentgenol. 105 (1969) 334–340.
Ravon, R., I. I. Boquier, J. P. Dupuy, J. Bokor, P. Ferss, J. Vidal, A. Dany: Un cas d'anévrysme géant intrapétreux et intra-caverneux de la carotide interne chez l'enfant. Neurochirurgie 22 (1976) 621–626.
Raymond, L. A., J. Tew: Large suprasellar aneurysms imitating pituitary tumour. J. Neurol. Neurosurg. Psychiat. 41 (1978) 83–87.
Rhomheimer, G.: Zur Symptomatologie der sellären Aneurysmen. Klin. Mbl. Augenhk. 134 (1976) 1–34.
Richardson, J. C., M. M. Hyland: Intracranial aneurysms. A clinical and pathological study of subarachnoid and intracerebral hemorrhage caused by berry aneurysms. Medicine (Baltimore) 20 (1941) 1–83.
Roski, R. A., R. F. Spetzler, F. E. Nielsen: Late complications of carotid ligation in the treatment of intracranial aneurysms. J. Neurosurg. 54 (1981) 583–587.
Rubinstein, M. K., G. Wilson, D. C. Levin: Intraorbital aneurysm of the ophthalmic artery. Report of an unique case and review of the literature. Arch. Ophthal. 80 (1968) 42–44.
Sacks, J. G., R. Lindenberg: Dolichoectatic intracranial arteries. Symptomatology and pathogenesis of arterial elongation and dilatation. John Hopkins Med. J. 125 (1969) 95–103.
Sadik, A. R., G. N. Buailovich, K. Shulman: Giant aneurysm of middle cerebral artery. J. Neurosurg. 22 (1965) 177–181.
Samson, S., E. A. Neuwelt, C. W. Beyer: Failure of extracranial-intracranial arterial bypass in acute middle cerebral artery occlusion. Case report. Neurosurgery 6 (1980) 185–188.
Santini, J. J., A. Gouazé: L'endo-anévrysmographie. A propos de 2 cas d'anévrysme sylvien géant. Rev. Otoneurophthalmol. 47 (1975) 9–13.
Sarwar, M.: Abducens nerve paralysis due to giant aneurysm of the medial carotid canal. J. Neurosurg. 46 (1977) 121–123.
Sarwar, M., S. Batnitzky, M. M. Schechter: Tumorous aneurysms. Neuroradiology 12 (1976) 79–97.
Sato, O., H. Kamitani: Giant aneurysm of the middle cerebral artery. Angiographic analysis of blood flow. Surg. Neurol. 4 (1975) 27–31.
Schiefer, W., F. Marguth: Intraselläre Aneurysmen. Acta Neurochir. 4 (1956) 344–354.
Schubiger, O., A. Valavanis, J. Hayek: Computerised tomography in cerebral aneurysms with special reference to giant intracranial aneurysms. J. Comput. Assist. Tomogr. 4 (1980) 24–32.
Scott, R. M., H. T. Ballantine: Spontaneous thrombosis of the giant middle cerebral artery aneurysms. J. Neurosurg. 37 (1972) 361–363.
Segal, H. D., R. L. Mc Laurin: Giant serpentine aneurysm. Report of two cases. J. Neurosurg. 46 (1977) 115–120.
Selker, R. G., S. K. Wolfson, I. C. Maroon, F. M. Steicken: Preferential cerebral hypothermia with elective cardiac arrest. Resection of “giant” aneurysm. Surg. Neurol. 3 (1976) 173–179.
Silverberg, G. D., B. A. Reitz, A. K. Ream, G. Taylor, D. R. Enzmann: Operative treatment of giant cerebral artery aneurysm with hypothermia and circulatory arrest. Report of a case. Neurosurgery 6 (1980) 301–305.
Smith, R. W., J. F. Alksnie: Stereotaxic thrombosis of inaccessible intracranial aneurysms. J. Neurosurg. 47 (1977) 833–839.
Soeur, M., J. Brihaye, C. Moerman: Pseudotumoral aneurysm in the third ventricle. Report of three cases. Acta Neurochir. 45 (1979) 247–258.
Sonntag, V. K., R. M. Yuan, B. M. Stein: Giant intracranial aneurysms. A review of 13 cases. Surg. Neurol. 8 (1977) 81–84.
Spetzler, R. F., R. A. Roski, H. Schuster, Y. Tahoaka: The role of EC-IC in the treatment of giant intracranial aneurysms. Neurological Research 2 (1980) 345–359.
Spetzler, F. R., H. Schuster, R. A. Roski: Elective extracranial-intracranial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J. Neurosurg. 53 (1980) 22–27.
Stark, R. J.: Supranuclear ophthalmoplegia with basilar artery aneurysms. Surg. Neurol. 12 (1979) 447–452.
Stebbens, W. E.: Intracranial artery aneurysms. Aus. Annal. Med. 3 (1954) 214–220.
Stebbens, W. E.: Ultrastructure of aneurysms. Arch. Neurol. 32 (1975) 798–807.
Steimle, R., G. Jacquet, M. Cotte-Rittaud, G. Pageaut, J. F. Bonneville, A. A. Razzak: Volumineux anévrysme pseudotumoral partiellement thrombosé du territoire de la sylvienne. Neurochirurgie 23 (1977) 73–80.
Story, J. L., W. E. Brown, Jr., H. Eidelberg: Cerebral revascularisation common carotid to distal middle cerebral artery bypass. Neurosurgery 2 (1978) 131–134.
Sundt, T. M., Jr.: Discussion Remark at the International Microsurgical Symposium. Frankfurt, July 9–11, 1981.
Sundt, T. M., Jr., D. Piepgras: Surgical approach to giant intracranial aneurysms. J. Neurosurg. 51 (1979) 731–742.
Sundt, T. M., Jr., J. R. Pluth, G. A. Gronert: Excision of a giant basilar aneurysm under profound hypothermia. Report of a case. Mayo Clinic Proceedings 47 (1972) 631–634.
Sutherland, G. R., M. E. King, S. J. Peerless, W. C. Vezina, G. W. Brown, M. J. Chamberlain: Platelet interaction within giant aneurysms. J. Neurosurg. 56 (1982) 53–61.
Sutton, D.: The vertebro-basilar system and its vascular lesions. Clin. Radiol. 22 (1971) 271–287.
Suzuki, J.: Cerebral Aneurysms. Neuron Publ. Comp., Tokyo, 1979.
Suzuki, J., H. Ohara: Origin, rupture and growth of cerebral aneurysms. A clinico-pathological study. In: Pia, H. W., C. Langmaid, J. Zierski: Cerebral Aneurysms. Springer, Berlin—Heidelberg—New York, 1979
Suzuki, J., T. Onuma: A giant intracranial aneurysm which disappeared angiographically following pneumoencephalography. Neurol. Med. Chir. (Tokyo) 16 (1976) 105–108.
Suzuki, J., T. Sato: Direct surgical treatment of giant intracranial aneurysms. Neurological Research 2 (1980) 305–325.
Symonds, C. P., S. P. Meadows, J. Taylor: Compression of the spinal cord in the neighbourhood of the foramen magnum. Brain 60 (1937) 52–84.
Taki, W., H. Handa, S. Yamagata, I. Matsuda, Y. Yonekawa, Y. Ikada, H. Inata: Balloon embolisation of a giant aneurysm using a newly developed catheter. Surg. Neurol. 12 (1979) 361–363.
Taptas, J. N.: Les dilatations et allongements de l'artère carotide interne. Rev. Neurol. 80 (1948) 338–354.
Terao, H., A. Ikeda, S. Kobayashi, A. Teraoka: A thrombosed giant aneurysm of the internal carotid artery with brain stem displacement. Surg. Neurol. 10 (1978) 157–160.
Terao, H., I. Muraoka: Giant aneurysm of the middle cerebral artery containing an important blood channel. J. Neurosurg. 37 (1972) 352–356.
Tönnis, W.: Zur Behandlung intracranieller Aneurysmen. Arch. klin. Chir. 189 (1937) 474–476.
Tomasello, F., V. Albanese, F. A. Cioffi: Giant serpentine aneurysm, a separate entity. Surg. Neurol. 12 (1979) 429–432.
Tulleken, C. A.: Giant aneurysms of the posterior fossa presenting as space occupying lesions. Clin. Neurol. Neurosurg. 79 (1976) 161–186.
Tytus, J. S., A. A. Ward: The effect of cervical carotid ligation on giant intracranial aneurysms. J. Neurosurg. 33 (1970) 184–190.
Usbeck, W.: Über ein als Tumor imponierendes Aneurysma der A. basilaris. Zbl. Neurochir. 15 (1958) 205–211.
Van't Hoff, W., R. W. Hornabrook, V. Marks: Hypopituitarism associated with intracranial aneurysms. Brit. Med. J. 2 (1961) 1190–1194.
Walsh, F. B., W. F. Hoyt: Clinical Neuro-ophthalmology, pp. 1737–1774. 3rd Ed. 1969. Williams and Wilkins, Baltimore 1969.
White, J. C., T. M. Ballantine: Intrasellar aneurysms simulating hypophyseal tumors. J. Neurosurg. 18 (1961) 35–50.
Whittle, I. R., D. B. Williams, G. M. Halmagyi, M. Besser: Spontaneous thrombosis of a giant intracranial aneurysm and ipsilateral carotid artery. J. Neurosurg. 56 (1982) 287–289.
Woźniak, M., W. Mazurowski, M. Chrzanowski: Przypadek olbrzymiego tetniaka tetnicy podstawnej mózgn. Neurol. Neurochir. Pol. 12 (1978) 345–349.
Yashin, H. E., B. J. Alpers: Aneurysm of the vertebral artery. Report of a case in which the aneurysm simulated a tumor of the posterior fossa. Arch. Neurol. and Psychiatry (Chicago) 51 (1944) 271–281.
Zumstein, B., M. G. Yasargil, M. Curic, H. J. W. Nanta: Experiences with the extra – to intracranial bypass in the surgical management of giant aneurysms. Neurological Research 2 (1980) 327–343.
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Pia, H.W., Zierski, J. Giant cerebral aneurysms. Neurosurg. Rev. 5, 117–148 (1982). https://doi.org/10.1007/BF01742676
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DOI: https://doi.org/10.1007/BF01742676