Giant brain aneurysms represent a formidable neurosurgical challenge: these life-threatening yet nonmalignant lesions are potentially curable by surgical obliteration. Remarkable recent advances toward safe and effective treatment are described in Giant Intracranial Aneurysms, edited by two leaders in this field, Drs Awad and Barrow.
The heart of the matter is this: the natural history of these lesions is usually dismal, their detection is now straightforward, and their obliteration can often be achieved with good results.
Data on natural history reviewed by Anson indicate that most patients with symptomatic giant aneurysms will die within a few years. Clinical presentation is usually due to subarachnoid hemorrhage or mass effect, but occasionally a giant aneurysm announces its presence by seizure, thromboembolism, headaches, or as an incidental finding on a noninvasive study.
In the chapter on imaging, magnetic resonance images show the aneurysm's anatomy and its relation to arteries and parenchyma. For operative planning,
Crowell RM. Giant Intracranial Aneurysms. JAMA. 1997;277(7):599-600. doi:10.1001/jama.1997.03540310097045