Multimodal management of giant cerebral aneurysms: review of literature and case presentation

Stroke Vasc Neurol. 2020 Mar 15;5(1):22-28. doi: 10.1136/svn-2019-000304. eCollection 2020.


The pathophysiology of giant cerebral aneurysms renders them difficult to treat. Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies. Since the introduction of the flow diversion technique, the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms. A subset of these giant aneurysms may persistent despite any treatment modality. Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach-both surgical and endovascular-rather than any single technique to provide a curative result with favourable patient outcomes. This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms. Additionally, an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.

Keywords: aneurysm; artery; coil; flow diverter.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Cerebrovascular Circulation
  • Combined Modality Therapy
  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / instrumentation*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Equipment Design
  • Hemodynamics
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / therapy*
  • Neurosurgical Procedures* / adverse effects
  • Treatment Outcome