Giant intracranial aneurysms: diagnosis with special reference to computerised tomography

The clinical presentation, radiological investigations and surgical management of 11 patients with giant intra cranial aneurysm (> 2.5 cm) have been reviewed. Most patients had signs and symptoms caused by the mass effect of the aneurysm. Only two presented with subarachnoid haemorrhage. The most helpful plain film finding was intracranial calcification. This varied from a mere fleck to the classical curvilinear variety. Computerised tomography (CT) scans were available on all 11 patients. All showed a space-occupying lesion of high density. Two types of enhancement were seen following intravenous contrast medium, (a) homogeneous and (b) rim enhancement with or without a patchy increase in density centrally. The CT appearances in some of the cases resembled those shown by other lesions such as neoplasm. Arteriography in almost all cases demonstrated the aneurysm but often under-estimated its size. On two occasions the aneurysm did not fill and the nature of the lesion demonstrated on the plain CT remained unconfirmed. Direct surgical attack rather than carotid ligation was the operation of choice. Most patients responded very well to this treatment.