Changes in volume of giant intracranial aneurysms treated by surgical strategies other than direct clipping

Background: Giant intracranial aneurysms (GIA) are often not eligible for direct clip occlusion. Surgical alternatives include partial clip occlusion or the placement of a cerebrovascular bypass or the combination of both. These alternative indirect strategies are expected to lead to a decrease in GIA volume over time rather than instantaneously. To examine whether this is the case, we analyzed follow-up imaging results 1 year after surgery. Methods: We retrospectively screened the prospective GIA Registry’s imaging database for anterior circulation GIA treated by surgical strategies other than direct clipping. We measured pre- and 1-year post-treatment GIA volume, lateral ventricle volume (LVV), and mid-line shift (MLS) in 19 cases. Results: After a mean follow-up of 466 days (standard deviation ±171) GIA volumes decreased from 9.6 cm³ (interquartile range (IQR) 6.1–14.1) to 4.3 cm³ (IQR 2.9–5.7; p < 0.01). Ipsilateral LVV increased from 8.6 cm³ (IQR 6.4–24.9) to 16.0 cm³ (IQR 9.1–27.2; p < 0.01) while contralateral LVV increased from 10.3 cm³ (IQR 7.3–20.1) to 11.7 cm³ (IQR 8.2–19.4; p = 0.02). MLS changed from 0.1 mm (IQR −1.9 to 2.0) to −0.9 mm (IQR −1.8 to 0.4; p = 0.03). The decrease in GIA volume correlated with the increase in ipsilateral LVV (r_s = 0.60; p = 0.01) but not with the changes in MLS (r_s = 0.41; p = 0.08). Conclusions: In our patient cohort, surgical strategies other that direct clipping for the treatment of anterior circulation GIA lead to a significant decrease in GIA volume over time. The resulting decrease in mass effect was more sensitively monitored by the measurement of changes in ipsilateral LVV than changes in MLS. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02066493.