Microsurgical principles of giant aneurysm repair

Many factors are involved in the successful microsurgical repair of a giant aneurysm. Because the rate of surgical morbidity is higher with giant aneurysms than with smaller aneurysms, appropriate patient selection is important. Patients' comorbid conditions need to be assessed to assure that the risk of treatment is less than the risk associated with the natural history of the lesion for that patient. Detailed radiographic studies help provide the anatomic detail to assess this treatment risk. Technical expertise must be developed over time, and confidence repairing simple vascular lesions must first be obtained. Appropriate setup of the operating room, familiarity with the available microsurgical instruments and clips, and adequate anesthesia all contribute to good outcomes.