Skull base approaches in the treatment of giant intracranial aneurysms

Giant intracranial aneurysms, defined as lesions greater than 25 mm, are rare intracranial lesions. They usually present as a result of hemorrhage, mass effect, or thromboembolism. Because of their complexity, these lesions often are associated with a poor prognosis. Central to preoperative planning and intraoperative success is the use of skull base approaches to these lesions. We often use the orbitozygomatic approach to approach giant aneurysms of the anterior circulation. This technique emphasizes the removal of bone to improve exposure and minimize brain retraction. We use one of four approaches to treat giant aneurysms of the posterior circulation: (1) the extended orbitozygomatic approach; (2) transpetrosal approach; (3) extended far-lateral approach; and (4) combina-tion approach. For treating giant intracranial aneurysms, skull base approaches to both the anterior and posterior circulations are a vital part of preoperative planning and intraoperative success.