目的探讨颅内巨大动脉瘤的临床特征及手术策略。方法对我科2004年1月到2010年1月收治的33例颅内巨大动脉瘤患者的临床特征及显微外科手术方法和疗效进行回顾性分析。结果患者出院时按GOS评分,术后早期恢复良好者20例,中、重残者9例,死亡4例,其中2例为术后出现大面积脑梗死后死亡,l例因呼吸衰竭而死亡,l例再出血家属放弃治疗后死亡;死亡率12.1%。结论颅内巨大动脉瘤在临床特征上既有普通动脉瘤的出血特征又有颅内肿瘤的占位特征,还可以表现为缺血特征,临床上易误诊。手术目的在于解除动脉瘤对周围重要结构的压迫、防止再出血并保持足够的脑供血。手术涉及硬膜外充分剥离、载瘤动脉较长时间阻断、组合夹闭及载瘤动脉塑形、血管重建等多种手段,故手术策略是在对颅内血管全面有效管理的基础上清除占位效应,而不是简单夹闭动脉瘤。 Objective To investigate the clinical features and surgical strategies of intracranial giant aneurysms. Methods The clinical features, microsurgery methods and efficacy of 33 patients with giant intracranial aneurysm admitted to our department from January 2004 to January 2010 were analyzed retrospectively. Results The patients were discharged according to GOS score, 20 cases were recovered well in early stage after operation, 9 cases were moderate and severe disability, 4 cases died, 2 cases died of large area cerebral infarction and 1 case died of respiratory failure , l cases of re-bleeding relatives to give up after treatment died; mortality 12.1%. Conclusion The intracranial giant aneurysms have both the hemorrhagic features of common aneurysms and the occupying features of intracranial tumors in clinical features, but also can be characterized as ischemic features, which are easily misdiagnosed clinically. Surgery aims to relieve the oppression of the aneurysm around the important structure, to prevent rebleeding and to maintain adequate blood supply to the brain. Surgery involves full epidural detachment, a longer time to carry the parent artery, combined clipping and parent artery shaping, revascularization and other means, so the surgical strategy is based on the comprehensive and effective management of intracranial vessels cleared Placeholder effect, rather than simply clipping the aneurysm.