Microsurgical management of giant intracranial aneurysms in the endovascular era

Microsurgical management of GIAs is effective, with high obliteration rates and good outcomes in 79.2% of patients, particularly for anterior circulation aneurysms. Location-specific strategies delivered optimized results, with bypass procedures required in selected cases. Preoperative collateral flow assessment is critical. Despite endovascular advancements in the management of GIAs (which might need retreatment in 20% of patients), microsurgery had a complete occlusion rate of 96.8%, demonstrating superior durability. These findings underscore the role of microsurgery in GIAs, emphasizing tailored approaches to minimize risks.