Giant aneurysms create difficulties to clip because of com − binations of wide neck , partial thrombosis , hard thrombus , thick wall or calcification , perforators arising 丘om sac , deep location and dome projection obstructing the appr 〔 }ach to the parent vessel . Aretrospective analysis of 209 aneurysm patients , treated for the last 30 years ( 99 giant and llO large ) was done. Posterior circulatigianton was carrying 230f them , and the anterior circu − lation lesions were 7 / on ICA , 28

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... n ACA and 23 on MCA . The acute stage bleeding aneurysms were 64 , chronic or unruptured were 145 . C] ippjng using a combination of fenestrated , angied and straight clips , under short temporary exclusion from circulation ( temporary c1 正 pping or balloon ) , in some cases with suction − decompression of the sac , The presence of a thrombus required 正 ts removal before fjnal clipping . Thick walled aneurysms were cilpped away 丘om the neck to avoid parent vessel stenosis .