Giant superior cerebellar artery (SCA) aneurysms are rare lesions with significant morbidity due to mass effect and present therapeutic challenges due to proximity to critical neurovascular structures.

A systematic literature review through the PubMed and Scopus databases was performed according to the PRISMA guidelines to identify cases of giant saccular SCA aneurysms treated either microsurgically or by endovascular techniques. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes as well as follow-up information were retrieved.

Data from 5 studies including 6 patients were obtained. Mean patient age was 53.83 years, with a male-to-female ratio of 2:1. Mean maximum aneurysm diameter was 31.3 mm. All patients presented at mRS 3 or more. A favorable outcome (mRS 0–2) was reported on 50% of cases. Two patients underwent microsurgery (one resulting in a favorable outcome), while two underwent endovascular treatment with both achieving a favorable outcome. Two more underwent a combination of microsurgical STA-SCA bypass followed by endovascular aneurysm treatment, both with unfavorable outcomes. All aneurysms were at least partially thrombosed; the ones treated microsurgically were debulked due to mass effect.

Giant SCA aneurysms may cause severe, often persistent neurologic morbidity due to brainstem compression and may be approached by either microsurgery or endovascular treatment. Advanced endovascular techniques may be required to prevent recurrence. Thrombosed aneurysms which cannot be safely embolized or ones with significant mass effect may benefit from microsurgical clip occlusion and may require debulking, while hybrid techniques should be used judiciously.