Strategies in intracavernous saccular aneurysms
Since the introduction of EC-IC bypass surgery in 1975 an additional method in the management of infraclinoid aneurysms has been available, as well as balloon catheter techniques in recent years and in addition to clipping, rhaphy, wrapping of the aneurysm and ligation of the internal carotid artery or trapping. We encountered 28 cases of infraclinoid aneurysms up until the end of 1985. Five patients were seen in severe condition on admission; they had no treatment and one of them eventually died. Direct clipping was possible in only 7 aneurysms regardless of their size, since dissection within the cavernous sinus even in large aneurysms was possible. Wrapping in broad-based large aneurysms was performed in 4 cases, since the clinical signs and symptoms as well as topographic anatomy did not lead us to expect an encroachment onto the cranial nerves. Endovascular techniques with a detachable balloon catheter were executed in 3 cases with an additional EC-IC bypass in two of these cases. Ligation of the internal carotid artery combined with an EC-IC bypass was achieved in 3 cases and in a further 2 cases only an EC-IC bypass was performed. In 2 cases trapping of the giant aneurysm by ligation of the internal carotid artery at the neck as well as distal to the aneurysms was performed. The results were satisfactory since the clinical signs and symptoms improved in most cases and no further deficits were encountered. Four patients died postoperatively. The various indications for the strategies applied are further discussed.
KeywordsInternal Carotid Artery Internal Carotid Cavernous Sinus Intracranial Aneurysm Saccular Aneurysm
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- 6.Heros RC (1983) Surgical management of large paraclinoid aneurysms. Contemp Neurosurg 5: 1–6Google Scholar
- 8.Hosobuchi Y (1985) Giant intracranial aneurysms. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 1404–1414Google Scholar
- 9.Kodama N, Mineura K, Fujiwara S, Suzuki J (1979) Surgical treatment of carotid-ophthalmic aneurysms. In: Suzuki J (ed) Cerebral aneurysms. Neuron Publ, Tokyo, pp 268–274Google Scholar
- 10.Koos WT, Perneczky A, Schuster H, Vorkapic P (1985) Zerebrale Riesenaneurysmen. In: Schürmann K (ed) Der zerebrale Notfall. Urban & Schwarzenberg, Munich, pp 163–176Google Scholar
- 12.Parkinson D (1982) Surgical management of internal carotid artery aneurysms within the cavernous sinus. In: Schmidek H, Sweet WH (eds) Operative neurosurgical techniques. Grune & Stratton, New York, pp 815–828Google Scholar
- 13.Pilcher C, Thuss C (1934) Current blood flow: III cerebral effects of occlusion of the common or internal carotid arteries. Arch Surg 29: 1024–1035Google Scholar
- 16.Roski RA, Spetzler RF (1985) Carotid ligation. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 1414–1422Google Scholar
- 19.Vorkapic P, Schuster H, Koos WTh, Perneczky A (1984) Die Bedeutung der extra-intrakraniellen Anastomose in der Behandlung von intrakraniellen Aneurysmen. Angio Arch 6: 117–119Google Scholar