Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion

Abstract

Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.

Large Paraclinoid Aneurysm With a Calcified Neck Treated by Tailored Multimodality Procedures-Case Report-

“…Proximal occlusion or trapping of the aneurysm is reported to be effective, especially using endovascular surgery. 7,14,23) In our case, the short distance between the aneurysm neck and the origin of the PcomA prevented endovascular internal trapping with preservation of the PcomA. Residual back flow into the aneurysm via the maxilloophthalmic anastomosis suggested that endovascular proximal occlusion with extracranialintracranial bypass or surgical trapping with extracranial-intracranial bypass would be less effective.…”

“…2,4,6,8,13,17) The use of endovascular surgery has also increased, but the results of endosaccular coil embolization may be less satisfactory for wide-necked aneurysms or aneurysms causing a mass effect. 3,7,[9][10][11]14,[20][21][22][23] Direct clipping sometimes results in incomplete obliteration of the aneurysm or compromise of the patency of the ICA if severe sclerotic change is present in the wall of the aneurysm neck or the parent artery. 13,14,16,24) We report a case of large paraclinoid aneurysm with a calcified neck treated by a tailored combination of multimodality procedures.…”

Multimodal Treatment for Complex Intracranial Aneurysms: Clinical Research

“…Rather, these complex lesions require parent artery occlusion with clip or coil with additive bypass surgery. These multimodal treatments have been found to significantly alter the natural course of these complex lesions 2,3,6,[9][10][11][12][13][14]18,19) . We found that multimodal treatment was both safe and effective in all fifteen patients with complex aneurysms.…”

“…This procedure, however, carries particular associated risks and is difficult to perform simultaneously during microsurgical clip application 3,7,16) . Cerebral revascularization, an adjunctive method used to treat complex aneurysms and cranial base tumors, has also been used to treat complex aneurysms, together with microsurgical clipping and endovascular coiling for parent artery occlusion 3,9,11,14,18,19) . Patients with giant intracranial aneurysms, in whom parent artery occlusion with clipping alone was associated with high complication rates, have also been treated by this method 19) .…”

Giant Aneurysm of the Cervical Internal Carotid Artery Treated by Proximal Coil Embolization under Temporary Balloon Occlusion

“…Traditionally, carotid ligations have been performed for the treatment of extra-and intracranial giant ICA aneurysms that are not treatable by direct surgery, Endovascular proximal occlusion methods are considered less invasive than carotid ligation, and the two methods are regarded as equally usefuL Endovascular proximal occlusions were formerly performed with detachable balloons 13 16. During parent artery coil occlusion, both distal thromboembolic complications and distal migration of the coils can occur.…”