Temporary balloon occlusion during the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms

Škrap, Miran; Petralia, Benedetto; Toniato, Giovanni

doi:10.1007/s00701-009-0566-0

Cited by 17 publications

(14 citation statements)

References 36 publications

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“…Skrap et al reported on temporary balloon occlusion during the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms 7. They had to move patients from the angiosuite to the OR after balloon placement.…”

Section: Discussionmentioning

confidence: 99%

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Murayama

Arakawa

Ishibashi

et al. 2012

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Murayama

Arakawa

Ishibashi

et al. 2012

J NeuroIntervent Surg

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“…Direct clipping of the aneurysm is the current gold-standard treatment. If the neck of the aneurysm is wide and cannot be clipped directly then vascular bypass grafting could also be considered (18). In the present patient, due to the broad-based neck and embedding of the aneurysms in the temporal bone, proximal vascular control was difficult to achieve safely (bypass was also difficult) and direct clipping was less likely to be successful.…”

Section: Discussionmentioning

confidence: 85%

Intrapetrous internal carotid artery aneurysm diagnosed on the basis of middle ear effusion: A case report

et al. 2015

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Abstract. The present study reports a rare case of a giant intrapetrous internal carotid aneurysm that compressed the internal jugular vein causing recurrent middle ear effusion in a 13-year-old female. Images obtained by computed tomography revealed middle ear effusion occupying the right side of the attic. Digital subtraction angiography (DSA) resulted in a diagnosis of a giant aneurysm of the right intrapetrous carotid artery, with a diameter of 25 mm and a neighboring area of compression of the internal jugular vein. The patient was treated successfully using coil embolization. The present study therefore indicates that DSA should be considered in the differential diagnosis of patients with middle ear effusion. Early treatment with coil embolization or other surgical treatments can be a life-saving therapeutic approach.

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“…It also provides a fast route for endovascular balloon occlusion of the paraclinoid ICA segment at the level of the aneurysm neck. 19,69,76 For this purpose, a standard balloon occlusion microcatheter system could be advanced intracranially through the double-lumen balloon catheter positioned at the cervical ICA. This technique is particularly helpful in the cases where a partially thrombosed aneurysm is treated, since it can provide durable flow arrest during intra-aneurysmal thrombectomy.…”

Section: The Development Of the Retrograde Suction Decompression Techmentioning

confidence: 99%

The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature

Flores¹,

White

Batjer

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Paraclinoid internal carotid artery (ICA) aneurysms frequently require temporary occlusion to facilitate safe clipping. Brisk retrograde flow through the ophthalmic artery and cavernous ICA branches make simple trapping inadequate to soften the aneurysm. The retrograde suction decompression (RSD), or Dallas RSD, technique was described in 1990 in an attempt to overcome some of those treatment limitations. A frequent criticism of the RSD technique is an allegedly high risk of cervical ICA dissection. An endovascular modification was introduced in 1991 (endovascular RSD) but no studies have compared the 2 RSD variations. METHODS The authors performed a systematic review of MEDLINE/PubMed and Web of Science and identified all studies from 1990-2016 in which either Dallas RSD or endovascular RSD was used for treatment of paraclinoid aneurysms. A pooled analysis of the data was completed to identify important demographic and treatment-specific variables. The primary outcome measure was defined as successful aneurysm obliteration. Secondary outcome variables were divided into overall and RSD-specific morbidity and mortality rates. RESULTS Twenty-six RSD studies met the inclusion criteria (525 patients, 78.9% female). The mean patient age was 53.5 years. Most aneurysms were unruptured (56.6%) and giant (49%). The most common presentations were subarachnoid hemorrhage (43.6%) and vision changes (25.3%). The aneurysm obliteration rate was 95%. The mean temporary occlusion time was 12.7 minutes. Transient or permanent morbidity was seen in 19.9% of the patients. The RSD-specific complication rate was low (1.3%). The overall mortality rate was 4.2%, with 2 deaths (0.4%) attributable to the RSD technique itself. Good or fair outcome were reported in 90.7% of the patients. Aneurysm obliteration rates were similar in the 2 subgroups (Dallas RSD 94.3%, endovascular RSD 96.3%, p = 0.33). Despite a higher frequency of complex (giant or ruptured) aneurysms, Dallas RSD was associated with lower RSD-related morbidity (0.6% vs 2.9%, p = 0.03), compared with the endovascular RSD subgroup. There was a trend toward higher mortality in the endovascular RSD subgroup (6.4% vs 3.1%, p = 0.08). The proportion of patients with poor neurological outcome at last follow-up was significantly higher in the endovascular RSD group (15.4% vs 7.2%, p < 0.01). CONCLUSIONS The treatment of paraclinoid ICA aneurysms using the RSD technique is associated with high aneurysm obliteration rates, good long-term neurological outcome, and low RSD-related morbidity and mortality. Review of the RSD literature showed no evidence of a higher complication rate associated with the Dallas technique compared with similar endovascular methods. On a subgroup analysis of Dallas RSD and endovascular RSD, both groups achieved similar obliteration rates, but a lower RSD-related morbidity was seen in the Dallas technique subgroup. Twenty-five years after its initial publication, RSD remains a useful neurosurgical technique for the management of large and giant parac...

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Temporary balloon occlusion during the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms

Abstract: The temporary balloon occlusion technique is useful and improves the safety of the unavoidable exposure of the parent artery in the surgical treatment of giant paraclinoid and vertebrobasilar aneurysms.

Cited by 17 publications

References 36 publications

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Intrapetrous internal carotid artery aneurysm diagnosed on the basis of middle ear effusion: A case report

The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature

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