Acta Neurochirurgica

, Volume 161, Issue 1, pp 185–195 | Cite as

Is surgical parent artery occlusion effective for intracranial aneurysms measuring over 10 mm in size? Result from long-term follow-up of size changes and outcomes

  • Shintaro Arai
  • Tohru Mizutani
  • Tatsuya Sugiyama
  • Kenji Sumi
  • Takato Nakajo
  • Masaki Matsumoto
  • Katsutoshi Shimizu
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm



There have been no long-term follow-up reports pertaining to chronological size changes in large or giant unruptured intracranial aneurysms treated with surgical parent artery occlusion (PAO). The object of this study is to investigate the utility and safety of surgical PAO by conducting a long-term follow-up of chronological aneurysm size changes and outcomes.


A retrospective study of 21 unruptured intracranial aneurysms measuring over 10 mm (20 patients) treated with surgical PAO in the period 2012–2017 was conducted. For aneurysms presenting with anterior circulation, high/low flow bypass was chosen and carried out concomitantly on the basis of preoperative balloon occlusion test results. Aneurysm size before and after surgery was evaluated chronologically using maximum diameter measurements taken from the same slice of MRI T2-weighted images. Moreover, post-surgery outcomes were evaluated according to a modified Rankin scale (mRS) at discharge.


PAO aiming for blind-alley formation was performed in 20 of 21 aneurysms (95.2%). Aneurysm size reduction was confirmed in 20 aneurysms (95.2%) after proper PAO, with an average reduction rate of 63.1% (range, 28–95%), during an average follow-up period of 27 months (range, 4–54 months). Eighteen (90.4%) of the 20 patients with 21 aneurysms returned to previous life with mRS score 0–2. With regard to preoperative symptoms, diplopia and visual impairment had improved in three patients (50%) and one patient (100%), respectively. Ischemic complications had occurred in five patients, two (9.6%) of whom were symptomatic and three (14.3%) were asymptomatic. The mortality rate in this study was 0%.


Surgical PAO for unruptured intracranial aneurysms measuring over 10 mm has been shown to be an effective method of treatment, eliciting a reduction in aneurysm size.


Blind-alley formation Flow alteration Giant aneurysms Large aneurysms Perforators Size changes Surgical parent artery occlusion 



No funding was received for this research.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Disclosure of funding



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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Shintaro Arai
    • 1
  • Tohru Mizutani
    • 1
  • Tatsuya Sugiyama
    • 1
  • Kenji Sumi
    • 1
  • Takato Nakajo
    • 1
  • Masaki Matsumoto
    • 1
  • Katsutoshi Shimizu
    • 1
  1. 1.Department of NeurosurgeryShowa University School of MedicineTokyoJapan

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