Summary
In three consecutive cases of giant left sided paraclinoid aneurysms we employed an endovascular retrograde suction decompression technique in combination with intra-operative angiography. A double-lumen balloon catheter was placed in the left internal carotid artery by the transfemoral route. After balloon inflation and placement of a temporary clip distal to the aneurysm blood was aspirated and the aneurysm collapsed. Thus further dissection of the aneurysm could easily be achieved and clips could be placed. Afterwards real-time digital subtraction angiography was performed. Intra-operative angiography led to clip repositioning in all cases either due to a clip induced stenosis of the parent vessel, or because of incomplete aneurysm obliteration. Afterwards successful clipping could be confirmed in all cases. Outcome was excellent in one case, good in the other. The third case, extremely complicated by an accompanying craniopharyngioma, showed a satisfactory outcome, but presented new neurological deficits.
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References
Albert FK, Forsting M, Aschoff A, Krieger D, Kunze S (1993) Clipping of proximal paraclinoid aneurysms with support of the balloon-catheter “trapping-evacuation” technique. Acta Neurochir (Wien) 125: 138–141
Alexander TD, Macdonald RL, Weir B, Kowalczuk A (1996) Intraoperative angiography in cerebral aneurysm surgery: A prospective study of 100 craniotomies. Neurosurgery 39: 10–18
Ausmann JI, Diaz FG, Sadasivan B, Gonzeles-Portillo M, Malik GM, Deopujari CE (1990) Giant intracranial aneurysm surgery: the role of microvascular reconstruction. Surg Neurol 34: 8–15
Barrow DL, Boyer KL, Joseph GJ (1992) Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30: 153–159
Batjer HH, Kopitnik TA, Giller CA, Samson DS (1994) Surgery for paraclinoid carotid artery aneurysms. J Neurosurg 80: 650–658
Batjer HH, Samson DS (1990) Retrograde suction decompression of giant paraclinoidal aneurysms. J Neurosurg 73: 305–306
Bouthillier A, Loveren van HR, Keller JT (1996) Segments of the internal carotid artery: A new classification. Neurosurgery 38: 425–433
Brawanski A, Ullrich O-W, Hartung U, Eigel P, Danhauser-Leistner I (1992) Circulatory arrest and hypothermia in the treatment of cerebral aneurysms: preliminary results. In: Piscol Ket al (eds) Advances in neurosurgery, Vol 20. Springer, Berlin Heidelberg New York Tokyo, pp 91–95
Day AL (1990) Aneurysms of the ophthalmic segment. J Neurosurg 72: 677–691
Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62: 667–672
Drake CG, Peerless SJ, Ferguson GG (1994) Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation. J Neurosurg 81: 656–665
Flamm ES (1981) Suction decompression of aneurysms. J Neurosurg 54: 275–276
Fox JL (1988) Microsurgical treatment of ventral (paraclinoid) internal carotid artery aneurysms. Neurosurgery 22: 32–39
Gurian JH, Vinuela F, Guglielmi G, Gobin YP, Duckwiler GR (1996) Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 39: 1150–1156
Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G (1983) Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 12: 153–163
Hosobuchi Y (1979) Direct surgical treatment of giant intracranial aneurysms. J Neurosurg 51: 743–756
Jennett B, Bond M(1975) Assessment of outcome after severe brain damage: a practical scale. Lancet 1: 480–484
Koyama T, Okudera H, Kobayashi S (1995) Computer-assisted geometric design of cerebral aneurysms for surgical simulation. Neurosurgery 36: 541–547
Kyoshima K, Kobayashi S, Wakui K, Ichinose Y, Okudera H (1992) A newly designed puncture needle for suction decompression of giant aneurysms. J Neurosurg 76: 880–882
Maeder PP, Meuli RA, Tribolet de N (1996) Three-dimensional volume rendering for magnetic resonance angiography in the screening and preoperative workup of intracranial aneurysms. J Neurosurg 85: 1050–1055
Mizoi K, Takahashi A, Yoshimoto T, Fujiwara S, Koshu K (1993) Combined endovascular and neurosurgical approach for paraclinoid internal carotid artery aneurysms. Neurosurgery 33: 986–992
Nutik SL (1988) Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg 69: 529–534
Peerless SJ, Hernesniemi J (1994) Clipping of a giant paraophthalmic aneurysm of the internal carotid artery. Strat Neurol Surg 2: 2–16
Schramm J, Koht A, Schmidt G, Pechstein U, Taniguchi M, Fahlbusch R (1990) Surgical and electrophysiological observations during clipping of 134 aneurysms with evoked potential monitoring. Neurosurgery 26: 61–70
Scott JA, Horner TG, Leipzig TJ (1991) Retrograde suction decompression of an ophthalmic artery aneurysm using balloon occlusion. J Neurosurg 75: 146–147
Serbinenko FA, Filatov JM, Spallone A, Tchurilov MV, Lazarev VA (1990) Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion. J Neurosurg 73: 57–63
Silverberg GD, Reitz BA, Ream AK (1981) Hypothermia and cardiac arrest in the treatment of giant aneurysms of the cerebral circulation and hemangioblastoma of the medulla. J Neurosurg 55: 337–346
Sinson G, Philips MF, Flamm ES (1996) Intraoperative endovascular surgery for cerebral aneurysms. J Neurosurg 84: 63–70
Swearingen B, Heros RC (1987) Common carotid occlusion for unclippable carotid aneurysms: an old but still effective operation. Neurosurgery 21: 288–295
Symon L, Vajda J (1984) Surgical experiences with giant intracranial aneurysms. J Neurosurg 61: 1009–1028
Taki W, Nishi S, Nakahara I, Kikuchi H, Iwata H (1992) Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg 77: 37–42
Tamaki N, Kim S, Ehara K, Asada M, Fujita K, Taomoto K, Matsumoto S (1991) Giant carotid-ophthalmic artery aneurysms: direct clipping utilizing the “trapping-evacuation” technique. J Neurosurg 74: 567–572
Tampiere D, Leblanc R, Oleszek J, Pokrupa R, Melançon D (1995) Three-dimensional computed tomographic angiography of cerebral aneurysms. Neurosurgery 36: 749–755
Taylor CL, Selman WR, Kiefer SP, Ratcheson RA (1996) Temporary vessel occlusion during intracranial aneurysm repair. Neurosurgery 39: 893–906
Yasargil (1984) Microneurosurgery, Vol II. Thieme, Stuttgart, pp 60–61
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Fahlbusch, R., Nimsky, C. & Huk, W. Open surgery of giant paraclinoid aneurysms improved by intraoperative angiography and endovascular retrograde suction decompression. Acta neurochir 139, 1026–1032 (1997). https://doi.org/10.1007/BF01411555
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DOI: https://doi.org/10.1007/BF01411555