Surgical strategy for large and giant internal carotid artery aneurysms

Objective To study clinical features and operative techniques of large and giant internal carotid artery aneurysm. Methods Surgical experiences from 48 patients with large and giant carotid artery aneurysms were retrospectively analyzed. Pterional approaches were taken in all the cases. The cervical internal artery was exposured and blocked transiently. The anterior clinoid process and roof and lateral crista of optic canal were drilled off intradurally to display proximal angle of the aneurysm in the cases of paraclinoid aneurysms. Retrograde suction was applied for decompression of aneurysm, if there was thrombus in aneurysm, CUSA was used to remove it, so that the aneurysm can be clipped satisfactorily and the optic nerve decompressed. Intraoperative EEG and SEP monitorings were applied to check the brain function. Ultrasonic Doppler was used to check the blood flow before and after the aneurysm was clipped. Results The aneurysms were clipped directly in 46 cases, aneurysm trapping with bypass of superficial temporal artery to MCA and external carotid artery to MCA with great saphenous vein graft in the 2 cavernous aneurysms. Postoperative angiography was taken in 43 cases, showing that most of aneurysms were clipped satisfactorily. According to GOS, good outcome occurred in 41 cases (85.4%) in the early stage, poor in 5 cases, and 2 died. Conclusion Sufficient exposure, rational temporary occlusion of parent artery, effective methods for the collapse of aneurysm, intraoperative EEG and SEP monitorings, and the use of ultrasonic Doppler make aneurysms be clipped satisfactorily.