Surgical treatment of giant carotid-ophthalmic aneurysms (a new treatment method)

Objective To investigate the possibility of the temporary occlusion of extracranial internal carotid artery(EICA) , intracranial distal internal carotid artery (IDICA) and post-communicating artery(PCA) for surgical treatment of giant carotid-ophthalmic aneurysm. Methods Matass test was given on the carotid artery of the aneurysm side after giant carotid-ophthalmic aneurysm was diagnosed by head CT or MRI and DSA. Only when over 70% of compensative rate of compensative circulation was confirmed, surgical date was defined. First the EICA was exposed, a pterional approach was performed. IDICA, optic nerve, post-communicating artery and aneurysm and its surrounding structures were exposed in proper order. EICA was occluded then IDICA, post-communicating arteries were clipped with temporary clips. After decompression of the aneurysm with a puncture needle, the aneurysm was clipped after the aneurysm collapse. TCD was used to monitor the blood flow of IDICA, post-communicating artery, and aneurysm before and after aneurysm clip. Results Patients was clear in consciousness, a new symptom and sign of nervous system were not seen. Carotid-ophthalmic aneurysms disappear by DSA, blood flow of internal carotid artery was normal. Conclusions A method of temporary occlusion of ECA and IDCA and post-communicating artery, direct puncture decompression of aneurysm and clip aneurysm is the method of convenient, safe ,and reliable result. TCD is of great benefit in during operation for appraising prognosis.