Puncture decompression technique used in clipping intracranial large and giant aneurysms

Objective To explore the role of puncturing the aneurysm to decompress in clipping intracranial large and giant aneurysms.Methods Different methods were used according to the different location of 25 cases of large and giant aneurysms.Cervical carotid internal artery was exposed and the pterional craniotomy was used for carotid-ophthalmic aneurysm,and direct pterion craniotomy used in the carotid-post communicating artery aneurysm.Temporary occluded the exposed the cervical internal carotid artery or the intracranial proximal segment of parent artery and distal segment of parent artery and its branches,then punctured aneurysm body and suck gushing blood with suction.When aneurysm body collapsed,remodel the parent artery and clipped aneurysm.As a thrombotic giant aneurysm which was incised then removed thrombus and clipped aneurysm after parent artery and its branches have been occluded provisionally.Microvascular doppler (MVD) was used to monitor before and after clipped aneurysms.Results The time of temporary occlusion vessels was 9-15 minutes.,the average time was 11 minutes.MVD monitor showed vortex flow disappearance of aneurysm and the bloodstream amplitude of the parent artery and its branches were not changed before and after clip.Postoperative DSA or CTA showed aneurysms disappeared and the bloodstream of the parent artery and its branches were normal after operation.Conclusions The temporary occlusion of the parent artery and its branches and the direct puncture of aneurysm body (or incise aneurysm and remove thrombus) to decompress are indicated for the most large and giant aneurysms (including thrombotic aneurysm).MVD is of benefit in providing operative safe and improving treatment effects in aneurysm surgery. Key words: Large and giant aneurysm;  Puncture;  Incision;  Decompression;  Clip