Mingzhe Zhang1, Tetsuyoshi Horiuchi2, Junpei Nitta3, Raynald Liu4, Yoshinari Miyaoka5, Takuya Nakamura5, Kazuhiro Hongo5. 1. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China. 2. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. Electronic address: tetuyosi@shinshu-u.ac.jp. 3. Kobayashi Neurosurgical Hospital, Nagano, Japan. 4. Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. 5. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Abstract
BACKGROUND: There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms. CASE DESCRIPTION: A 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Ipsilateral A1 of the anterior cerebral artery was hypoplastic, and posterior communicating artery was patent. Intraoperative proximal test occlusion at cervical internal carotid artery under neurophysiological monitoring, instead of preoperative balloon test occlusion, was performed to assess whether low-flow bypass was sufficient. The monitoring was unchanged during test occlusion, and the aneurysm was successfully trapped without high-flow bypass. Neither ischemic lesion nor neurologic deficits were found postoperatively. CONCLUSIONS: Intraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm.
BACKGROUND: There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms. CASE DESCRIPTION: A 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Ipsilateral A1 of the anterior cerebral artery was hypoplastic, and posterior communicating artery was patent. Intraoperative proximal test occlusion at cervical internal carotid artery under neurophysiological monitoring, instead of preoperative balloon test occlusion, was performed to assess whether low-flow bypass was sufficient. The monitoring was unchanged during test occlusion, and the aneurysm was successfully trapped without high-flow bypass. Neither ischemic lesion nor neurologic deficits were found postoperatively. CONCLUSIONS: Intraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm.
Authors: Tanya N Turan; Osama O Zaidat; Gary S Gronseth; Marc I Chimowitz; Antonio Culebras; Anthony J Furlan; Larry B Goldstein; Nestor R Gonzalez; Julius G Latorre; Steven R Messé; Thanh N Nguyen; Rajbeer S Sangha; Michael J Schneck; Aneesh B Singhal; Lawrence R Wechsler; Alejandro A Rabinstein; Mary Dolan O'Brien; Heather Silsbee; Jeffrey J Fletcher Journal: Neurology Date: 2022-03-22 Impact factor: 9.910