Abstract
From March, 1973 through December, 1991, the authors have surgically treated 885 cases of intracranial aneurysms. Among these cases there were large intracranial aneurysms, which are sometimes difficult to treat, and the authors discuss their results in treating 36 giant aneurysms, greater than 2.5 cm, and 39 big aneurysms, greater than 2 cm. For 6 early aneurysm cases, ligation of the ICA with a STA-MCA anastomosis was performed. Clipping was done for 59 cases, trapping for 6 cases, coating for 2 cases, and an aneurysmectomy for 2 cases, one of these latter cases also requiring an M_1-M_2 anastomosis. Fifteen acute-stage operation cases required immediate surgery, and a good recovery was achieved in 4 cases. The remaining 11 cases, however, developed complications due to the severe grade of their SAH. In contrast, out of 60 cases of delayed stage operation cases of aneurysms, the rusults in 43 cases were excellent and a further 12 cases developed only a temporary postoperative complication, so that a total of 55 cases (92%) ultimately had a good recovery, and 5 cases resulted in a permanent neurological deficit. Based on these results, whenever possible, delayed stage operations are recommended. As for operational techniques, if temporary clips are to be used, the maintenance of the peripheral blood flow must be ensured, and so the authors use short-time temporary clipping with brain-protecting drugs, or they perform bypass surgery prior to the temporary clipping. They recommend, however, tentative clipping rather than temporary clipping. The term tentative clipping means the use or an aneurysm dome clip or a neck clip, such clipping sometimes including the arterial branches. This tentative clipping method has been found useful for avoiding an aneurysmal rupture, and for easy dissection of the aneurysmal site, making a fine and safe dissection of the aneurysm possible. Finally, the selection of the proper clip is important, and they have found fenestrated clips useful in reconstructing the artery with clips.
