Abstract
Preservation of blood flow in both the afferent and efferent cerebral arteries from the cerebral aneurysm is crucial to obtain satisfactory surgical results in the treatment of patients with unruptured cerebral aneurysms. However, we sometimes encounter troubles regarding occlusion of efferent cerebral arteries including perforating arteries. Such troubles occur when the aneurysm neck is broad, and when wall of aneurysm and neighboring arteries is thick and arteriosclerotic.
Dome clipping sufficiently away from aneurysmal neck should be performed in such cases. Separation of efferent artery from adhesion to the dome of aneurysm may injure the arterial wall. Various functional and morphological monitoring systems (Doppler ultrasound, Transit flowmeter, Intraoperative digital subtraction angiography, motor evoked potential, somatosensory evoked potential, arterial pressure of the middle cerebral artery, among others) are helpful to detect ischemia of the efferent artery's territory. Although bypass surgery is also helpful in efferent artery occlusion, prophylactic bypass may result in better surgical result than bypass necessarily made after occlusion of the efferent artery.
