Abstract
Direct clipping of thrombosed or large cerebral aneurysm is sometimes difficult and has relatively high morbidity. Flow alteration with bypass could be a treatment option for such unclippable aneurysms. The author's cases are presented. Twenty-nine complex aneurysms were treated between January 2006 and December 2013. Ruptured/unruptured aneurysms were 7 cases/22 cases, respectively. Six aneurysms were symptomatic with mass sign. Treatment strategies were as follows: 1) Clipping or trapping using bypass or thrombectomy (17 cases), 2) Bypass with proximal occlusion (flow alteration) (10 cases), 3) Bypass with distal occlusion (flow alteration) (2 cases). Aneurysms treated finally with clipping or trapping could be cured with relatively low morbidity. Furthermore, thrombectomy after clipping or trapping led to the recovery of the symptoms. On the other hand, flow alteration techniques induced intra-aneurysmal thrombosis in all aneurysms, but 2 intracranial aneurysms ruptured after partial thrombosis. Therefore, intra-aneurysmal thrombosis after flow alteration techniques does not always result in the cure of aneurysms, and care should be taken for the possibility of recanalization after this treatment.
