Abstract
Nine cases of large/giant aneurysm arising from the terminal portion of the internal carotid artery (ICA) were analyzed. The presenting symptoms were subarachnoid hemorrhage in 6 cases and visual disturbance in 2 cases. One case was asymptomatic. Eight cases were treated with angioplastic clipping by using various decompression methods. One case with marked atherosclerosis in the aneurysm wall was treated with proximal occlusion of the ICA with high-flow bypass. Intraoperative monitoring of motor-evoked potential (MEP) was performed in 5 of the 9 cases. Three of the 4 cases treated without MEP monitoring had permanent ischemic complications. Intraoperative MEP monitoring is useful to prevent ischemic complications caused by insufficient flow in the anterior choroidal artery during ICA aneurysm surgery, especially in cases treated with clipping using the suction decompression method. An experienced surgical team is important to treat emergency cases.
