2022 Volume 50 Issue 6 Pages 525-529
Flow diversion (FD) has become mainstream for cavernous carotid aneurysm (CCA) treatment owing to its high occlusion/low complication rate. Nevertheless, retreatment, including open surgery, is needed in some cases. To safely achieve open surgery, traditional balloon test occlusion (BTO) has been performed preoperatively. However, BTO has potential disadvantages such as patient burden and vascular access site complications. We devised a novel technique—intraoperative test occlusion—to evaluate ischemic tolerance intraoperatively. While the cervical internal carotid artery is occluded for 15 minutes, ischemic tolerance is evaluated using somatosensory evoked potential (SEP)/motor evoked potential (MEP). Herein, we present a case of CCA who developed progressive oculomotor nerve palsy after FD. Following low-flow bypass, intraoperative test occlusion was performed. After confirmation of unchanged SEP/MEP, the cervical internal carotid artery was ligated. The postoperative course was uneventful. Our surgical strategy may reduce patient burden and BTO-related complications. Further investigations are warranted to fully demonstrate the usefulness of intraoperative test occlusion.
