Abstract
Since the introduction of the operative microscope and various clips, aneurysm surgery has become safe. But there are still some aneurysms that are difficult to be clipped because of location, direction or size.
Four hundred and sixty cases of intracranial aneurysms were operated on from September 1976 to March 1984. In 17 cases clipping was not possible. Thus, the purpose of this paper is to evaluate those aneurysms which could not be clipped and to provide useful information for further treatment.
17 cases in which clipping was impossible included six internal carotid ophthalmic giant aneurysms, two internal carotid bifurcation giant fusiform aneurysms, two posterior communicating big aneurysms, one posterior cerebral artery giant aneurysms, one middle cerebral artery thrombosed aneurysm, three basilar artery aneurysms, one vertebral aneurysm, and one case of Megadolico Basilar and Carotid artery.
Ligation of the internal carotid artery following STA-MCA anastomosis was done in six cases of internal carotid ophthalmic anerysms. Ophthalmoplegia or visual disturbance developed in two patients more than a week after the operation probable at the time the aneurysm thrombosed. Therefore, these ophthalmic aneurysms should he clipped using fenestrated clips, or coagulated or punctured to reduce their size.
Cases of giant fusiform aneurysm of internal carotid bifurcation or Megadolico Basilar and Carotid artery present more risk of cerebral infarction than of bleeding. Therefore, treatment to prevent cerebral infarction in these aneurysms must be undertaken. There were three cases of thromhosed aneurysm, of the basilar artery, vertebral artery and middle cerebral artery respectively. There is no operative indication for completely thrombosed aneurysm.
Feeder clipping was performed in two cases of big aneurysms of the posterior communicating artery, and the postoperative course was good without any neurological deficit. Angiography revealed that the aneurysm was not exposed postoperatively. Therefore, if the aneurysm was fed by only the posterior communicating artery in the angiogram, feeder clipping of the posterior communicating artery is one of the methods of treatment.
