A case of high cervical and a case of intracavernous sinus ICA aneurysm were treated with ICA ligation combined with STA-MCA bypass. There was good resolution of mass signs and no ischemic complications.
This method of treatment is effective not only for the improvement of clinical signs but also for the prevention of post ligation ischemia.
There have been some reports stating that STA-MCA bypass does not always prevent cerebral ischemia after the ICA ligation, especially in cases with critically low residual CBF during trial ICA occlusion.
For these cases, gradual ICA ligation paralleling the development of bypass-flow, or more electively high flow graft bypass might be considered.
