Abstract
Ten patients with internal carotid giant aneurysm were managed by combining internal carotid artery (ICA) ligation with an STA-MCA anastomosis. Pre-, intra- and postoperative hemodynamics were examined by angiography and/or with a bidirectional ultrasonic Doppler flowmeter. Intraoperative Doppler flow measurement of the STA on the side of the anastomosis showed that the flow increased with an increase of ipsilateral ICA trial occlusion and the flow pattern changed from an external to an internal carotid type. Carotid occlusion was completed one to five days after the start of gradual occlusion. The degree of occlusion was adjusted by the monitor of the flow patterns recorded by the Doppler flowmeter at the poststenotic region. Bypass patency was confirmed in all anastomoses by postoperative transcutaneous Doppler flow studies.
Postoperative serial CT studies revealed total occlusion of the aneurysm in nine patients and a remarkable decrease in size in five. In the remaining aneurysm, at the intracranial bifurcation of the ICA, intraaneurysmal thrombosis was subtotal and a supplemental clip was applied to the Al segment. Although five patients developed TIAs or diabetes insipidus simultaneously with aneurysmal occlusion, there were no permanent neurological deficits. Only one patient, the one in whom neck clipping of the aneurysm was performed by direct intracranial surgery with temporary occlusion of the ICA, developed permanent neurological deficits.
