If, at direct exposure, it is impossible to clip the neck of a giant aneurysm because of its size, location and a neck not suitable for clipping, ligation of the proximal parent artery presents an alternative surgical treatment.
Ten patients with intracranial aneurysms were treated by ligation of the proximal parent artery. The locations of the aneurysms were intracavernous in four patients, paraophthalmic in one, basilar in one and vertebral in the other four. Four patients were managed by combining the ligation with EC-IC bypass.
In six patients with giant intracranial aneurysms, the effect of ligation was followed by repeated CT scans with angiographic correlation. The aneurysm thrombosed soon after ligation, and with time, gradually organized with a reversal of the mass effect. In the other four patients who had had symptoms of hemorrhage, no evidence of hemorrhage was seen postoperatively.
The main concern is the safety of the ligation, though no ischemic signs developed in this series. Recently, we have often used the balloon catheter technique and select the patients who may not tolerate ligation observation of the changes of consciousness and neurological signs, EEG monitoring, measurement of back pressure and checking cross-circulation in the angiogram during clamping the artery by inflating the balloon are undertaken. Our policy is to use an abrupt occlusion of the proximal parent artery combined with the EC-IC bypass on the same day. In on patient who showed ischemic symptoms during the Matas test, a vein graft between the external carotid artery and the middle cerebral artery was used in order to give a larger flow, which can provide better protection, and resulted in good clinical application.
