Neck clipping is technically difficult in some cases of intracranial aneurysm. Cervical carotid ligation and coating of an aneurysm have been employed as an alternative method in such patients.
One of the four cases that had undergone cervical carotid ligation in our hospital developed subarachnoid hemorrhage eight years after surgery and was found to have multiple aneurysms including three in the contralateral carotid and one in the basilar system.
If carotid ligation plays a role in the contralateral aneurysm formation due to hemodynamic changes in the cerebral circulation, it should at least be avoided for younger patients.
Extracranial and intracranial bypass surgery is recommended prior to or at the time of carotid ligation because it may prevent ipsilateral ischemic complications as well as the development of a contralateral aneurysm following the ligation.
Among seven patients who underwent coating operations with muscle pieces and Biobond, one rebled from the previously coated aneurysm six years after surgery. The coating method should be indicated only for small and/or fusiformed aneurysms that can be completely coated.
