Abstract
The authors report their experience with direct surgery for partially thrombosed giant intracranial aneurysm (PT-GIA) showing mass effect without recent subarachnoid hemorrhage. Three cases with the lesions located in the VA-PICA, IC-Pcom and MC, respectively, are presented.
Thrombectomy, aneurysmectomy and neck-clipping are thought to be reasonable operation for these PT-GIAs. Intraoperative problems and management of PT-GIA are described.
The most common and dangerous complication is major vessel occlusion or stenosis induced by slipping of a clip. To prevent this, we have following devices. (1) The dome of the PT-GIA is opened first, and the thrombus is removed piece by piece. (2) In the neck, fine thromboendarterectomy is performed. (3) The CUSA system is very useful for thromboendarterectomy. (4) Finally, the neck is clipped safely after the PT-GIA has been converted into a pliable sac.
Such internal decompression of the PT-GIA allows us to identify the surrounding tissue and prevent damage to perforating vessels at neck-clipping.
When a PT-GIA is embedded in the brain stem, aneurysmectomy should be restricted to a partial one or the brain may be injured.
Intraoperative aneurysmal rupture, one problem that may arise, can be controlled by short temporary occlusion of the proximal main artery with the neck being clipped safely. All three patients showed satisfactory postoperative courses.
