Abstract
The authors presented two patients of giant aneurysm who had taken unexpected eventful coures during their treatment.
Case 1; 47 y. o. female with chronic renal failure. Her chief complaint was bitemporal hemianopia and a giant aneurysm was found in the C2 portion of right internal carotid artery. Cross flow was good. Craniotomy was intolerable to her because of renal failure. Gradual ligation of IC was done by Selverstone clamp. She developed progressive left hemiparesis and Urokinase and low molecular dextran solution was given and started hyperbaric oxygen treatment. In the evening three times of SAH occured and she became coma and dead next day. Case 2; 61 y. o. male; past history of SAH 15 years ago who was admitted for ruptured giant aneurysm. The giant aneurysm was exposed by interhemispheric approach. About 70% of dome was yellowish hard and left A1 entered into the dome where left A2 emerged from, therefore clipping was given up. It was coated with Biobond and Bemsheet. A new bleb was protruded from the dome a year later and reexposure was done, however it was so hard that clipping was impossible. It was coated in the same way.
Discussion; In the Case 1 the cause of hemiparesis could be extension of thrombus. UK and low molecular dextran treatment might dissolve the clot and SAH occured subsequently. If we could use a detachable balloon and obliterate the aneurysm, SAH should be avoided. In the Case 2 if we had done either copper wire electrothrombosis as well as coating or creation of new anterior communicating artery using temporary clip, new bleb might be avoided. Each treatment has high risk for thrombosis of anterior cerebral artery or brain damage by too longer temporary clipping.
