Abstract
Surgical problems and our strategies for large carotid cave aneurysms (medially faced C3 aneurysms) were pointed out as follows.
Exposure of proximal neck: Anterior clinoid process is removed extradurally, after keeping the proximal (neck) and distal (intracranial) ICA.
Optic nerve injury: Dural sheath of the optic nerve, ophthalmic artery and Dawson's artery are preserved.
Ischemic complication: Local heparinization of ICA and irrigation of aneurysm sac during temporary trapping to prevent the embolism. Balloon Matas test before surgery.
Positioning of the clips: Dissection of aneurysm enough to reform the kinked ICA. For broad neck aneurysm, multiple clipping technique with a new type of curved blade fenestrated clip was used.
