Reconstructive surgery may be the second best method in a such case, in which neck clipping of aneurysm seems to be impossible or difficult and it cannot help selecting proximal clipping or trapping of the parent artery. Many kinds of reconstructive surgical procedures have been reported. STA (superficial temporal artery)-MCA (middle cerebral artery) anastomosis is the most common procedure. But, this method is not useful in all cases. It is not suitable for the purpose of the reconstruction of anterior cerebral artery. In some case, the amount of blood flow through the STA is not enough to maintain the function of the brain. For these reasons, not only STA-MCA anastomosis but also various kinds of reconstructive procedures should be used according to the needs of each cases.
In the last five years, 46 reconstructions of the parent artery have been performed prior to or secondary to the aneurysm surgery. The reason why these procedures were needed were as follows,
1) 6 patients with incidental aneurysm was estimated to have cerebral ischemia due to the occlusion of internal carotid artery or middle cerebral artery.
2) In 10 cases, the aneurysm was so big or giant, which might be difficult to be clipped. So, STA-MCA anastomosis or A3-A3 side to side anastomosis was made prior to clipping of aneurysm for the purpose of prolongation of parent artery occlusion time.
3) 3 cases with intracavernous giant aneurysm were applied the STA-MCA anastomosis and 18 cases who had a giant aneurysm at the ophthalmic or intracavernous portion of ICA were treated with the anastomosis between the cervical external carotid artery and the middle cerebral artery using a radial artery graft.
4) 7 cases with dissecting aneurysms of the vertebral artery were applied various kinds of reconstructive procedures.
5) In 6 cases, some troubles had occurred during surgery and some reconstruction were made for countermeasures against the occlusion of parent artery.
In this paper, our techniques and methods of reconstructive procedures with some examples were reported, and the cause of deterioration was discussed. To summarize our interpretation of results, it should be noted that in aneurysm surgery it is advisable to prepare simultaneously various kinds of reconstructive procedures as well, not only for the patients with a giant aneurysm or an unusual aneurysm like as dissecting aneurysm but also with an usual aneurysm. High flow bypass with a radial artery graft and intracranial interarterial bypass like as A3-A3 side to side anastomosis and M1-M2 anastomosis should be used widely in the future.
Last, please excuse me if I overemphasized my opinion more subjectively than was necessary. And I will be glad if this paper is any help to young neurosurgeons.
