Abstract
Between 1987 and 1995, 10 patients with giant intracranial carotid aneurysms were surgically treated in our department. Three patients with carotid cavernous aneurysms (all 3 patients presented with cranial nerve dysfunction and tolerated balloon test occlusion) were treated by either common carotid ligation or internal carotid ligation. After treatment the symptoms resolved and MRI demonstrated the gradual disappearance of the mass.
The other 7 patients, including 4 carotid ophthalmic aneurysms, 2 carotid posterior communicating aneurysms and 1 carotid bifurcation aneurysm (3 patients presented with progressive visual loss, and 4 patients presented with subarachnoid hemorrhage) were treated by direct clipping. Four patients had visual loss preoperatively; in 3 patients in which the aneurysms were clipped via Dolenc's intra-extradural combined approach the vision was improved, and in the other patient with conventional pterional approach it was made worse. Direct clipping always required temporary clipping of the aneurysmatic vessels.
Three patients without angiographic cross-filling across the anterior communicating artery who had a relatively low stump pressure at the balloon test occlusion, suffered postoperative cerebral infarction; 1 of them died and 2 remained moderately disabled.
Surgical strategy should be considered in each patient according to the stage of individual collateral circulation.
