Two Cases of Large Carotid-ophthalmic Artery Aneurysms: Direct Clipping Using the “Trapping-evacuation” Method with Balloon Catheter

Abstract

We performed the trapping-evacuation method in 2 cases of large carotid-ophthalmic aneurysm. In Case 1, the patient, a 41-year-old female, complained of headache. Magnetic resonance angiography (MRA) revealed a left internal carotid aneurysm, which proved to be a large carotid-ophthalmic aneurysm by left carotid angiogram. A left frontotemporal craniotomy was performed and the aneurysm was exposed by the pterional approach after the anterior clinoid process resection. During the operation, the double-lumen catheter was inserted for the temporary proximal occlusion of the internal carotid artery. Then the intracranial internal carotid artery distal to the aneurysm was occluded with a temporary clip. The aneurysm was collapsed by evacuation through the balloon catheter with a 20ml syringe. The aneurysm was clipped and intraoperative digital subtraction angiography (DSA) was carried out to confirm successful obliteration of the aneurysm.
In Case 2 the patient, a 43-year-old female, was suffered from a sudden headache and consciousness disturbance. CT scan on admission showed acute subdural hematoma and intracerebral hematoma of the right temporal lobe. Right carotid angiogram revealed a large ophthalmic-carotid aneurysm and middle cerebral artery aneurysms. Direct surgery was carried out for a ruptured middle cerebral artery aneurysm on Day 0. On Day 46 after admission the unruptured large ophthalmic-carotid aneurysm was treated by trapping-evacuation method as in Case 1.
In conclusion, the trapping-evacuation method using balloon catheter for the large or giant internal carotid aneurysms was useful for the treatment of direct clipping. Intraoperative DSA was valuable not only for the balloon technique but also for the confirmation of complete clipping of the aneurysm.