Six patients with giant intracranial aneurysms, which measured over 2.5cm in diameter, were treated by ligation of the proximal parent artery. The location of the aneurysms were intra-cavernous in three patients, paraophthalmic in one, basilar in one, and vertebral in one. Ligation was performed on the cervical internal carotid artery in two patients, common carotid artery in two, basilar artery in one, and intracranial vertebral artery in one. Three patients were managed by combining the proximal parent artery ligation with an extracranial-intracranial arterial bypass.
The effect of ligation was followed by repeated computed tomography scans with angio-graphic correlation. The aneurysm thrombosed soon after ligation, and with time, gradually organized with a reversal of the mass effect. In four patients, the aneurysm completely lost its mass effect upon the adjacent structures. In the other two patients, the aneurysm is gradually losing its mass effect.
For giant aneurysms treated with ligation of the proximal parent artery, computed tomography scans are a useful method for continuing review, producing precise information concerning actual size, thrombus formation, and various pathological changes.

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Seven cases of large and giant carotid-ophthalmic aneurysms were presented. All the patients underwent intracranial surgery. In 4 cases the neck of the aneurysm was occluded. In other 3 cases gradual occlusion of the internal carotid artery in the neck combined with EC-IC bypass was done. There was one death after clipping the aneurysm because of massive infarction.
Other cases were uneventful or recovered from temporary ischemic symptoms after operation.
Exposure of the carotid artery in the neck and EC-IC bypass are recommended before direct attack. Full exposure of the internal carotid artery from the bifurcation to the origin of the ophthalmic artery is necessary. Ligation of the neck of the aneurysm with thread is a time-consuming and unsuccessful method for treating these aneurysms. In most cases clipping is. successful only after opening or resection of the the dome of the aneurysm. But after opening the dome, unexpectedly long-time, temporary trapping may be necessary to complete the clipping. Mobidity and mortality is mostly related to the ischemic insult during these procedures. Prevention of ischemia and the choice of appropriate clips before opening the dome is necessary. If the clipping is considered dangerous, gradual occlusion of the internal carotid artery with EC-IC, bypass is recommended.

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The authors report two operated cases of thrombosed giant aneurysm of anterior communicating artery.
Operations were performed by bifrontal craniotomy and interhemispheric approach. Treatment of the aneurysmal neck was performed after partial resection of aneurysmal body. During these procedure, temporary occlusion of the afferent and/or efferent arteries under the administration of 20% mannitol was done as occasion demands.
In this report, we show the problems in our operation and discussed mainly on surgical treatment of thrombosed giant aneurysm of anterior communicating artery.

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The authors report here a case of big internal carotid artery (ICA) curvature aneurysm, stressing a feasibility and a pitfall of an application of an EC/IC bypass in its treatment.
The case was a 50 year-old female complaining a progressing left visual disturbance. A cerebral angiography revealed a big 2cm in diameter left ICA aneurysm, also showing a poor cross (right to left) circulation and a poor collateral circulation via the posterior communicating artery. An EEG under carotid compression showed an appearance of 3-4 Hz slow waves at the left temporal area 8min. after carotid compression.
A simple direct aneurysmal neck clipping seemed impossible and ICA ligation was also intolerable.The authors, therefore, operated this aneurysm in the following 4 steps.
1) left STA-MCA anastomosis, 2) left ICA trapping, 3) aneurysmal neck clipping after aneurysmectomy, 4) release of trapped ICA.
The operation was performed uneventfully. The trapping time of the ICA was 7, 10 and 10 min., 3 times in all. Postoperatively the case showed a moderate aphasia and a right hemiparesis. A CT-scan showed a moderate cerebral infarction at the left frontotemporal area.
The authors have treated 11 cases of inaccessible ICA aneurysms through ICA ligation combined with an EC/IC bypass (STA-MCA anastomosis), with good results. Any of them, however, showed no EEG slowing under carotid compression, in contrast with the present case. In cases of the poorly developed circle of Willis, the ICA ligation is intolerable and the collateral through the STA-MCA bypass is insufficient.
On the contrary, an EC/IC bypass with a long vein graft may form a sufficient collateral circulation in the treatment of inaccessible aneurysms with poorly developed circle of Willis. Our data shows that the bypass (donor) flow of the routine STA-MCA anastomosis is 52ml/m (n:8) and that of the EC/IC bypass with a long vein graft is 126ml/m (n:6).

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Thirty five patients with giant aneurysms of intracranial internal carotid artery were experienced from 1961 to 1983. Four out of 35 were given no treatment, eight were operated directly and the remaining 23 were treated by indirect surgery; carotid ligation was performed in 14 cases and carotid ligation with STA-MCA anatomosis in nine.
At follow-up, 17 out of 23 patients (73.9%) operated indirectly were living useful lives; ten of these cases were treated by carotid ligation, seven by carotid ligation with STA-MCA anastomosis. Eighteen out of 23 cases were examined by CT scan to investigate the fate of the giant aneurysm following carotid ligation. Follow-up periods were from one month to 12 years.
CT findings which prove the effectiveness of indirect surgical treatment were observed in 17 cases (94.6%). However, complications after carotid ligation cannot be neglected; four out of 14 patients performed carotid ligation only were lost. Therefore, combined therapy consisting of neck internal carotid ligation and STA-MCA anastomosis is recommended to prevent complications due to carotid ligation.
Sequential CT scans are useful for observation of the fate of the giant aneurysm after carotid ligation and for evaluation of the prognosis of patients.

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A case of internal carotid giant aneurysm successfully treated by a detachable balloon catheter, is reported.
A 27-year-old female was admitted to our hospital on September 9, 1982, with chief complaint of double vision. Neurological examination at admission revealed abducens and trigeminal nerves paresis on the right side. Internal carotid angiograms showed a presence of giant aneurysm (2.8×2.8cm) originating from petrosal portion of the right internal carotid artery.
On October 27, 1982, STA-MCA double anastomoses were performed to prevent ischemic episode during intravascular procedure. Under local anesthesia, the giant aneurysm was treated by the maneuver after Debrun on October 29, 1982. Initially the authors attempted to introduce the balloon into the internal carotid artery distal to neck of the aneurysm under an intention of treatment by trapping of aneurysmal neck. However, it was unsuccessful and neck of the aneurysm and the internal carotid artery proximal to the aneurysmal neck were eventually occluded by the initial balloon without complication. The initial balloon was detached after confirmation of no change of EEG, somatosensory evoked potential and neurological signs for 70 minutes. The second balloon was introduced into the internal carotid artery proximal to the first balloon for further assurance of interruption of carotid flow.
The aneurysm was not visualized on postop erative angiography performed on December 8, 1983 and the right abducens and trigeminal nerves paresis subsided following intravascular balloon procedure.
Advantages and problems of detachable balloon technique for treatment of giant aneurysm, are discussed.

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The therapeutic destinations of 22 aneurysms of vertebrobasilar system were reported. These aneurysms consisted of 15 aneurysms at the distal part of the basilar artery including 1 basilar artery-superior cerebellar artery aneurysm (BAT·An) and 7 vertebral artery-posterior inferior cerebellar artery aneurysms (VP·An). The operability of BAT·Ans was 46.7% due to severity of their preoperative states, of which managements were very difficult, while 100% of VP·Ans were operable. Mostly half of BAT·An resulted in preoperative death, whose possible causes might be the direct damage of brain stem by the first rupture of aneurysms, the secondary damage by vasospasms and the aneurysmal rerupture by sudden changes of intracranial pressure.
Mortalities of our series were very high, ie, 57.1% in BAT·Ans and 14.2% in VP·Ans respectively, because these figures included early cases which were approached subtemporally to BAT·Ans in our series. Several factors which might affect on mortality were abstracted as follows; 1) subtemporal approach, 2) long time application of temporary clips on main trunk, 3) continuous strong retraction of brain, 4) suspected damage of important perforating arteries, 5) coating procedures of aneurysm.
Our surgical experiences of aneurysms at posterior circulation lead us to some principles of operation. Selected approach is transsylvian pterional one to BAT·An and suboccipital lateral route to VP·An. Cautions must be paid not to pull perf orators out of parent arteries when retracting brain, to select microsurgical apparatus with smooth round tip and to choose appropriate clips. It would be better to retract brain intermittently by spatula with narrowed tip.
We often encountered postoperative transient signs of lower cranial nerves, which disturbed recovery of general conditions. So dissection of them around aneurysm has to be treated protectively.

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Surgical treatment of the basilar artery aneurysm has been one of the difficult surgery even if surgery is performed under the operating microscope.
The authors reported that the surgical approach to the basilar artery aneurysm had to be discussed, especially in the case of a high placed basilar artery aneurysm. There are four approaching routes to a basilar artery aneurysm by pterional approach, namely routes 1 and 2 is through the space between the internal carotid artery, and the optic nerve or the temporal lobe. Route 3 is through the triangular space between the internal carotid artery, the optic chiasma and the A₁ portion. Route 4 is through the triangular space between the A₁ portion, M₁ portion and the base of the frontal lobe. The authors reported that the routes 3 and 4 are the easier approach to the high placed basilar artery aneurysm.

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The accumulated cases of the vertebro-basilar aneurysms are now 162 and the number of aneurysms are 167. Among them, the Basilar-bifurcation (BA-BIF ), basilar-superior cerebellar (BA-SCA), basilar-anterior inferior cerebellar (BA-AICA) aneurysms and aneurysms from P₁ portion are considered to be potentially indicated for trans-sylvian approach. Those account for approximately 60% of the whole cases.
Variety of anatomical structure:
1) Internal carotid artery (ICA): The length and the curvature of ICA are important factors. The longer ICA without an atheroma is easier in retraction and the one with lateralconvex curvature is difficult.
2) Anterior cerebral artery (ACA): The long and redundant At may offer an opportunity of approach through the space between ICA and the optical nerve. Clipping through this space is rarely possible (only two cases), but observation of the opposite Pi through this space is useful.
3) Posterior communicating artery (P. COMM. A.): For BA-SCA aneurysm, P. COMM. A. is lifted upward to make a sufficient space for clipping and for BA-BIF aneurysms, especially when located high, a space medial to P. COMM. A. should be made through its perforators.
4) Oculomotor nerve: The arachnoid should be sut only medial to the nerve. The nerve will be spontaneously displased laterally beneath the tentorium.

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Two cases of vertebral aneurysm at the origin of PICA were operated on at the Department of Neurosurgery, School of Medicine, University of Kanazawa at 1982. Two patients could work and led normal family lives postoperatively.
The posterior fossa was exposed with the Nap position by using a hemioccipital incision and a left suboccipital craniotomy. It was important to remove the lateral side of the occipital bone closely adjacent to the sigmoid sinus, the base of the occipital bone and the hemi-arch of the atlas so that the exposure could be low enough. The dura was opened and the arachnoid was opened over the foramen magnum. The cerebellar hemisphere was gently elevated by using the brain retractors. The arachnoidal opening was enlarged toward the lateral gutter. The highest dentate ligament was identified, transected. This permit exposure of the vertebral atery as it enters the dura. The vertebral artery was followed rostrally. The IX, X and XI cranial nerves were encountered as they lay stretched over the PICA aneurysm. The dome of aneurysm of case 1 was closely adherent to medulla. These nerves were separated from the aneurysm using a fine nerve hook. The neck of aneurysm was clipped by Sugita clip. Surgical complications noted were left hypoglossal nerve palsy for a month. In second case, the aneurysm were mounted the postero-lateral hemisphere, and therefor partial removal of cerebellum was performed. After the aneurysm had been completely exposed, the neck of aneurysm was amenable to clipping of its neck.

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Two patients with an aneurysm of vertebro-basilar (VB) junction were operated by“transpetrosal approach”. Both patients were hospitalized having the symptoms of subarachnoid hemorrhage, and angiography showed a saccular VB junction aneurysm directed toward the brainstem. Subtemporal craniotomy was made above the external meatus, and upper rim of the anterior part of pyramid bone was drilled extradurally. Small dural incisions were made above and below the superior petrosal sinus, and tentorium was incised 1 cm in length after clipping of the petrosal sinus. The aneurysm was visualized without retraction of the brainstem, and it was clipped between Vth and VIIth cranial nerves through this bone defect. The first patient had VIIth and VIIIth cranial nerve palsy postoperatively due to careless opening of internal meatus. The second patient had no neurological deficit except for transient VIth cranial nerve palsy. Complete clipping of the aneurysm was confirmed by postoperative angiography in both cases.
The characteristic point of this method is to avoid the retraction damage of the temporal lobe or brainstem, which is considered to be hazardous in the patient operated through the subtemporal or the suboccipital route.

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The authors experienced 162 cases of the posterior circulation aneurysm. Among them, the aneurysms arising from the vertebral artery and its branches were 63 (38% of the whole aneurysm of the posterior circulation). The first successful operation on such vertebro-basilar aneurysm was described as the one by Schwartz (1946), but Olivecrona was successful in a treatment of peripheral posterior inferior cerebellar aneurysm in 1932.
The most common site of aneurysm is at the take-off of the posterior inferior cerebellar artery (VA-PICA) aneurysm and“lateral suboccipital approach”is the choice of treatment for them. The authors prefer the prone position and the surgeons stand by the shoulder of the patients (not at the top of the head). Aneurysms exist more commonly on the left side, so the prone position offer considerable advantage to a right-handed surgeon. The opposite is true in a lateral position : the right side aneurysm may be better treated by a right-handed surgeon in a lateral position.
The location of VA-PICA aneurysm is classified by A-P view of angiography. Type A : An aneurysm is above the knee portion of the vertebral artery. The distal portion of the vertebral artery is hidden behind the aneurysm. Type B: An aneurysm is just beneath the knee. Type C: An aneurysm is far below the knee.
The other useful radiometery is a measurement of the distance to the aneurysmal neck from the midline and the clivus. When an aneurysm is located within 10mm of the midline, or 13mm or more from the clivus, the postoperative cranial nerve palsy is possible. There was no postoperative death in above vertebral aneurysms.

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Sixteen patients with VA-PICA aneurysm were treated in our department from 1965 to 1982_Direct approach to the aneurysm was carried out in 11 cases out of 16 (Table 1). We encountered difficulties in access to the aneurysm in 5 cases (case 2, 4, 6, 13, 15) and in clipping procedures in 4 cases (case 6, 7, 10, 15 ). These difficulties found in operation were evaluated in relation to angiographical findings. The aneurysms located between 0 to 5 mm from the midline or more than 21 mm from the lateral point of the foramen magnum (Fig. 2) could be reached with difficulty through unilateral suboccipital craniotomy (Fig. 3). The aneurysms with the dome directed posteriorly had to be treated carefully because of their possible adhesion to or invagination into the medulla oblongata. The aneurysms with the dome directed medially were difficult to be clipped because they exist on the opposite side of the vertebral artery.
In our experience, it is found very useful in such aneurysms as the dome directed medially or the distal vertebral artery running medially to move the vertebral artery ventrally by dissecting perforators. The peripheral vertebral artery to the aneurysm, contralateral vertebral artery and initial portion of the basilar artery can be identified through the space between medulla oblongata and the vertebral artery, which can be called “medulla oblongata-vertebral triangle (Fig. 4)”.

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A case with vertebro-basilar junction aneurysm, who was operated on by suboccipital approach, is reported. A 19-year-old policeman was admitted to our clinic with a history of subarachnoid hemorrhage. Vertebral angiography demonstrated a saccular aneurysm arising at the vertebro-basilar junction. Lateral position on the left and suboccipital approach was very useful for exposure of the aneurysm and its surrounding structures. Neck clipping was done without damage to the brain stem and the lower cranial nerves.

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A 48-year-old man was admitted to our hospital with subarachnoid hemorrhage following ruptured aneurysm which was likely to be saccular shaped on Rt. vertebral artery angiogram. Neck clipping was performed about 1 M after onset. However, about 24 hours after radical operation, he suffered from tetraplegia. Its cause was considered to be the circulatory disturbance of basilar artery territory which was induced by embolus after neck clipping procedure. Discussing the angiographic findings in detail, it was evident that the aneurysm was not saccular but dissecting. Dissecting aneurysm in this case, proximal clipping or ligation was seemed to be the best method.

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Seven cases with paraclinoid giant and large internal carotid artery were treated with combined ICA ligation and extracranial-intracranial arterial bypass. By using measurements of cortical blood flow with thermal diffusion method and internal carotid arterial pressure during operation, it was possible to select a patient for abrupt and gradual carotid ligation. All of the grafts were proven patent by angiogram. Also all of the aneurysms were proven thrombosed by angiogram and enhanced computed tomography. Three patients developed transient hemiparesis. One patient developed very mild permanent hemiparesis. Five patients had improvement of pre-existing extra-ocular palsies and visual field defects. Only one patient in whom direct clipping was tried revealed worsening of visual field defect. Trapping procedure was found to increase an ICA stump pressure and thus unnecessary. Prophylactic EC-IC bypass with abrupt or gradual carotid ligation selected by intraoperative cortical blood flow and ICA stump pressure measurement seems to be an effective method of treatment and adjunct to the operation for paraclinoid large and giant aneurysms.

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Specially designed probes were made and an electromagnetic flow meter with autozero balance system was used to facilitate the measurements of intracranial main cerebral arterial blood flow during aneurysm surgery. Blood flow could be measured at the internal carotid artery (ICA), M₁ portion of the middle cerebral artery (MCA) and A₁ portion of the anterior cerebral artery (ACA). The effects of brain retraction and induced hypotension on cerebral arterial blood flow were also investigated.
The mean arterial blood flow in ICA, M, and A, were 144 ml/min, 81 ml/min and 52 ml/min, respectively. Test occlusion of ICA, MCA and ACA demonstrated the collateral capacity in each patient. Induced hypotension showed that a lower arterial blood pressure of autoregulatory response was 58 mmHg in normotensive patients. Brain retraction, ranging from 150 to 300 mm H₂O (average 250 mm H₂O), decreased blood flow approximately 20 percent of the control value.
It was suggested that our specially designed probes and electromagnetic flow meter were useful to investigate the cerebral circulation and gave important clues to manage the main cerebral arteries and protect the ischemic insults of the brain during aneurysm surgery.

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Internal carotid artery flow was monitored in 52 patients undergoing surgery for intracranial saccular aneurysms. An electromagnetic flow probe was positioned on the common carotid artery and the external carotid artery was clipped during the intracranial surgery. Trimetaphan camsilate (Arfonad^®) was used for induced hypotension. In 42 patients the mean arterial blood pressure (MABP) was reduced to 60 mmHg and in 27 patients to 40mmHg. There was a significant relationship between aging and internal carotid artery flow during induced hypotension. However, surgical grade did not relate to internal carotid artery flow. In 11 patients with basilar top aneurysms a significant reduction of internal carotid artery flow was monitored during the retraction of the intracranial portion of internal carotid artery in frontotemporal approach to the aneurysm.

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The doppler ultrasound has been recorded from the main cerebral arteries and fundus of the aneurysm to investigate the hemodynamics in each site during aneurysm surgery. The doppler sound was analyzed by two methods; (1) power spectrogram analysis with a data processor, (2) quantitative spectrum analysis with Angioscan II.
The pattern of the power spectrogram obtained from main cerebral artery showed the shape of one peak hill, in which the peak located at the frequency of 500-600 Hz. The doppler sound recorded from the aneurysm demonstrated the characteristic power spectrogram. Namely, the spectrogram exhibited the shape of hill with three peaks, ranging from 100-500 Hz. In the quantitative spectrum analysis, doppler sound from main cerebral arteries demonstrated a characteristic arterial blood flow pattern with systolic notch and high values of % window, more than 40. The doppler sound from aneurysm did not show a characteristic arterial blood flow pattern, and exhibited an evident reduction of peak frequency and low values of % window, lower than 20.
It is suggested that the power spectrogram or quantitative spectrum analysis of doppler ultrasound is a useful method to investigate the hemodynamics in each cerebral vessels during aneurysm surgery.

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Intraoperative application of real-time ultrasonography during 13 neurosurgical operations for intracranial aneurysms is reported. In two cases, aneurysms themselves could be detected clearly by the real-time ultrasonic imaging. Especially, in the case with large aneurysm, the information about the nature of the aneurysmal wall could be obtained. And, of course, other coexisting lesions with the aneurysm, namely, intracerebral hematoma, massive subarachnoid hemorrhage and hydrocephalus, could be recognized clearly. So, the real-time intraoperative ultrasonography is considered to be useful in aneurysm surgery and the surgical approach to aneurysms can be performed more safely with the real-time ultrasound imaging.

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The authors have reported that the appearance of electromyogram (EMG) of vascular smooth muscle reflects histological changes of vascular wall in bovine cerebral artery. The present study makes a comparative examination of the appearance of vascular EMG by administration of human fresh blood, histological findings of the vascular wall and the degree of vasospasm and its duration using human cerebral artery gained at autopsy (1). Furthermore, the correlation between the appearance of vascular EMG during operation and the degree of vasospasm on the pre-surgical angiograms in the ruptured aneurysm cases (2).
The result was as follows: (1) In the 13 cases which died of non-SAH diseases, vascular EMG showed burst or sporadic appearance except for 2 cases with severe arteriosclerosis. In the 14 cases which died of vasospasm following SAH, electrical discharge was not recognized in 9 cases with marked myonecrosis of vascular wall. Vascular EMG could be detected in cases which died within 1 week from the appearance of vasospasm or in cases which shows local narrowing on the angiogram, and corresponded to the degree of the myonecrosis of the vascular wall. (2) In 9 SAH cases and 1 non-SAH case which showed no narrowing on the angiogram, spontaneous discharge was well recognized and the frequency of discharge increased on the thermic stimulation by injecting of 20°C and 40°C physiological salt solution. But in 5 cases of severe diffuse narrowing and 4 cases of irregular narrowing, no electrical discharge was observed with no response to thermic stimulation. Appearance of vascular EMG was well consistent with the degree of narrowing on the pre-surgical angiogram.
The appearance of vascular EMG corresponds to the degree of organic change of the vascular wall in human cerebral artery. The induction of vascular EMG during operation can anticipate the functional reversibility of the vessel with vasospasm and play a role as the index for selecting treatment such as vasodilator, induced hypertension, hypervolemia, etc..

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We operated on vertebral junctional aneurysm which was opacified only via the right vertebral artery, under the monitoring of intraoperative brain-stem auditory evoked potentials, BAEP's. During the operation, the BAEP was profoundly changed after applying a temporary clip to the rt. VA, namely the development of the each wave became poor and the latency of the wave V was significantly prolonged. But after releasing the temporary clip the distorted waveform became normalized gradually and the initial waveform was regained until the closing of the dura. The change of the BAEP which was seen in this case was reversible retrospectively. It is necessary for the future to establish the objective and quantitative criteria which can indicate the critical level to operative procedures.

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Development or improvement of operative instruments has a most importance for the progress in neurological surgery. In the following, some newly developed instruments were demonstrated in detail and discussed its usefulness in intracranial aneurysm surgery. 1) Intraoperative serial angiographic system and its head holder. As a film changer, Puck U-24/30 and its stand Puck Wop-24/35 were introduced. As the head holder which incorporated with the above mentioned angiographic system, basic arch of the multipurpose head flame made by Mizuho Ika-Kikai was modified as to not disturb the x-ray beam of its vertical direction. These instrument was indispensable to localize aneurysm in M₃ accompanied with large parietal AVM. 2) Movable ceiling suspended“Schaukasten”. The“Schaukasten”sized for a 35×43cm film was suspended under the ceiling. When it is in use, it was placed near by the operator's right side. It was very useful especially to ascertain the operative view with angiogram or CT findings during operation. 3) Round tipped suction cannulae. In order to minimize injury to brain or blood vessels during manipulation, tip of suction cannulae was made thicken, round and smooth. It was quite satisfactory especially for removal of cisternal clot. 4) Specially angled disposable microknives. As these knives were angled 65°on its flat at 4mm from tip, it was useful to cut dura transversely in deep and narrow space such as in IC-ophthalmic aneurysm surgery.

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Three kinds of new surgical instruments for cerebral aneurysm are introduced. The first instrument is custom made clip for internal carotid aneurysm. It is a bayonet clip which has sickle-shaped blade. It fits to the outer curvature of th e internal carotid artery so as to be able to avoid incomplete clipping of the neck behind the IC.
The second instrument is special made spatula which has a saline dripping system. With using it the operative field can be kept clean so as to find the fine bleeding point and also the tip of the bipolar coagulator can be get rid of adherence of coagulated tissue.
The third is suction instrument which has oval shaped tip and a scale on its surface at intervals of 5mm. With this oval suction tip, fine retraction of the brain is possible freely without stopping the suction.

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We treated for anterior communicating artery aneurysms by stereotaxic occlusion with transsphenoidal approach.
[Method] Under general anesthesia the patient is inserted the catheter through the femoral artery for operative angiography. The patient's head is adjusted Wells stereotaxic instrument. A small portion to the planum sphenoidale on the stereotaxic trajectory is removed. The aneurysm was filled with iron-acrylic mixture injected through the needle with magnetic probe. 1 hour after injecting the mixture the operation finished. The patient has returned to work 7 months after the onset of SAH.
[Discussion] This method has many advantages and disadvantages. It can be utilized for patients who are not candidates for conventional craniotomy because of heart or cerebrovascular disease. It is associated with short hospitalization, and no incidence of postoperative spasm. These advantages presumably result from the minimal brain and blood vessel manipulation associated stereotaxic approach. The disadvantage of the procedure depend on the aneurysm's site and size, has the risk of occlusion of the parent artery and need the extensive equipment required. We believed that this technique can be considered in the neurosurgical therapy for certain aneurysm of Acom aneurysm.

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A stereotactically guided operation was performed in two cases of deep-seated aneurysms which were difficult to be obliterated by the usual method.
One aneurysm was located in the peripheral region of the right posterior cerebral artery, and the other was in the superolateral region of the right lateral ventricle.
The target point was determined on the aneurysm and the needle was introduced into the brain up to the point about five milimeter to the target, and indigocarmine was injected pulling out the probe. We sucked out the brain tissue along the track stained with indigocarmine. The aneurysms were resected after coagulating the parent arteries. Brain edema was mild on postoperative computed tomography.
We suggest that our technical procedure was eligible for the deep-seated peripheral aneurysm.

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