Treatment strategy for giant aneurysms in the cavernous portion of the internal carotid artery
Autor: | Jun Ichi Kuratsu, Takamasa Mizuno, Yutaka Kai, Jun-ichiro Hamada, Jun-ichiro Kuroda, Tatemi Todaka, Shigetoshi Yano, Motohiro Morioka, Hideo Takeshima |
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Rok vydání: | 2007 |
Předmět: |
Adult
Male medicine.medical_specialty External carotid artery Anastomosis Magnetic resonance angiography Brain Ischemia Postoperative Complications Aneurysm medicine.artery Diplopia Oculomotor Nerve Diseases medicine Humans Thrombus Radial artery Aged Tomography Emission-Computed Single-Photon Cerebral Revascularization medicine.diagnostic_test business.industry Intracranial Aneurysm Middle Aged medicine.disease Embolization Therapeutic Surgery Treatment Outcome Bypass surgery cardiovascular system Cavernous Sinus Female Neurology (clinical) Radiology Internal carotid artery business Carotid Artery Internal |
Zdroj: | Surgical Neurology. 67:148-155 |
ISSN: | 0090-3019 |
Popis: | Background As direct surgery to treat giant aneurysms of the ICA is difficult, ICA occlusion is the conventional treatment in patients with BTO tolerance. To determine whether bypass surgery should be performed after carotid occlusion by trapping or proximal occlusion, we developed a treatment strategy that includes BTO and SPECT. Methods We report 19 patients with symptomatic giant aneurysms in the cavernous portion of ICA. The appropriate type of bypass surgery was determined by the results of BTO and SPECT. The type of ICA occlusion selected was based on the evaluation of retrograde filling of the aneurysm during BTO. Results In all 19 patients, the ICA was sacrificed; 10 patients also underwent bypass surgery (low-flow bypass with STA-MCA anastomosis, n = 7; medium-flow bypass with radial artery graft, n = 2; high-flow bypass with vein graft, n = 1). Coil trapping was performed in 11 patients; proximal occlusion in 8. In 18 patients, there were no ischemic complications after treatment; 1 patient who had been treated by proximal ICA occlusion developed transient ischemia due to an intra-aneurysmal thrombus. Cranial nerve palsies were improved in 16 patients. Conclusions Based on our experience, we recommend that patients with giant aneurysms in the cavernous portion of the ICA be evaluated by BTO and SPECT. In conjunction with bypass surgery, ICA trapping or proximal occlusion constitutes an effective treatment strategy. |
Databáze: | OpenAIRE |
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