Direct Clipping for Large and Giant Juxta Dural Ring Internal Carotid (IC) Artery Aneurysms

• DATE Isao

  Department of Neurological Surgery, Okayama University Graduate School of Medicine and Dentistry

• OHMOTO Takashi

  Department of Neurological Surgery, Okayama University Graduate School of Medicine and Dentistry

• Isao DATE

• Takashi OHMOTO

• 岡山大学大学院医歯学総合研究科神経病態外科学(脳神経外科)

• Department of Neurological Surgery Okayama University Graduate School of Medicine and Dentistry

Bibliographic Information

Other Title

• 直接クリッピング術を施行した硬膜輪近傍の大型・巨大内頸動脈瘤の検討

Abstract

Direct clipping for large and giant juxta dural ring internal carotid (IC) aneurysms is a difficult neurosurgical procedure. We describe the importance of skull base surgery techniques and the usefulness of the suction-decompression method for direct clipping of these aneurysms. We have treated 9 large (15-24 mm) and 6 giant (25 mm ≦) aneurysms in this region by direct clipping during the past 6 years. The patients presented with subarachnoid hemorrhage in 4 cases, visual disturbance in 7 cases and in 4 cases the aneurysms were incidentally discovered. Preoperative ipsi lateral IC balloon test occlusion showed neurological symptoms in 2 cases. Proximal control of IC during surgery was performed either by intravascular balloon catheter or direct exposure in the neck. A conventional pterional craniotomy was performed, the anterior clinoid process and optic canal and strut were drilled off intradurally, and the dural ring was clearly delineated. Mobilization of IC and the optic nerve became easier with these procedures. Before clipping, suction-decompression was commonly used to reduce aneurysmal size enough to facilitate dissection from the surrounding structures. Multiple clips were used: fenestrated clips in 11 cases and straight clips in 4 cases. Although 1 case had postoperative ischemic complication in the ipsilateral cerebral hemisphere, complete clipping was performed in the other 14 cases without ischemic complication. Postoperative improvement of visual symptoms was observed in 4 cases in which surgery was performed within 3 months of onset. In conclusion, skull base surgery techniques and the suction-decompression method play important roles in obtaining good surgical outcomes for direct clipping of large and giant juxta dural ring IC aneurysms.

Journal

• 脳卒中の外科 = Surgery for cerebral stroke

  脳卒中の外科 = Surgery for cerebral stroke 31 (4), 295-302, 2003-07-31

Keywords

• direct clipping
• juxta-dural ring aneurysm
• giant aneurysm
• suction-decompression
• internal carotid artery

Details

• CRID: 1570572702492816000
• NII Article ID: 110003739562
• NII Book ID: AN10061756
• ISSN: 09145508
• Web Site: https://search.jamas.or.jp/link/ui/2004039511
• Text Lang: ja
• Data Source:
  • CiNii Articles