Surgery of Large and Giant Paraclinoid Aneurysms of the Internal Carotid Artery: Results of Treatment of 48 Patients

Sh.Sh. Eliava, Yu.M. Filatov, A.S. Kheireddin, O.B. Sazonona

Burdenko Research Institute of Neurosurgery, Russian Academy of Medical Science, Moscow, Russia


Introduction. Surgical treatment of giant aneurysms of a paraclinoid segment of the internal carotid artery is a complicated problem of cerebrovascular neurosurgery. Many years ago patients with such aneurysms, treated at the Institute, were subject to different endovasal interventions, combined with applying extra-intracranial microanastomosis. The situation changed with introduction of intravascular aspiration of blood (IAB) 1995.

Materials and Methods. Our series included 48 cases with giant or large aneurysms of the ICA paraclinoid segment, operated with use of IAB. A course of 10 aneurysms was pseudotumorous; symptoms of SAH and a state severity of the II-IV degrees (Hunt-Hess scale) were watched in 33 cases; 5 patients had combined symptoms. There were gigantic (22) and large (26) aneurysms, saccular aneurysms (30) and fusiform aneurysms (18) of upper localization (10), central localization (5) and lower localization (3) (according to our own classification). All the patients were operated with using IAB, intraoperative EEG and eletrocorticographic monitoring. Standard IAB consisted in temporary distal exclusion of aneurysm and retrograde direct aspiration of blood through an exposed cervical segment of ICA or endovasal aspiration with use of a biluminal balloon-catheter.

Results. Aneurysms were excluded in 38 cases (79.2%): 35 of them were clipped; trapping clipping was performed in 1 patient; subtotal clipping of aneurysm with coating of its functioning pericervical part with gauze was made in 2 cases. We failed to clip aneurysm in 7 patients. Thus, intervention was limited to strengthening of its walls with surgical gauze and fibrin-thrombin glue. It resulted in their partial thrombosing. Results, watched on discharge, were as follows: no changes in a neurologic status or minor augmentation of symptoms - 41 cases (85.4%), unilateral amaurosis - 2 cases (4.2%), hemiparesis - 2 cases. Three patients died (6.25%) of delayed ischemic disorders (2) and rupture of a coated aneurysm (1).

Conclusion. Surgical interventions with use of IAB and EEG and electrocorticographic movitoring are an effective method of treatment of large and giant paraclinoid aneurysms of the internal carotid artery.