Combined intravascular parent artery and ophthalmic artery occlusion for giant aneurysms of the supraclinoid internal carotid artery

Abstract

Parent artery occlusion is an effective method to treat internal carotid giant aneurysms. However, incomplete parent artery occlusion may cause revascularization. Here, a modification of the parent artery occlusion procedure for giant aneurysms of the internal carotid artery is described. Three patients with giant aneurysms of the internal carotid artery at the supraclinoid portion between the origin of the ophthalmic artery and the posterior communicating artery were treated by a combination of parent artery occlusion and occlusion of the origin of the ophthalmic artery. All patients had a giant aneurysm that manifested as cranial nerve palsy due to mass effect. A balloon occlusion test of the ipsilateral internal carotid artery together with the ophthalmic artery showed that permanent occlusion was tolerable. It was confirmed that the ipsilateral eye was supplied by maxilloophthalmic anastomosis instead of the ophthalmic artery. Cranial nerve palsy and visual acuity were markedly improved in two cases after the therapy. Follow-up selective internal and external carotid angiography did not demonstrate the aneurysm. Combined parent artery and ophthalmic artery occlusion is an effective treatment for a giant aneurysm located between the ophthalmic artery and the posterior communicating artery.