Detachable Balloon Technique を用いた, 直達手術不能な内頸動脈瘤へのアプローチ

Abstract

Using the detachable balloon technique, we treated two patients with inaccessible giant internal carotid aneurysms located at the cavernous and the petrosal portion.An angiogram of the first patient, a 27 year-old female with the right trigeminal and abducens paresis revealed a giant right internal carotid aneurysm at the petrosal protion. Three days after right STA-MCA double anastomoses, intravascular surgery was performed. The internal carotid aneurysm was trapped with Debrun's No.16 and No.9 balloons placed distal and proximal to the aneurysmal neck. Following the surgery, her neurological deficit disappeared, with no repeat ischemic episode. Neuroradiological examinations showed a thrombosed right internal carotid artery with no visualization of aneurysm.Angiogram of the second patient, a 56 year-old female with left oculomoter palsy, revealed a giani left internal carotid aneurysm at the cavernous portion. Using two Debrun's No.16 balloons, trapping of internal carotid aneurysm was performed three days after left STA-MCA anastomosis. whose anastomosis was not patent at the time of intravascular surgery. Following the trapping, transient sensory aphasia appeared. However, the oculomotor palsy gradually improved, and the aneurysm and the left internal carotid artery were found to be completely thrombosed on neuroradiological examination.We emphasize that the trapping of the internal carotid aneurysm by the detachable balloon technique with an EC-IC bypass is the safest and most beneficial method in terms of the lesser possibility of delayed ischemic complications caused by newly developed collateral vessels to the parent artery at a site close to the aneurysm.