Direct operation on intracavernous giant aneurysm

Abstract

Operation on an intracranial giant aneurysm is one of the most difficult types of surgery. On the other hand operation of the cavernous sinus poses a challenge to neurosurgeons. We had a case of bilateral intracavernous giant aneurysms clipped by direct surgery. This woman developed bilateral abducens palsy, CT showed round contrast enhanced masses situated in both cavernous sinuses. Angiography showed bilateral intracavernous giant aneurysms. The patient was followed up in the outpatient clinic. She started complaining of a headache 2 years afterward. Repeat angiography showed the aneurysm increasing in size. An operation was scheduled following a balloon Matas test monitored by EEG, SEP and clinical symptoms. Frontotemporal craniotomy was done by the usual method. The anterior clinoid process and sphenoid wing were drilled. The cavernous sinus was opened after temporary trapping of the internal carotid artery. The aneurysm was opened and cut to make a carotid artery by clipping. The embolus and air was flushed out before opening and temporary clips. Patient had developed ophthalmoplegia which was improving 3 months after the operation.