Extracranial-intracranial bypass and aneurysm trapping for the treatment of large and giant paraclinoid carotid aneurysms

Abstract

Objective To explore the methods and effects of extracranial-intracranial (EC-IC) bypass and aneurysm trapping for the treatment of large and giant paraclinoid aneurysms. Methods The clinical data of 12 patients with paraclinoid aneurysms were analyzed retrospectively. Those patients were admitted to Department of Neurosurgery, the First Affiliated Hospital of Soochow University between April 2014 and February 2018. There were totally 12 aneurysms in 12 patients, including 8 giant and 4 large aneurysms. There were 1 case of postoperative bleeding of aneurysm embolization and 1 case of thrombotic aneurysms and 1 case of blood blister-like aneurysm. All cases underwent EC-IC high flow bypass and trapping of the aneurysms. The outcomes were evaluated based on the Glasgow Outcome Scale (GOS). Results Intraoperative fluorescein angiography and ultrasound suggested bridge vascular patency. The assessment at discharge indicated a GOS of 4-5 (good outcome) in 9 cases and GOS of 2-3 (severe disability) in 3 cases. There was no death. One was lost to follow-up. Eleven patients were followed up for 6-46 months post operation. The GOS of 4-5 (good outcome) was reported in 10 cases and 2 (severe disability) in 1 case. The bridge vascular patency was revealed in 10 cases. Conclusion The operation of EC-IC bypass combined with aneurysm trapping seems effective in the treatment of large and giant paraclinoid aneurysms. Key words: Intracranial aneurysm; Carotid artery, internal; Treatment outcome; Prognosis; Cerebral revascularization