Abstract
The best treatment for intracranial aneurysm is neck-clipping. However, direct clipping of some giant aneurysms is difficult and surgical results are not satisfactory. We report a case of internal carotid artery giant aneurysm clipped by birect surgery. The patient is a 60-year-old female with visual field defect. Right carotid angiogram demonstrated a giant aneurysm (34×25×26mm) at the supraclinoid portion and no cross circulation was seen. The balloon occlusion test was performed and regional blood flow (rCBF) was assessed using 99mTC-HM-PAO SPECT. The neurological signs appeared 10 seconds after the inflation of balloon. A decrease of rCBF was demonstrated in the occluded cerebral hemisphere. Therefore, an interposed long saphenous vein bypass was utilized between the superior thyroid artery and precentral artery to supply high blood flow rapidly. The aneurysmal dome was punctured and the neck was clipped with 4 Sugita's clips under temporary trapping of internal carotid artery. The postoperative course was uneventful. A slight decrease of rCBF in the territory of the middle cerebral artery in the affected hemisphere was demonstrated following SPECT. Thus, there remain questions as to whether the vein graft should be ligated or not after successful neck clipping.
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