Abstract
A 51-year-old man presented with a persistent headache and blurred vision. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) showed a giant aneurysm of the right internal carotid artery (ICA) measuring approximately 30 × 25 mm. After a balloon test occlusion (BTO) of the right ICA, preoperative DSA showed good crossflow from the left-hand ICA via the anterior communicating artery (AcomA). Interdisciplinary discussion resulted in the decision to go for microsurgical treatment. The giant aneurysm was approached via a right-hand pterional craniotomy and completely excluded from circulation using the trapping technique with two clips on the ICA. Postoperative DSA confirmed the complete occlusion of the aneurysm. The patient did not develop any new neurological symptoms during the follow-up. The management of large and giant aneurysms of the PcomA by means of the trapping technique is the main topic of this chapter.
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Balamurugan S, Agrawal A, Kato Y, Sano H. Intra operative indocyanine green videoangiography in cerebrovascular surgery: an overview with review of literature. Asian J Neurosurg. 2011;6:88–93. https://doi.org/10.4103/1793-5482.92168.
Barrow DL, Alleyne C. Natural history of giant intracranial aneurysms and indications for intervention. Clin Neurosurg. 1995;42:214–44.
Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355:928–39. https://doi.org/10.1056/NEJMra052760.
Drake CG. Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg. 1979;26:12–95. https://doi.org/10.1093/neurosurgery/26.cn_suppl_1.12.
Gewirtz RJ, Awad IA. Giant aneurysms of the anterior circle of Willis: management outcome of open microsurgical treatment. Surg Neurol. 1996;45(5):409–20; discussion 420–1. https://doi.org/10.1016/0090-3019(95)00437-8.
Gnanalingham KK, Colquhoun I, van Dellen J. Temporal lobe seizures: unusual presentation of a giant unruptured posterior communicating artery aneurysm. Br J Neurosurg. 2003;17(4):370–1. https://doi.org/10.1080/02688690310001601324.
Jahromi BS, Mocco J, Bang JA, Gologorsky Y, Siddiqui AH, Horowitz MB, Hopkins LN, Levy EI. Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms. Neurosurgery. 2008;63(4):662–74; discussion 674–5. https://doi.org/10.1227/01.NEU.0000325497.79690.4C.
Lawton MT, Spetzler RF. Surgical management of giant intracranial aneurysms: experience with 171 patients. Clin Neurosurg. 1995;42:245–66.
Lawton MT, Spetzler RF. Surgical strategies for giant intracranial aneurysms. Neurosurg Clin N Am. 1998;9(4):725–42.
Lesley WS, Rangaswamy R. Balloon test occlusion and endosurgical parent artery sacrifice for the evaluation and management of complex intracranial aneurysmal disease. J Neurointerv Surg. 2009;1(2):112–20. https://doi.org/10.1136/jnis.2009.000539.
Linskey ME, Jungreis CA, Yonas H, Hirsch WL Jr, Sekhar LN, Horton JA, Janosky JE. Stroke risk after abrupt internal carotid artery sacrifice: accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT. AJNR Am J Neuroradiol. 1994;15(5):829–43.
Locksley HB, Sahs AL, Sandler R. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. 3. Subarachnoid hemorrhage unrelated to intracranial aneurysm and A-V malformation. A study of associated diseases and prognosis. J Neurosurg. 1966;24(6):1034–56. https://doi.org/10.3171/jns.1966.24.6.1034.
Mathis JM, Barr JD, Jungreis CA, Yonas H, Sekhar LN, Vincent D, Pentheny SL, Horton JA. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. AJNR Am J Neuroradiol. 1995;16:749–54.
Matsukawa H, Fujii M, Akaike G, Uemura A, Takahashi O, Niimi Y, Shinoda M. Morphological and clinical risk factors for posterior communicating artery aneurysm rupture. J Neurosurg. 2014;120(1):104–10. https://doi.org/10.3171/2013.9.JNS13921.
Misra BK, Warade A, Purandare H. Giant intracranial aneurysms: microsurgery. In: Singh VP, Nair MD, editors. Progress in clinical neuroscience, vol. 29. Delhi: Thieme; 2014. p. 122–42.
Sorteberg A, Bakke SJ, Boysen M, Sorteberg W. Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain. Neurosurgery. 2008;63(4):651–60; discussion 660–1. https://doi.org/10.1227/01.NEU.0000325727.51405.D5.
Stendel R, Pietilä T, Al Hassan AA, Schilling A, Brock M. Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry. 2000;68(1):29–35. https://doi.org/10.1136/jnnp.68.1.29.
Velat GJ, Zabramski JM, Nakaji P, Spetzler RF. Surgical management of giant posterior communicating artery aneurysms. Neurosurgery. 2012;71(1 Suppl Operative):43–50; discussion 51. https://doi.org/10.1227/NEU.0b013e31824c05a0.
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378): 103–10. https://doi.org/10.1016/s0140-6736(03)13860-3.
Yaşargil M. Giant intracranial aneurysms. In: Yaşargil MG, editor. Microneurosurgery, volume 2: Clinical considerations: surgery of the intracranial aneurysms and results. New York: Thieme-Stratton; 1984. p. 296–304.
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Haj, A., Brawanski, A., Wendl, C., Schebesch, KM. (2020). Posterior Communicating Artery Aneurysm: Surgical Trapping of a Giant Posterior Communicating Artery Aneurysm – Balloon Test Occlusion and Clip Ligation for Trapping. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_159-1
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