• Yutaka Kai, Jun-ichiro Hamada, Motohiro Morioka, Shigetoshi Yano, Takamasa Mizuno, Jun-ichiro Kuroda, Tatemi Todaka, Hideo Takeshima, and Jun-ichi Kuratsu.
• Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan. ykai@kaiju.medic.kumamoto-u.ac.jp
• Surg Neurol. 2007 Feb 1; 67 (2): 148-55; discussion 155.

BackgroundAs direct surgery to treat giant aneurysms of the ICA is difficult, ICA occlusion is the conventional treatment in patients with BTO tolerance. To determine whether bypass surgery should be performed after carotid occlusion by trapping or proximal occlusion, we developed a treatment strategy that includes BTO and SPECT.MethodsWe report 19 patients with symptomatic giant aneurysms in the cavernous portion of ICA. The appropriate type of bypass surgery was determined by the results of BTO and SPECT. The type of ICA occlusion selected was based on the evaluation of retrograde filling of the aneurysm during BTO.ResultsIn all 19 patients, the ICA was sacrificed; 10 patients also underwent bypass surgery (low-flow bypass with STA-MCA anastomosis, n = 7; medium-flow bypass with radial artery graft, n = 2; high-flow bypass with vein graft, n = 1). Coil trapping was performed in 11 patients; proximal occlusion in 8. In 18 patients, there were no ischemic complications after treatment; 1 patient who had been treated by proximal ICA occlusion developed transient ischemia due to an intra-aneurysmal thrombus. Cranial nerve palsies were improved in 16 patients.ConclusionsBased on our experience, we recommend that patients with giant aneurysms in the cavernous portion of the ICA be evaluated by BTO and SPECT. In conjunction with bypass surgery, ICA trapping or proximal occlusion constitutes an effective treatment strategy.

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