• Mingzhe Zhang, Tetsuyoshi Horiuchi, Junpei Nitta, Raynald Liu, Yoshinari Miyaoka, Takuya Nakamura, and Kazuhiro Hongo.
• Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Harrison International Peace Hospital, Hebei Medical University, Hebei, China.
• World Neurosurg. 2019 Feb 1; 122: 129-132.

BackgroundThere is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms.Case DescriptionA 61-year-old woman presented with a 1-month history of double vision. Neuroimages revealed an unclippable giant internal carotid artery aneurysm located from the cavernous sinus to proximal site of the posterior communicating artery. Ipsilateral A1 of the anterior cerebral artery was hypoplastic, and posterior communicating artery was patent. Intraoperative proximal test occlusion at cervical internal carotid artery under neurophysiological monitoring, instead of preoperative balloon test occlusion, was performed to assess whether low-flow bypass was sufficient. The monitoring was unchanged during test occlusion, and the aneurysm was successfully trapped without high-flow bypass. Neither ischemic lesion nor neurologic deficits were found postoperatively.ConclusionsIntraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm.Copyright © 2018 Elsevier Inc. All rights reserved.

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