Indication and Problems of Extracranial-intracranial Bypass in the Treatment of Giant Aneurysms of the Internal Carotid Artery

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The outcome of giant intracranial aneurysms is still unfavorable, even though neurosurgical technique has advanced recently. We report 2 patients with giant aneurysm of the internal carotid artery (ICA) who were treated by trapping and high flow bypass, using saphenous vein, and made successful recoveries.<BR>Case I: A 58-year-old woman presented with a progressing visual disturbance on the left side. Preoperative MRI and angiograms demonstrated a giant aneurysm arising from the left ICA. She became drowsy and had right hemiparesis on balloon occlusion test. She underwent a saphenous vein graft with trapping, because of premature rupture. Postoperatively, she had mild expressive aphasia and right hemiparesis, but she recovered well with physical therapy and returned to social life as a housewife.<BR>Case 2: A 46-year-old woman presented with a progressing visual disturbance on both sides. Preoperative MRI and angiograms revealed a giant thrombosed aneurysm of the left ICA. She was asymptomatic, but hemispheric cerebral blood flow on the left side was reduced on balloon occlusion test. She underwent a saphenous vein graft, trapping and evacuation of intraaneurysmal blood, because the left ICA was markedly arteriosclerotic. Postoperatively, her visual disturbance improved conspicuously and she returned to social life completely.<BR>Needless to say, the ideal treatment of cerebral aneurysm is a neck clipping, but high flow bypass with trapping could be indicated, when the neck cannot be clipped for various reasons in patients with giant intracranial aneurysm.
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