Introduction: Despite the continuing evolution of neurointervention, large and giant internal carotid artery (ICA) aneurysms remain challenging for endovascular treatment. Although the use of flow diverter (FD) has shown promising results, some fatal complications including delayed ipsilateral parenchymal hemorrhage or delayed aneurysm rupture can occur. Microsurgical management of large and giant ICA aneurysms is also challenging due to a number of reasons but with appropriate microsurgical techniques, surgical treatment can be the best treatment option for large and giant ICA aneurysms. We report our series of surgically treated large and giant ICA aneurysms using RSD method.
Methods: From January, 2005 to December, 2015, 68 of 117 large and giant aneurysms underwent microsurgical treatment. Among them, eighteen aneurysms were treated microsurgically using RSD method. Following data of eighteen aneurysms were reveiwed retrospectively : demographic data, aneurysmal size and location, initial presenting symptom, and surgical outcome assessed by the modified Rankin Scale (mRS).
Results: Eighteen aneurysms were treated microsurgically using RSD method and all the aneurysms were located on intradural ICA between the distal dural ring and the bifurcation of the ICA except one which was located on juxta-dural ring portion. Fifteen patients were women, and the average age was 53 years. Five aneurysms were giant, and the mean size was 18.9 mm. Five presented with subarachnoid hemorrhage. In 13 patients with unruptured aneurysm, 8 patients had a visual symptom, 4 had headache, 1 had tinnitus. Sixteen patients presented good or excellent results at discharge, and 2 patients presented poor results.
Conclusions: Our series demonstrates good results with these high-risk lesions. The RSD is safe and effective technique to treat large and giant ICA aneurysms, especially for patients not amenable for endovascular intervention.
Patient Care: Proper use of retrograde suction decompression technique will help cerebrovascular surgeon treat large/giant internal carotid artery aneurysm effectively.
Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of application of retrograde suction decompression technique when treating large/giant iternal carotid artery aneurysm.