[Retrograde suction decompression technique for paraclinoidal aneurysms].

Abstract

INTRODUCTION: Paraclinoidal carotid artery aneurysms pose technical surgical problems with regard to acquisition of the proximal control and safe intracranial exposure due to brisk retrograde flow through the ophthalmic artery and cavernous branches. Simple trapping of the aneurysm by cervical internal carotid artery clamping and intracranial clipping may not adequately soften the lesion. PATIENTS AND METHODS: Fifteen patients with giant and complexes large paraclinoidal aneurysms were operated on. We utilized microneurosurgical techniques, specialized neuroanesthesia, mild hypothermia, barbiturical brain protection, electroencephalographic monitoring and retrograde suction decompression technique described by Batjer et al. Patients were followed at Intensive Care Unit and were evaluated three months later. RESULTS: . 74% were female and there was a 14% of multiplicity. There was not intraoperative aneurysmal rupture and all aneurysms were clipped. We obtained 67% of good recovery, 27% of partial recovery, and no patient died. CONCLUSION: Retrograde suction decompression technique was useful for surgical treatment of paraclinoidal aneurysms. We introduced three technical modifications to the original procedure: intraoperative mild hypothermia, heparin utilization for endovascular procedure and intraoperative surgical evaluation of the vascular anatomical wall to select optimal area for angiocatheter insertion and temporary clipping. Modifications improve results.