DIRECT CLIPPING OF BASILAR TRUNK ANEURYSMS USING TEMPORARY BALLOON OCCLUSION

In the surgical treatment of basilar trunk aneurysms, there is still c onsiderable technical difficulty in gaining both proximal artery contr ol and a sufficient operative field. The authors describe their experi ence in five patients with basilar trunk aneurysms treated using tempo rary balloon occlusion and intraoperative digital subtraction angiogra phy. With the patient under general anesthesia, a heparinized angiogra phy catheter was guided into the dominant vertebral artery by means of the Seldinger technique. A silicone balloon catheter was introduced c oaxially through the angiography catheter to the basilar artery just p roximal to the aneurysm. The balloon was inflated tentatively to evalu ate the appropriate inflation volume, then the balloon catheter was wi thdrawn back into the angiography catheter to prevent thrombus formati on. After exposure of the aneurysm, the occlusion balloon was advanced again and inflated temporarily within the basilar artery to prevent p remature rupture and to facilitate dissection of the aneurysm. The mea n duration of temporary balloon occlusion was 22 minutes. There were n o patients with postoperative deficits attributable to the temporary o cclusion. The results of aneurysm clip placement were confirmed by int raoperative digital subtraction angiography immediately after clipping . No patient suffered from distal embolism or other complications rela ted to vessel catheterization. From this experience, it is concluded t hat this intraoperative endovascular technique can contribute to the s uccess of surgery for complex cerebral aneurysms, particularly for bas ilar trunk aneurysms in which proximal vascular control is difficult.