OPEN SURGERY OF GIANT PARACLINOID ANEURYSMS IMPROVED BY INTRAOPERATIVE ANGIOGRAPHY AND ENDOVASCULAR RETROGRADE SUCTION DECOMPRESSION

In three consecutive cases of giant left sided paraclinoid aneurysms w e employed an endovascular retrograde suction decompression technique in combination with intra-operative angiography. A double-lumen balloo n catheter was placed in the left internal carotid artery by the trans femoral route. After balloon inflation and placement of a temporary cl ip distal to the aneurysm blood was aspirated and the aneurysm collaps ed. Thus further dissection of the aneurysm could easily be achieved a nd clips could be placed. Afterwards real-time digital subtraction ang iography was performed. Intra-operative angiography led to clip reposi tioning in all cases either due to a clip induced stenosis of the pare nt vessel, or because of incomplete aneurysm obliteration. Afterwards successful clipping could be confirmed in all cases. Outcome was excel lent in one case good in the other. The third case, extremely complica ted by an accompanying craniopharyngioma, showed a satisfactory outcom e, but presented new neurological deficits.