COMBINED EXTRACRANIAL-INTRACRANIAL BYPASS AND INTRAOPERATIVE BALLOON OCCLUSION FOR THE TREATMENT OF INTRACAVERNOUS AND PROXIMAL CAROTID-ARTERY ANEURYSMS

A protocol for the treatment of selected intracavernous and proximal i nternal carotid artery aneurysms is described. Intraoperative angiogra phy is used together with intraoperative balloon occlusion of the inte rnal carotid artery and electroencephalography to optimize the timing of an extracranial-intracranial bypass before occlusion of the carotid artery and to provide intraoperative documentation of graft patency. This protocol has been used successfully in seven patients with comple x aneurysms that were unsuitable for other endovascular methods or a d irect microsurgical approach. Six aneurysms were located in the cavern ous sinus, and one was located on the supraclinoid portion of the inte rnal carotid artery. There were no permanent complications; one patien t had a brief episode of dysphasia, which resolved without sequelae.