Abstract
A 53-year-old female patient presented with rapidly progressing visual loss due to optic atrophy on the left-hand side. Computed tomography (CT), magnetic resonance imaging (MRI), and digital subtraction angiography (DSA) showed a giant paraclinoid aneurysm of the internal carotid artery (ICA) on the left-hand side, measuring approximately 35 × 23 mm, with subsequent compression of the left optic nerve. After interdisciplinary discussion, we decided to treat the aneurysm in two stages. Microsurgical partial clipping was followed by implanting flow diverter stents. Surgery was conducted under deep hypothermia and circulatory arrest. The giant aneurysm was approached via a left-sided pterional craniotomy and an anterior clinoidectomy using six Sugita clips. Eight months after this initial surgery, eight flow diverter stents were also implanted. Control DSA conducted a further 8 months after the flow diverter implantation confirmed complete occlusion of the aneurysm with reconstruction of the left ICA. At that time, the visual impairment had not improved, but the patient showed no new neurological symptoms. One year after the flow diverter treatment, a thrombotic occlusion of the left ICA occurred, which required emergent thrombectomy. The management of large and giant aneurysms of the distal ICA using induced hypothermia and circulatory arrest is the main topic of this chapter.
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Haj, A., Brawanski, A., Wendl, C., Schebesch, KM. (2019). Paraclinoid Internal Carotid Artery Aneurysm: Two-Stage Treatment of a Giant Paraclinoid Internal Carotid Artery Aneurysm with Partial Clip Ligation, Followed by Flow Diverter Implantation; Late Thrombotic Flow Diverter Occlusion, Recanalized by Endovascular Means, with Good Clinical Outcome. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_118-1
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