Suction decompression assisted clipping of large and giant internal carotid artery aneurysms

Background: The microsurgical treatment of large and giant aneurysms poses a challenge and direct clipping is still prefferred: this is very dificulttask withrisksofintraoperativerupture. Microsurgical clipping with angioplastic arrangement of clips at the neck along with retrograde suction evacuation of the blood from the proximal internal carotid artery and aneurysm have been advocated in order to avoid these problems. Methods: This is a retrospective study of 13 patients with 13 large/ giant internal carotid artery aneurysms, who were managed surgically with retrograde suction decompression assisted clipping at our center over a period of last 2 years. The clinical profile, details of surgical management, complications and outcome of these patients were analysed. In the preoperative assessment, MRI/MR Angiography brain, 3Dimensional- Computed Tomography scan along with diagnostic angiography and balloon occlusion test were performed. The surgical technique has been described in detail. Results: The age ranged from 36-79 years old. There were 7 males and 6 females. 11 patients had unruptured aneurysms, while 2 presented with subarachnoid hemmorrhage. There were no peri-operative complications. In the post-operative period, one patient had severe disabilty with right sided hemiparesis due to the thrombo-embolic phenomenon, while the rest had an excellent outcom, with no mortality. Conclusions: Retrograde suction decompression is an effective aid in surgical management of large and giant aneurysms with many advantages. It is certainly an extremely useful adjunct for obtaining early proximal control so that safe clip application can be achieved. Intra-operative angiography can be performed easily to check adequacy of aneurysm clipping. Integration of endovascular techniques in management of complex aneurysms has made posible the advancement of the therapeutic armentarium.