Retrograde Suction Decompression Assisted Clipping of Large and Giant Cerebral Aneurysms: Our Experience

Abstract

Objective: The aim of this study was to present our experience with retrograde suction decompression in clipping of large and giant cerebral aneurysms and analyze its advantages and pitfalls.

Methods: A retrospective analysis of 27 patients with large and giant intracranial aneurysms treated by suction decompression assisted clipping between November 2005 and February 2010 was done. The surgical technique and the outcome of patients were reviewed.

Results: All aneurysms were successfully clipped, and postoperative 3-D CTA or DSA revealed no major branch occlusion or residual aneurysm. There was no surgical mortality in both giant and large aneurysm groups.

Conclusion: Retrograde suction decompression is a successful adjunct to clipping of large and giant cerebral aneurysms.

suction decompression - clipping - large aneurysms - giant aneurysms

References

• 1 Fulkerson DH, Horner TG, Payner TD. et al . Endovascular retrograde suction decompression as an adjunct to surgical treatment of ophthalmic aneurysms: analysis of risks and clinical outcomes.  Neurosurgery. 2009;  64 (3 Suppl) 107-111
• 2 Fan YW, Chan KH, Lui WM. et al . Retrograde suction decompression of paraclinoid aneurysm – a revised technique.  Surg Neurol. 1999;  51 129-131
• 3 Stendel R, Pietilä T, Al Hassan AA. et al . Intraoperative microvascular Doppler ultrasonography in cerebral aneurysm surgery.  J Neurol Neurosurg Psychiatry. 2000;  68 29-35
• 4 Xu BN, Sun ZH, Jiang JL. et al . Surgical management of large and giant intracavernous and paraclinoid aneurysms.  Chin Med J (Engl). 2008;  20: 121 1061-1064
• 5 Mizoi K, Takahashi A, Yoshimoto T. et al . Combined endovascular and neurosurgical approach for paraclinoid internal carotid artery aneurysms.  Neurosurgery. 1993;  33 986-992
• 6 Kato Y, Sano H, Watabe T. et al . Minimally invasive procedures for the management of large and giant aneurysms: our experience.  Surgery for Cerebral Stroke. 2009;  37 156-161
• 7 Kato Y, Sano H, Katada K. et al . Application of three-dimensional CT angiography (3D-CTA) to cerebral aneurysms.  Surg Neurol. 1999;  52 113-121
• 8 Sano H, Kato Y, Shankar K. et al . Treatment and results of partially thrombosed giant aneurysms.  Neurol Med Chir (Tokyo). 1998;  38 (Suppl) 58-61
• 9 Steiger HJ, Lins F, Mayer T. et al . Temporary aneurysm orifice balloon occlusion as an alternative to retrograde suction decompression for giant paraclinoid internal carotid artery aneurysms: technical note.  Neurosurgery. 2005;  56 E442
• 10 Parkinson RJ, Bendok BR, Getch CC. et al . Retrograde suction decompression of giant paraclinoid aneurysms using a No. 7 French balloon-containing guide catheter. Technical note.  J Neurosurg. 2006;  105 479-481
• 11 Flamm ES. Suction decompression of aneurysms. Technical note.  J Neurosurg. 1981;  54 275-276
• 12 Batjer HH, Samson DS. Retrograde suction decompresssion of giant paraclinoidal aneurysms. Technical note.  J Neurosurg. 1990;  73 305-306
• 13 Tamaki N, Kim S, Ehara K. et al . Giant carotid- ophthalmic artery aneurysms: direct clipping utilizing the “trapping-evacuation” technique.  J Neurosurg. 1991;  74 567-572
• 14 Scott JA, Horner TG, Leipzig TJ. Retrograde suction decompression of an ophthalmic artery aneurysm using balloon occlusion. Technical note.  J Neurosurg. 1991;  75 146-147
• 15 Fulkerson DH, Horner TG, Payner TD. et al . Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: a 16-year experience of a combined neurosurgical and endovascular team.  Neurosurgery. 2009;  64 218-229
• 16 Arnautović KI, Al-Mefty O, Angtuaco E. A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms.  Surg Neurol. 1998;  50 504-518
• 17 Elhammady MS, Nakaji P, Farhat H. et al . Balloon-assisted clipping of a large paraclinoidal aneurysm: a salvage procedure.  Neurosurgery. 2009;  65 E1210-1211
• 18 Hoh DJ, Larsen DW, Elder JB. et al . Novel use of an endovascular embolectomy device for retrograde suction decompression-assisted clip ligation of a large paraclinoid aneurysm: technical case report.  Neurosurgery. 2008;  62 (5 Suppl 2) ONSE412-ONSE413
• 19 Shibata Y, Fujita S, Kawaguchi T. et al . Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery.  Neurol Med Chir (Tokyo). 2000;  40 30-35
• 20 Imizu S, Kato Y, Sangli A. et al . Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope.  Minim Invas Neurosurg. 2008;  51 199-203
• 21 Dashti R, Laakso A, Niemelä M. et al . Application of microscope integrated indocyanine green video-angiography during microneurosurgical treatment of intracranial aneurysms: a review.  Acta Neurochir Suppl. 2010;  107 107-109
• 22 Profeta G, De Falco R, Ambrosio G. et al . Endoscope-assisted microneurosurgery for anterior circulation aneurysms using the angle-type rigid endoscope over a 3-year period.  Childs Nerv Syst. 2004;  20 811-815

Correspondence