title: Complex paraclinoidal and giant cavernous aneurysms: importance of preoperative evaluation with temporary balloon occlusion test and SPECT.
abstract: In the treatment of complex paraclinoidal and giant cavernous aneurysms, preservation of the patency of the internal carotid artery (ICA) is not always possible, and therapeutic occlusion of the carotid is still an important option for their management. A complete preoperative evaluation of the carotid reserve circulation, including the use of temporary balloon occlusion test and single photon emission computerized tomography (SPECT) should be included in the current paradigms of paraclinoidal and intracavernous aneurysms management. We present a series of fifteen patients with sixteen giant or complex carotid cavernous or ophthalmic aneurysms that were treated following a protocol for our preoperative decision-making analysis. Extracranial to intracranial saphenous vein bypass was reserved to the cases where carotid occlusion would be associated with high risk of ischemic complications and was performed in three patients. Besides the difficulties in dealing with those complex aneurysms, good clinical outcome was possible in our experience with the designed paradigm.
authors.affiliation: Serviço de Neurocirurgia, Departamento de Cirurgia, Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, UFRJ, 21941-590 Rio de Janeiro RJ, Brazil. aversa@hucff.ufrj.br
authors.forename: Antônio Aversa
authors.initials: AA
authors.lastname: do Souto
authors.forename: Flavio S
authors.initials: FS
authors.lastname: Domingues
authors.forename: Gaudencio
authors.initials: G
authors.lastname: Espinosa
authors.forename: Eduardo
authors.initials: E
authors.lastname: Wajnberg
authors.forename: Haroldo
authors.initials: H
authors.lastname: Chagas
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Tragante
authors.forename: Marcelo
authors.initials: M
authors.lastname: Altino
authors.forename: Charles
authors.initials: C
authors.lastname: André
authors.forename: Jorge Marcondes
authors.initials: JM
authors.lastname: de Souza
mesh_terms: D000328:Adult; D021721:Balloon Occlusion; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015899:Tomography, Emission-Computed, Single-Photon