title: Treatment strategy for giant aneurysms in the cavernous portion of the internal carotid artery.
abstract: BACKGROUND
  As direct surgery to treat giant aneurysms of the ICA is difficult, ICA occlusion is the conventional treatment in patients with BTO tolerance. To determine whether bypass surgery should be performed after carotid occlusion by trapping or proximal occlusion, we developed a treatment strategy that includes BTO and SPECT.
  
  
  METHODS
  We report 19 patients with symptomatic giant aneurysms in the cavernous portion of ICA. The appropriate type of bypass surgery was determined by the results of BTO and SPECT. The type of ICA occlusion selected was based on the evaluation of retrograde filling of the aneurysm during BTO.
  
  
  RESULTS
  In all 19 patients, the ICA was sacrificed; 10 patients also underwent bypass surgery (low-flow bypass with STA-MCA anastomosis, n = 7; medium-flow bypass with radial artery graft, n = 2; high-flow bypass with vein graft, n = 1). Coil trapping was performed in 11 patients; proximal occlusion in 8. In 18 patients, there were no ischemic complications after treatment; 1 patient who had been treated by proximal ICA occlusion developed transient ischemia due to an intra-aneurysmal thrombus. Cranial nerve palsies were improved in 16 patients.
  
  
  CONCLUSIONS
  Based on our experience, we recommend that patients with giant aneurysms in the cavernous portion of the ICA be evaluated by BTO and SPECT. In conjunction with bypass surgery, ICA trapping or proximal occlusion constitutes an effective treatment strategy.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan. ykai@kaiju.medic.kumamoto-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kai
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yano
authors.forename: Takamasa
authors.initials: T
authors.lastname: Mizuno
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Kuroda
authors.forename: Tatemi
authors.initials: T
authors.lastname: Todaka
authors.forename: Hideo
authors.initials: H
authors.lastname: Takeshima
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kuratsu
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods / Q000592:standards; D004172:Diplopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome