title: Surgical distal outflow occlusion for the treatment of complex intracranial aneurysms: experience with 18 cases.
abstract: BACKGROUND
  Selected intracranial aneurysms still require parent artery occlusion. Although such occlusion is usually performed proximal to the aneurysm, in rare instances, it may be difficult or impossible to access the proximal parent artery.
  
  
  OBJECTIVE
  To describe the use of parent artery sacrifice distal to the aneurysm (distal outflow occlusion) in the management of complex aneurysms not amenable to standard microsurgical or endovascular therapy.
  
  
  METHODS
  We reviewed a comprehensive database of intracranial aneurysms evaluated between 1997 and 2013. Hospital records, neuroimaging studies, operative reports, and outpatient clinic notes were examined for all patients treated with distal outflow occlusion.
  
  
  RESULTS
  Eighteen patients (11 women, 7 men; ages 28-69 years) underwent surgical distal outflow occlusion. Eight (44%) underwent concomitant distal revascularization. Intraoperative and delayed postoperative angiography was performed in every case. Nine presented with acute subarachnoid hemorrhage, 1 had a remote bleeding episode. The remaining lesions were unruptured; 3 were discovered incidentally, 3 had symptomatic cerebral edema, 1 had transient ischemic attacks, and 1 had cranial neuropathy. The average follow-up period was 6.5 years; no patient was lost to follow-up review. Two aneurysms required delayed endovascular treatment. Overall, 16 patients achieved a good outcome, 1 had moderate disability, and 1 died.
  
  
  CONCLUSIONS
  We describe our experience with distal outflow occlusion in the treatment of complex aneurysms not amenable to primary clip reconstruction or endovascular therapy. This technique has been described in very limited fashion in the past and may be particularly useful for patients requiring parent artery occlusion when proximal occlusion is challenging or impossible.
authors.affiliation: National Brain Aneurysm Center at the John Nasseff Neuroscience Institute, Allina Health, United Hospital, St. Paul, Minnesota.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Nussbaum
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D060205:Therapeutic Occlusion; D016896:Treatment Outcome