title: Usefulness of Suction Decompression Method Combined with Extradural Temporopolar Approach During Clipping of Complicated Internal Carotid Artery Aneurysm.
abstract: BACKGROUND
  Surgical clipping of complicated internal carotid artery (ICA) aneurysms can be very difficult because strong adhesion may hinder dissection of the perforators and surrounding anatomical structures from the aneurysm dome. We describe our experience in the clipping of these aneurysms using retrograde suction decompression (RSD) combined with extradural temporopolar approach (ETA) and discuss its advantages and pitfalls.
  
  
  METHODS
  This retrospective study included 30 consecutive patients with complicated ICA aneurysms treated by direct clipping with RSD assistance between March 2004 and March 2015.
  
  
  RESULTS
  The aneurysms were located on the paraclinoid ICA in 20 cases, the posterior communicating artery bifurcation in 8, ICA bifurcation in 1, and the anterior wall of the ICA in 1. No patient suffered any complication related to the puncture of the common carotid artery. Surgical outcome was good recovery in 20 patients, moderate disability in 4, severe disability in 4, and vegetative state in 1. One patient died of re-rupture of the aneurysm caused by incomplete dome clipping. Two patients suffered cerebral infarction, caused by anterior choroidal artery infarction in 1 patient.
  
  
  CONCLUSIONS
  Retrograde suction decompression combined with ETA is a useful technique for clipping of complicated ICA aneurysms.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan. Electronic address: naotani@ndmc.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Terushige
authors.initials: T
authors.lastname: Toyooka
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ueno
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tomura
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Tomiyama
authors.affiliation: Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakao
authors.affiliation: Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome
keywords: Extradural anterior clinoidectomy; Extradural temporopolar approach; Paraclinoid aneurysm; Suction decompression