Occlusion of the important arterial branches or incomplete neck clipping may occur during internal carotid artery aneurysm surgery due to small arterial branches from the IC adhering to the aneurysm inself, or due to insufficient visualization of the aneurysmal neck by the aneurysmal dome. Therefore it is mandatory that these small arterial branches be completely dissected without causing circulatory disturbances before approaching the neck of the aneurysm. However, there is a danger of premature rupture by such dissection under normotension, which may cause life threatening bleeding especially in IC aneurysm surgery.
We have currently adopted the procedure of temporarily occluding the anterior choroidal artery, the posterior communicating artery or the internal carotid artery, or trapping the IC, or a combination of these during surgery of the IC aneurysm under the administration of a brain protective substance (Sendal cocktail 20%mannitol 10ml/kg, Vit. E 10mg/kg, Phenytoin 10mg/kg). And after complete dissection of the aneurysmal neck and absence of any vascular involvement is confirmed, ligation is performed to produce an aneurysmal neck followed by clipping.
In this paper, our operative procedures for IC aneurysms are described.