Usefulness of Suction Decompression Method Combined with Extradural Temporopolar Approach During Clipping of Complicated Internal Carotid Artery Aneurysm

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. MATERIALS AND 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.