Combined Treatment of Intracranial Aneurysms: Surgical Clipping After Endovascular Bypass by the Use of a New Free Flow Balloon—A New Method : Neurosurgery

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Combined Treatment of Intracranial Aneurysms

Surgical Clipping After Endovascular Bypass by the Use of a New Free Flow Balloon—A New Method

Mpairamidis, Evriviadis

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Neurosurgery 67(2):p E521, August 2010. | DOI: 10.1227/01.NEU.0000384048.10659.3A
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To the Editor:

Treatment options of cerebral aneurysms are basically two: direct surgical clipping and endovascular coil embolization. Treatment of each patient requires a multidisciplinary approach of a neurosurgeon and the interventional radiologists. Some patients—for example, those with basilar bifurcation aneurysms, difficult anterior circulation aneurysms, the elderly, or those in poor clinical condition—are more likely to require coil embolization, whereas others—such as those with large middle cerebral aneurysms—are more likely to require direct operative treatment.

Herewith, we introduce a new technique that comes to help the surgeon when surgical treatment has been decided. To better understand the aspect of the procedure we divide the entire operating time into 3 phases The first phase involves the placement of a free flow balloon in the exact location of the aneurysm under angiographic guidance (Figure, A). This balloon will be fashioned in a way to exclude the aneurysm from the blood circulation while at the same time it will allow blood flow through its lumen. In the second phase the patient is taken to the operating theatre and a direct surgical clipping will be performed in a standard fashion (Figure, B). In the last phase the balloon will be deflated (Figure, C). It is likely that this method will reduce intraoperative ruptures. Also this balloon could be used in coiling procedures after introducing the coiling material since this free flow balloon will offer more operative time when it is inflated into the vessel. Furthermore the greatest value of this method will be in the cases of giant aneurysms that need superficial temporal artery-middle cerebral artery (STA-MCA) bypass after preoperative confirmation with test balloon occlusion. It is obvious that by this method, a difficult and danger procedure can be avoided. In conclusion this new combined method comes to offer safer aneurysm dissection without temporary proximal clipping and an avoidance of STA-MCA bypass. The problem to be solved is the construction of the balloon.


Evriviadis Mpairamidis

Athens, Greece

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