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Direct clipping of a giant aneurysm at the cavernous portion of the internal carotid artery (IC-GA) is very difficult because of the topographical speciality of the cavernous sinus and because of the large size of the aneurysm. There have thus been various strategies for the treatment of IC-GA. Four cases of IC-GA have recently been treated at this hospital. The initial sympton in all cases was an ocular problem. Neurological findings on admission showed abducens nerve palsy in two cases, oculomotor nerve palsy in one and attenuation of visual acuity in one. A CT scan after infusion of contrast media revealed a high-density mass in three cases and a lowdensity mass with ring enhancement at the cavernous portion in another. In these cases, a carotid artery angiogram demonstrated a giant aneurysm at the cavernous portion with a diameter of more than 25mm. Gradual ligation of the internal carotid artery (IC) was performed with an extracranial to intracranial bypass (EC-IC bypass) in two cases and trapping of the IC with an EC-IC bypass in two other cases. Postoperative ischemic complication developed in one case in which trapping of the IC with an EC-IC bypass was performed, but marked improvement was obtained by medical treatment. Postoperative CT scans showed the formation of a thrombus in the cavernous portion in all cases. Finally, the combination of the EC-IC bypass procedure with IC ligation or with a trapping of the IC seems to be a effective method of treatment for IC-GA.

Intracranial Microvascular Anastomosis with Ligation and Trapping of the Internal Carotid Artery for Giant Aneurysm at IC-cavernous Portion