Surgical Experience on directly treated 18 Intracranial Aneurysm

ABSTRACT

Eighteen intracranial aneurysm were operated upon with direct approach under the surgical microscope. The aneurysms arising in the anterior communicating artery(8) were most common, followed by internal carotid artery(6), middle cerebral artery(2), posterior communicating artery(1), anterior cerebral artery(1) in order. We preferred pterional approach. And the timing of operation was scheduled as soon as possible if other conditions permitted. Mannitol administration, hypotensive anesthesia, Sugita clip, biobond or aneurysmostat were utilizes during the operation. The aneurysmal neck was clipped with Sugita clip mostly, but wrapping was also carried out in certain condition. The elasticity of the Sugita clip is seemed to be better than others. In even Sugita clip, however, overopening at the time of clipping made it weak and resulted in incomplete occlusion of the aneurysm neck. To obtain successful aneurysmal surgical result, following surgical care should be taken. 1) lesser brain retraction, 2) complete removal of subarachnoid clots, 3) Meticulous hemostasis of micro-oozing from bridging vein and internal dural surface. Uneventful two surgical cases were found to be fatal due to hidden post-operative oozing clots from the internal surface of the dura.