Combining Internal Carotid Ligation with Low-Flow Bypass for Treating Large-Giant Cavernous Sinus Segment Aneurysms: A Report of Four Cases.

OBJECTIVE: We summarize the treatment effectiveness and experience of 4 patients who underwent internal carotid ligation combined with low-flow bypass as a treatment for large-giant cavernous sinus segment (CS ICA) aneurysms.

METHODS: Surgery-suitable patients with large-giant CS ICA aneurysms received internal carotid ligation combined with low-flow superficial temporal artery-middle cerebral artery bypass surgery. All the patients were followed up for aneurysm prognosis, anastomosis patency, and occurrences of low-flow-related ischemic complications.

RESULTS: Four suitable cases between 2012 and 2015 were studied. They consisted of 1 man and 3 women, with the mean age of 56.3 ± 11.9 years. Maximum and minimum aneurysm diameter were 26 mm and 20 mm, respectively, with an average of 22.3 ± 2.6 mm. During surgery, the mean blockage time of the middle cerebral artery was 19.3 ± 1.3 minutes. Postoperative computed tomography angiography examination indicated that thrombosis could be found in the aneurysm lumen. No patient was found with low-flow-related ischemic complications after surgery. The mean postoperative follow-up time was 25.0 ± 10.4 months. During the follow-up period, no patient showed low-flow-related ischemic complications or aneurysm recurrence.

CONCLUSIONS: For patients with large-giant CS ICA aneurysms, treatment of internal carotid ligation combined with low-flow superficial temporal artery-middle cerebral artery bypass surgery was an effective and safe surgical strategy. To improve surgery safety and for appropriate selection of surgery cases, the details, risks, and benefits associated with the surgery should be considered by the surgeon.