Carotid Ophthanlmic Artery Aneurysm |
Case #103: Flow-Assisted Neurosurgery |
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Courtesy F.T. Charbel, MD, Associate Professor, Dept. of Neurosurgery,
University of IL at Chicago
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Introduction |
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A patient presented with a giant ophthamic aneurysm which required multiple fenetrated clip placements around the
internal carotid artery (ICA).
First, the aneurysm was trapped by occluding the ICA in the neck and intracranially below the posterior
communicating artery.
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Baseline Flow Measurements |
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Flows
were measured in the anterior cerebral (ACA)and middle cerebral artery (MCA) before and after aneurysm trapping.
Flow in the M1 changed very little, from about 70 ml/min to 60 ml/min, so the surgeon determined that this would be
a safe temporary occlusion site.
The decision was made to try to preserve the internal carotid artery, if possible.
It was necessary to deflate the aneurysm, which was causing pressure on the optic nerve, before clipping.
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ACA baseline flow measurement
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MCA baseline flow measurement
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Post-Clip Flow Measurements |
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Two angle femetrated clips were placed around
the ICA.
Flow measurements after clipping showed that ICA
flow had dropped from 78 to 33 ml/min.
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ICA flow compromised after clipping.
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Post-Clip Adjustment Flow Measurements |
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It took many clip reapplications, coupled with
flow measurements, to improve ICA flow to the optimal value of 66 mL/min.
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After several clip repositionings, flow increased to 66 ml/min
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Summary |
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The post-operative angiogram showed excellent
clipping. However, it was clear that, despite the multiple views from the radiographers, it was impossible to know if there was truly complete absence of compromise of the
internal carotid artery. This exemplifies the importance of flow-based neurosurgery.
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