Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparative Analysis of Feasibility of the Retrograde Suction Decompression Technique for Microsurgical Treatment of Large and Giant Internal Carotid Artery Aneurysms

  • Kim, Sunghan (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Park, Keun Young (Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine) ;
  • Chung, Joonho (Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Yong Bae (Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Jae Whan (Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Huh, Seung Kon (Department of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2021.03.12
  • Accepted : 2021.05.12
  • Published : 2021.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Retrograde suction decompression (RSD) is an adjuvant technique used for the microsurgical treatment of large and giant internal carotid artery (ICA) aneurysms. In this study, we analyzed the efficacy and safety of the RSD technique for the treatment of large and giant ICA aneurysms relative to other conventional microsurgical techniques. Methods : The aneurysms were classified into two groups depending on whether the RSD method was used (21 in the RSD group vs. 43 in the non-RSD group). Baseline characteristics, details of the surgical procedure, angiographic outcomes, clinical outcomes, and procedure-related complications of each group were reviewed retrospectively. Results : There was no significant difference in the rates of complete neck-clipping between the RSD (57.1%) and non-RSD (67.4%) groups. Similarly, there was no difference in the rates of good clinical outcomes (modified Rankin Scale score, 0-2) between the RSD (85.7%) and non-RSD (81.4%) groups. Considering the initial functional status, 19 of 21 (90.5%) patients in the RSD group and 35 of 43 (81.4%) patients in the non-RSD group showed an improvement or no change in functional status, which did not reach statistical significance. Conclusion : In this study, the microsurgical treatment of large and giant intracranial ICA aneurysms using the RSD technique obtained competitive angiographic and clinical outcomes without increasing the risk of procedure-related complications. The RSD technique might be a useful technical option for the microsurgical treatment of large and giant intracranial ICA aneurysms.

Keywords

References

  1. Arnautovic KI, Al-Mefty O, Angtuaco E : A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms. Surg Neurol 50 : 504-518; discussion 518-520, 1998 https://doi.org/10.1016/S0090-3019(97)80415-6
  2. Batjer HH, Kopitnik TA, Giller CA, Samson DS : Surgery for paraclinoidal carotid artery aneurysms. J Neurosurg 80 : 650-658, 1994 https://doi.org/10.3171/jns.1994.80.4.0650
  3. Batjer HH, Samson DS : Retrograde suction decompression of giant paraclinoidal aneurysms. Technical note. J Neurosurg 73 : 305-306, 1990 https://doi.org/10.3171/jns.1990.73.2.0305
  4. Cataldi S, Bruder N, Dufour H, Lefevre P, Grisoli F, Francois G : Intraoperative autologous blood transfusion in intracranial surgery. Neurosurgery 40 : 765-771; discussion 771-772, 1997 https://doi.org/10.1097/00006123-199704000-00021
  5. Cho YD, Park JC, Kwon BJ, Han MH : Endovascular treatment of largely thrombosed saccular aneurysms: follow-up results in ten patients. Neuroradiology 52 : 751-758, 2010 https://doi.org/10.1007/s00234-009-0622-8
  6. Cognard C, Weill A, Castaings L, Rey A, Moret J : Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology 206 : 499-510, 1998 https://doi.org/10.1148/radiology.206.2.9457205
  7. Drake CG : Giant intracranial aneurysms: experience with surgical treatment in 174 patients. Clin Neurosurg 26 : 12-95, 1979 https://doi.org/10.1093/neurosurgery/26.CN_suppl_1.12
  8. Fan YW, Chan KH, Lui WM, Hung KN : Retrograde suction decompression of paraclinoid aneurysm--a revised technique. Surg Neurol 51 : 129-131, 1999 https://doi.org/10.1016/S0090-3019(98)00093-7
  9. Flamm ES : Suction decompression of aneurysms. Technical note. J Neurosurg 54 : 275-276, 1981 https://doi.org/10.3171/jns.1981.54.2.0275
  10. Flores BC, White JA, Batjer HH, Samson DS : The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature. J Neurosurg 130 : 902-916, 2018 https://doi.org/10.3171/2017.11.jns17546
  11. Fulkerson DH, Horner TG, Payner TD, Leipzig TJ, Scott JA, Denardo AJ, et al. : Endovascular retrograde suction decompression as an adjunct to surgical treatment of ophthalmic aneurysms: analysis of risks and clinical outcomes. Neurosurgery 64 (3 Suppl) : ons107-ons111; discussion ons111-ons112, 2009
  12. Guresir E, Wispel C, Borger V, Hadjiathanasiou A, Vatter H, Schuss P : Treatment of partially thrombosed intracranial aneurysms: single-center series and systematic review. World Neurosurg 118 : e834-e841, 2018 https://doi.org/10.1016/j.wneu.2018.07.063
  13. Jo KI, Yang NR, Jeon P, Kim KH, Hong SC, Kim JS : Treatment outcomes with selective coil embolization for large or giant aneurysms : prognostic implications of incomplete occlusion. J Korean Neurosurg Soc 61 : 19-27, 2018 https://doi.org/10.3340/jkns.2016.0101.018
  14. Kattner KA, Bailes J, Fukushima T : Direct surgical management of large bulbous and giant aneurysms involving the paraclinoid segment of the internal carotid artery: report of 29 cases. Surg Neurol 49 : 471-480, 1998 https://doi.org/10.1016/S0090-3019(97)00374-1
  15. Kyoshima K, Kobayashi S, Nitta J, Osawa M, Shigeta H, Nakagawa F : Clinical analysis of internal carotid artery aneurysms with reference to classification and clipping techniques. Acta Neurochir (Wien) 140 : 933-942, 1998 https://doi.org/10.1007/s007010050196
  16. Lee SH, Kwun BD, Kim JU, Choi JH, Ahn JS, Park W, et al. : Adenosineinduced transient asystole during intracranial aneurysm surgery: indications, dosing, efficacy, and risks. Acta Neurochir (Wien) 157 : 1879-1886; discussion 1886, 2015 https://doi.org/10.1007/s00701-015-2581-7
  17. Liu JM, Zhou Y, Li Y, Li T, Leng B, Zhang P, et al. : Parent artery reconstruction for large or giant cerebral aneurysms using the tubridge flow diverter: a multicenter, randomized, controlled clinical trial (PARAT). AJNR Am J Neuroradiol 39 : 807-816, 2018 https://doi.org/10.3174/ajnr.A5619
  18. Luzzi S, Gallieni M, Del Maestro M, Trovarelli D, Ricci A, Galzio R : Giant and very large intracranial aneurysms: surgical strategies and special issues. Acta Neurochir Suppl 129 : 25-31, 2018 https://doi.org/10.1007/978-3-319-73739-3_4
  19. Matano F, Mizunari T, Kominami S, Suzuki M, Fujiki Y, Kubota A, et al. : Retrograde suction decompression of a large internal carotid aneurysm using a balloon guide catheter combined with a blood-returning circuit and STA-MCA bypass: a technical note. Neurosurg Rev 40 : 351-355, 2017 https://doi.org/10.1007/s10143-016-0808-6
  20. Ogilvy CS, Carter BS : Stratification of outcome for surgically treated unruptured intracranial aneurysms. Neurosurgery 52 : 82-87; discussion 87-88, 2003 https://doi.org/10.1097/00006123-200301000-00010
  21. Oishi H, Teranishi K, Yatomi K, Fujii T, Yamamoto M, Arai H : Flow diverter therapy using a pipeline embolization device for 100 unruptured large and giant internal carotid artery aneurysms in a single center in a Japanese population. Neurol Med Chir (Tokyo) 58 : 461-467, 2018 https://doi.org/10.2176/nmc.oa.2018-0148
  22. Otani N, Wada K, Toyooka T, Fujii K, Ueno H, Tomura S, et al. : Retrograde suction decompression through direct puncture of the common carotid artery for paraclinoid aneurysm. Acta Neurochir Suppl 123 : 51-56, 2016 https://doi.org/10.1007/978-3-319-29887-0_7
  23. Parkinson RJ, Bendok BR, Getch CC, Yashar P, Shaibani A, Ankenbrandt W, et al. : Retrograde suction decompression of giant paraclinoid aneurysms using a No. 7 French balloon-containing guide catheter. Technical note. J Neurosurg 105 : 479-481, 2006 https://doi.org/10.3171/jns.2006.105.3.479
  24. Payner TD, Horner TG, Leipzig TJ, Scott JA, Gilmor RL, DeNardo AJ : Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. J Neurosurg 88 : 441-448, 1998 https://doi.org/10.3171/jns.1998.88.3.0441
  25. Sheen JJ, Park W, Kwun BD, Park JC, Ahn JS : Microsurgical treatment strategy for large and giant aneurysms of the internal carotid artery. Clin Neurol Neurosurg 177 : 54-62, 2019 https://doi.org/10.1016/j.clineuro.2018.12.014
  26. Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Sakai N : Endovascular treatment of unruptured paraclinoid aneurysms: single-center experience with 400 cases and literature review. AJNR Am J Neuroradiol 37 : 679-685, 2016 https://doi.org/10.3174/ajnr.A4577
  27. Shin DS, Carroll CP, Elghareeb M, Hoh BL, Kim BT : The evolution of flow-diverting stents for cerebral aneurysms; historical review, modern application, complications, and future direction. J Korean Neurosurg Soc 63 : 137-152, 2020 https://doi.org/10.3340/jkns.2020.0034
  28. Smith RR : Surgical management of neurovascular disease. Neurosurgery 40 : 418, 1997 https://doi.org/10.1097/00006123-199702000-00048
  29. Takeuchi S, Tanikawa R, Goehre F, Hernesniemi J, Tsuboi T, Noda K, et al. : Retrograde suction decompression for clip occlusion of internal carotid artery communicating segment aneurysms. World Neurosurg 89 : 19-25, 2016 https://doi.org/10.1016/j.wneu.2015.12.095
  30. Tamaki N, Kim S, Ehara K, Asada M, Fujita K, Taomoto K, et al. : Giant carotid-ophthalmic artery aneurysms: direct clipping utilizing the "trapping-evacuation" technique. J Neurosurg 74 : 567-572, 1991 https://doi.org/10.3171/jns.1991.74.4.0567
  31. Ten Brinck MFM, Jager M, de Vries J, Grotenhuis JA, Aquarius R, Morkve SH, et al. : Flow diversion treatment for acutely ruptured aneurysms. J Neurointerv Surg 12 : 283-288, 2020 https://doi.org/10.1136/neurintsurg-2019-015077
  32. UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, et al. : The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366 : 2474-2482, 2012 https://doi.org/10.1056/NEJMoa1113260
  33. Walcott BP, Koch MJ, Stapleton CJ, Patel AB : Blood flow diversion as a primary treatment method for ruptured brain aneurysms-concerns, controversy, and future directions. Neurocrit Care 26 : 465-473, 2017 https://doi.org/10.1007/s12028-016-0318-y
  34. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. : Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362 : 103-110, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3