[Follow-up study of inaccessible giant aneurysms of the intracranial internal carotid artery].

Inaccessible giant aneurysms of the internal carotid artery had been treated with various methods. But these results are not always satisfactory. To determine the optimal treatment for these aneurysms, long-term follow-up study was carried out in 8 patients. They included 7 females and one male with ages ranging from 18 to 72 years. The aneurysms arose at the cavernous portion in 6 patients, at bifurcation of the posterior communicating artery and the ophthalmic artery in 2 patients. All but 2 patients had multiple cranial nerve palsies before admission. Those patients younger than 60 years had the ligation of the internal or common carotid arteries with or without EC-IC bypass. The others had conservative treatments including repeated Matas test. Follow-up period was 17 to 112 months after discharge. Follow-up results showed gradual decrease of the size of the aneurysms on CT scan and improvement of signs in all 3 operated cases. But only one aged patient who had repeated Matas maneuver had spontaneous improvement of her signs. There was no improvements in the others with conservative treatment. From the results of the present study, we would like to recommend carotid ligation with EC-IC bypass for the patients younger than 60 years after preoperative balloon occlusion test. When the patients were intolerable in temporary balloon occlusion of the internal carotid artery, detachable balloon embolization or electrothrombosis with copper wire also will be the treatment of choice. In the aged patients with high surgical risk, repeated balloon occlusion test or Matas test seems to be effective to promote intra-aneurysmal thrombosis.