Neuroendovascular therapy combined with neurosurgery for large and giant intracranial internal carotid artery aneurysm presenting mass effect

Introduction: Large and giant intracranial internal carotid artery (ICA) aneurysms presenting mass effect are sometimes treated by combined neuroendovascular therapy and neurosurgery. In this article, we survey such kinds of combined treatment in our institute. Materials and Methods: Sixteen patients underwent such a treatment, out of 60 cases, with large and giant intracranial ICA aneurysms presenting mass effect. Neuroendovascular therapy included proximal occlusion of ICAs in 13 patients and trapping of ICAs, together with aneurysms in 3 patients. Neurosurgery included vein grafting in nine patients and superficial temporal artery–middle cerebral artery anastomosis in seven patients. Results: Clinical symptoms improved immediately in 12 of the patients. Symptomatic impairment of ipsilateral cerebral blood flow was observed in two of them and visual acuity disturbance caused by ophthalmic artery occlusion in one. The advantage of endovascular occlusion over surgical ligation is to occlude ICAs as close to the aneurysm as possible to avoid collateral flow to the aneurysm. Conclusion: Neuroendovascular therapy, combined with neurosurgery for large and giant intracranial internal carotid artery aneurysms presenting mass effect, is a useful treatment option.