Microneurosurgery: volume. 2 by Mahmut Gashni Yasargil

By Mahmut Gashni Yasargil

Medical concerns, surgical procedure of the Intracranial Aneurysma and effects

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Prior to performing cervical carotid artery ligation, the adequacy of cerebral collateral circulation must be carefully evaluated. The following methods have been employed. 1) Cerebral angiography. A complete study should include cross-compression of the ipsilateral (aneurysm bearing) carotid artery to evaluate the anterior communicating artery, and compression of the ipsilateral carotid artery during vertebral injection to evaluate the posterior communicating artery. 2) Matas test. Digital compression of the ipsilateral carotid artery is monitored by neurological evaluation and by electroencephalography (Matas and Alien 1911).

Salazar (1980) reported 15 patients who underwent angiography for various nonhemorrhagic disorders in whom a total of 18 asymptomatic aneurysms were found. These patients were operated on with no mortality. Thus it would seem that most patients in whom an aneurysm is found during evaluation for neurological complaints should be advised to have the aneurysm clipped. Age and coexistent illness may of course weigh against operative therapy. A number of aneurysms which were unruptured and asymptomatic were encountered in the present series.

Vascular spasm, however, was only seen at angiography in 9/74 (12%) of 31 cases, although the significance of this finding is doubtful as most cases were admitted very soon after the hemorrhage. Relevant is the observation that at necropsy, pale infarction was not seen even when the premorbid angiogram had shown severe spasm. All the aneurysms fell within the average range of size from 5-30 mm in diameter. The 30 per cent incidence of aneurysm of the carotid termination contrasts remarkably with quoted figures of 3-5% in most adult series.

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