[Thrombectomy without temporary clipping for giant partially thrombosed saccular aneurysms]

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neuroradiology

Background:

• Cerebral aneurysm thrombosis complicates microsurgical treatment.
• Thrombi and calcifications in the aneurysm neck hinder adequate clipping.
• Thrombectomy increases procedural time and the risk of cerebral ischemia due to temporary arterial clipping.

Purpose of the Study:

• To evaluate thrombectomy without temporary arterial clipping for giant anterior circulation aneurysms.
• Assess the efficacy and safety of this modified thrombectomy technique.

Main Methods:

• Four patients with giant, partially thrombosed saccular aneurysms underwent thrombectomy without temporary clipping.
• Aneurysms were >80-90% thrombosed with parietal thrombi.
• Mean thrombectomy time was 82 minutes; mean temporary clipping time was 12 minutes.

Main Results:

• All patients achieved favorable clinical and radiological postoperative outcomes.
• The study presents surgical stages and video of key procedural aspects.
• Successful thrombectomy was performed with minimal bleeding before definitive clipping.

Conclusions:

• Thrombectomy without parent artery clipping is effective for giant partially thrombosed intracranial aneurysms.
• Reduced temporary blood flow discontinuation decreases the risk of cerebral ischemia.
• This technique is beneficial for complex aneurysms of the middle cerebral and internal carotid arteries.