Retrograde Suction Decompression Assisted Clipping of Large and Giant Cerebral Aneurysms: Our Experience

Abstract

Retrograde suction decompression is a successful adjunct to clipping of large and giant cerebral aneurysms.

Retrograde Suction Decompression for Clip Occlusion of Internal Carotid Artery Communicating Segment Aneurysms

“…In our series, surgical RSD-assisted clipping allowed for successful surgical management of C1 aneurysms, as previously reported. 6,7 Treatment of C1 aneurysms can be hindered by large aneurysm size, arachnoid adhesions of the aneurysm dome or neck to the surrounding neurovascular structures (PcomA, ATPA, AchA, the oculomotor nerve, and the dura of skull base), or the presence of calcifications on the proximal ICA. The RSD technique provides proximal vascular control of the ICA, and allows softening and shrinking of the aneurysm sac by continuous suction, thus improving the surgical view and visualization of the aneurysm neck and its surrounding structures, and allowing the neurosurgeon to place the permanent clips safely and correctly.…”

“…The RSD technique provides proximal vascular control of the ICA, and allows softening and shrinking of the aneurysm sac by continuous suction, thus improving the surgical view and visualization of the aneurysm neck and its surrounding structures, and allowing the neurosurgeon to place the permanent clips safely and correctly. 6 Previously, the surgical RSD technique has been applied mainly for large or giant aneurysms. However, treatment of medium-sized aneurysms that are attached to the PcomA, ATPA, or AchA may benefit from this technique to achieve direct clipping and final occlusion…”

“…3 Batjer and Samson 4 in 1990 and Tamaki et al 5 in 1991 described the surgical retrograde suction decompression (RSD) technique as an alternative to achieve proximal vascular control of the parent vessel, to improve the visualization of the aneurysm neck, and to reconstruct the parent vessel without occluding important perforators. 1,[4][5][6][7][8][9][10][11][12] Subsequently, the adoption of less invasive procedures has led to the use of the endovascular suction decompression technique as an option to surgical exposure; however, it carries a higher risk of ICA dissection. 1,[6][7][8][9]12 The surgical RSD technique has been applied mainly for large or giant aneurysms located in the ophthalmic (C2)/clinoid (C3) segment of the ICA, and less often for C1 aneurysms.…”

“…1,[4][5][6][7][8][9][10][11][12] Subsequently, the adoption of less invasive procedures has led to the use of the endovascular suction decompression technique as an option to surgical exposure; however, it carries a higher risk of ICA dissection. 1,[6][7][8][9]12 The surgical RSD technique has been applied mainly for large or giant aneurysms located in the ophthalmic (C2)/clinoid (C3) segment of the ICA, and less often for C1 aneurysms. 13 Previous case series of RSD-assisted clipping focused mainly on C2/C3 aneurysms or failed to show the results of RSD-assisted clipping for C1 aneurysms.…”

“…13 Previous case series of RSD-assisted clipping focused mainly on C2/C3 aneurysms or failed to show the results of RSD-assisted clipping for C1 aneurysms. 6,7 The present study analyzed 20 consecutive patients with C1 aneurysms treated through direct microsurgical clipping assisted by RSD to provide proximal control of the parent vessel to evaluate the surgical technique and feasibility of RSD for direct clipping of C1 aneurysms.…”