COMPLEX PARACLINOIDAL AND GIANT CAVERNOUS ANEURYSMS Importance of preoperative evaluation with temporary balloon occlusion test and SPECT

ABSTRACT- In the treatment of complex paraclinoidal and giant cavernous aneurysms, preservation of the patency of the internal carotid artery (ICA) is not always possible, and therapeutic occlusion of the carotid is still an important option for their management. A complete preoperative evaluation of the carotid reserve circulation, including the use of temporary balloon occlusion test and single photon emission com-puterized tomography (SPECT) should be included in the current paradigms of paraclinoidal and intracav-ernous aneurysms management. We present a series of fifteen patients with sixteen giant or complex carotid cavernous or ophthalmic aneurysms that were treated following a protocol for our preoperative decision-making analysis. Extracranial to intracranial saphenous vein bypass was reserved to the cases where carotid occlusion would be associated with high risk of ischemic complications and was performed in three patients. Besides the difficulties in dealing with those complex aneurysms, good clinical outcome was pos-sible in our experience with the designed paradigm. KEY WORDS: intracranial aneurysm, cavernous aneurysm, SPECT, balloon occlusion. Aneurismas paraclinoideos complexos e cavernosos gigantes: importância da avaliação pré-operatória com teste de oclusão temporária com balão e SPEC