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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1805019
Case Report

Extracranial-Intracranial Bypass with Reconstruction Clip Surgery Following Failed Flow Diverter Therapy for a Giant Internal Carotid Aneurysm: A Case Report

Hung Manh Ngo 
1   Department of Neurosurgery, Viet Duc Hospital, Hanoi, Vietnam
2   Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
,
Minh Quang Ngo 
3   College of Health Sciences, Vin University, Hanoi, Vietnam
› Author Affiliations Funding None.
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Abstract

Flow diverter (FD) is often the first-line treatment for giant internal carotid artery aneurysms, with a high rate of aneurysm occlusion. However, up to 10% of giant cerebral aneurysms increase in size after FD treatment. Surgery is usually considered if the giant internal carotid artery aneurysm continues to enlarge and cause compression. We report a case of a giant internal carotid artery aneurysm that continued to increase in size after FD treatment and was subsequently treated surgically. We also review the literature on the management of giant cerebral aneurysms that increased in size after FD. A 41-year-old female patient was diagnosed with a right giant internal carotid artery aneurysm and was initially treated with FD. After FD, the patient's vision in the right eye did not improve. Despite medical treatment, her vision continued to deteriorate. The patient presented at our hospital with reduced vision in both eyes. Magnetic resonance imaging and digital subtraction angiography with balloon test occlusion confirmed the presence of a giant thrombosed aneurysm in the right internal carotid artery, compressing the right optic nerve and optic chiasm. The patient underwent external carotid artery-middle cerebral artery bypass surgery using a radial artery graft, aneurysm sac dissection with thrombus removal, and reconstructive clipping of the aneurysm neck. After surgery, the patient's vision in both eyes improved immediately and did not develop any new neurological symptoms. Extracranial-intracranial arterial reconstructive surgery is a viable option for treating giant internal carotid artery aneurysms that have undergone FD treatment but continue to present with progressive mass effects.

Keywords

giant internal carotid artery aneurysm - reconstructive clips - EC-IC bypass - flow diversion devices - cerebral revascularizations - vision loss

Author's Contributions

H.M.N., the primary doctor, conceived the original idea, performed the surgeries, and was responsible for writing and revising the manuscript. M.Q.N. conducted patient follow-ups and contributed to writing the manuscript. All authors participated in interpreting and discussing the results, and they collectively reviewed and approved the final manuscript for submission.


Ethical Approval

The study was approved by the Research Ethics Committee of University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam. The procedures used in this study adhere to the tenets of the Declarations of Helsinki.


Patients' Consent

The patient's parents have consented to the submission of the case report for submission to the journal. Written consent form is available upon request.




Publication History

Article published online:
20 March 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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