{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:36:32Z","timestamp":1784162192946,"version":"3.55.0"},"reference-count":27,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground:<\/jats:title>\nVery large and giant aneurysms (\u226520 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult.<\/jats:p>\n<\/jats:sec>\n\nCase Description:<\/jats:title>\nTwo cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping.<\/jats:p>\n<\/jats:sec>\n\nConclusion:<\/jats:title>\nTrapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_462_2019","type":"journal-article","created":{"date-parts":[[2019,10,19]],"date-time":"2019-10-19T06:28:20Z","timestamp":1571466500000},"page":"205","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm"],"prefix":"10.25259","volume":"10","author":[{"given":"Seiei","family":"Torazawa","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan."},{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideaki","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeo","family":"Tanishima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya, Shizuoka, 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