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Surgical Flow Diversion for Giant Fusiform ICA Intracranial Aneurysm

A 48-year-old lady presented with left eye blindness for many months. Before the presentation, she had a headache. Brain scans showed a giant fusiform aneurysm affecting the entire intracranial carotid artery pressing on the optic nerve causing blindness and also pressing on the brainstem about to result in hand and leg weakness. The angiogram showed there was no cross circulation meaning there was no blood flow between the right and left carotid arteries inside the head. This was not a case for flow diverter insertion. Hence a decision was made to surgically make a vascular conduit between the neck carotid artery and the brain middle cerebral artery and bypass the giant aneurysm. This bypass will allow the neck carotid artery to be closed and stop the blood flow through the aneurysm, thereby allowing the aneurysm to gradually collapse and disappear while preserving normal blood flow through the brain.

The video shows the patients MRI scans, DSA, CT angiogram before surgery with the giant fusiform Internal carotid artery (ICA) aneurysm inside the head of the patient. The surgical video shows the bypass being made between the neck-ICA and brain- Middle cerebral artery (MCA) using the leg saphenous vein. Immediate Postop DSA (Digital subtraction angiogram) shows the functioning bypass to the normal brain but slowing of blood flow through the giant ICA aneurysm because of ligation of the neck ICA .

After 2 years follow-up, the DSA shows the aneurysm has not filled and the vessels remodeling around it. 5 years Post-OP MRI has shown that the aneurysm has regressed (Disappeared) almost fully. The patient is doing well as a homemaker.

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