Regional cerebral blood flow assessment prior to balloon detachment in the treatment of intracranial giant aneurysms.

Three patients with giant aneurysms (2 internal carotid and 1 anterior communicating) were treated by internal carotid occlusion with a detachable balloon. 133Xe regional cerebral blood flow (rCBF) was performed on each patient on admission. Due to low CBF, one patient received a superficial temporal artery--middle cerebral artery (STA-MCA) bypass. The rCBF was repeated when the balloon was inflated in the internal carotid prior to detachment of the balloon. All three patients were discharged within one week with no neurologic deficit. The rCBF assessment appears useful to decide which patient will tolerate acute balloon occlusion of the internal carotid and to help select patients who will need an extra-cranial-intracranial (EC-IC) bypass to avoid ischemic complication.