Treatment of Supraclinoid Internal Carotid Artery Iatrogenic Pseudoaneurym with Extracranial-to- Intracranial Bypass and Trapping: Demonstration of Technique with Video Presentation.

Intracranial pseudoaneurysms (IP) represent about 1% of all patients presenting with an intracranial aneurysm. In true intracranial aneurysms, the intima, internal elastic lamina, and media are disrupted, but the adventitia is intact. In pseudoaneurysms, there is disruption of all three layers of the arterial wall, thus resulting in higher rates of re-hemorrhage and thrombus formation. Patients with IP commonly present with subarachnoid hemorrhage or thromboembolic complications. Until now, no specific guidelines have been established for the ideal treatment of pseudoaneurysms. Although IP have higher rates of morbidity and mortality compared to true intracranial aneurysms, surgical treatment can prevent catastrophic hemorrhagic and thrombotic complications. Despite recent advances in endovascular techniques that allow safe approaches to complicated intracranial vascular pathologies, vascular trapping and bypass remains the definitive and safe treatment for IP. Based on our experience and related literature, we consider the latter treatment in experienced hands as an effective and decisive treatment modality to prevent the devastating complications of IP. In this article, we discuss the surgical management of iatrogenic intracranial internal carotid artery pseudoaneurysms by trapping, and extracranial-intracranial bypass through a case illustration in which the technique is demonstrated via a video presentation.