An Aneurysm of the Intracranial Carotid Artery Treated Surgically *

The problem of the surgical treatment of intracranial aneurysms was brought before the Cushing Society in April of 1938. At this time German2 reported a posterior cerebral aneurysm that had been successfully excised. The problem of the proper selection of cases in which operation would be indicated formed the basis for most of the discussions of German's paper. The experiences of Godfrey Jefferson were cited and several individual experiences were related (McKenzie, Lyerly, and Fay). In these later cases the aneurysm, in the majority of instances, had been diagnosed at the time of craniotomy, removed, and survival had followed in more than one experience. Many of the members had observed spontaneous recoveries, and Wilkins reported a case in which 16 years elapsed following complete recovery before the second rupture occurred. This patient survived with a partial hemiplegia. In May of 1938, Dandy1 reported a successful intracranial carotid aneurysm ligation, utilizing a silver clip for the sac, applying it anteriorly to the anterior communicating artery. This success was highly praised by Matas, who felt that another chapter had been written in the surgical treatment of aneurysms. Dandy has been successful in several subsequent cases and it was his experience and his suggestion of "trapping" the carotid aneurysm that prompted operation in the case here reported.