Hunterian Ligation

Hunterian ligation (parent vessel occlusion) is generally only considered if occlusion of the aneurysm neck is dangerous or impossible. It reduces flow past the aneurysm, often reducing the size of the lesion and even occasionally causing spontaneous thrombosis.

This can be an excellent option for some giant proximal ICA aneurysms (particularly when presenting with cavernous sinus syndrome), fusiform aneurysms, serpentine MCA aneurysms, wide-necked basilar artery aneurysms and certain vertebral lesions.

A pre-operative test occlusion with or without a hypotensive challenge and CBF measurements is often performed endovascularly. This can be combined with semi-quantitative measures of CBF, such as positron emission tomography, single photon emission computerized tomography (SPECT) scans or transcranial doppler (TCD) ultrasound monitoring to increase reliability. If collateral circulation is adequate, parent vessel occlusion alone is appropriate. Even with experience, there is a 5% risk of delayed stroke in patients who initially tolerate the balloon occlusion.

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