Clinical and radiological findings and surgical management of ruptured aneurysms at the non-branching sites of the internal carotid artery

Abstract Ruptured aneurysms located at the non-branching sites of the internal carotid artery, including blister-like aneurysms, possess unique clinical and technical features. This report presents nine consecutively managed patients with these types of aneurysm, detailing the clinical and radiologi...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2009-08, Vol.16 (8), p.1018-1023
Main Authors: Otani, Naoki, Takasato, Yoshio, Masaoka, Hiroyuki, Hayakawa, Takanori, Yoshino, Yoshikazu, Yatsushige, Hiroshi, Sumiyoshi, Kyoko, Miyawaki, Hiroki, Aoyagi, Chikashi, Takeuchi, Satoru, Suzuki, Go
Format: Article
Language:English
Subjects:
Adult
Aged
Aneurysm, Ruptured - diagnostic imaging
Aneurysm, Ruptured - surgery
Blister-like aneurysm
Carotid Artery Diseases - diagnosis
Carotid Artery Diseases - diagnostic imaging
Carotid Artery Diseases - surgery
Carotid Artery, Internal - diagnostic imaging
Carotid Artery, Internal - surgery
Cerebral Angiography
Diagnosis, Differential
Female
Humans
Imaging, Three-Dimensional
Intracranial Aneurysm - diagnosis
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Male
Middle Aged
Neurology
Subarachnoid hemorrhage
Surgical outcome
Tomography, X-Ray Computed
Treatment Outcome
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Summary:Abstract Ruptured aneurysms located at the non-branching sites of the internal carotid artery, including blister-like aneurysms, possess unique clinical and technical features. This report presents nine consecutively managed patients with these types of aneurysm, detailing the clinical and radiological characteristics and surgical outcomes. The initial angiography identified aneurysmal lesions in six of the nine patients with two of these patients requiring additional three-dimensional (3D) angiography. In three patients the aneurysm was only diagnosed on second or third angiograms. Six patients had blister-like aneurysms, and two had saccular-shaped aneurysms diagnosed on the basis of intraoperative findings. One patient with a saccular aneurysm died without surgery. Eight patients underwent a microsurgical procedure: clipping in five, clipping on wrapping with suturing in two and trapping in one. Three of these eight patients had an intraoperative rupture. A favorable outcome was obtained in seven patients. Advances in microsurgical techniques to prevent premature rupture and 3D radiological diagnosis with careful pre-operative consideration of the surgical strategies will be required for a further improvement of the clinical outcome.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2008.05.025