Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: Internal carotid artery trunk aneurysms

Citation
A. Ogawa et al., Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: Internal carotid artery trunk aneurysms, NEUROSURGER, 47(3), 2000, pp. 578-583
Citations number
21
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
NEUROSURGERY
ISSN journal
0148-396X → ACNP
Volume
47
Issue
3
Year of publication
2000
Pages
578 - 583
Database
ISI
SICI code
0148-396X(200009)47:3<578:AANSIT>2.0.ZU;2-Z
Abstract
OBJECTIVE: Aneurysms at nonbranching sites in the supraclinoid internal car otid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical e ntity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. METHODS: Forty-eight patients had aneurysms that were intraoperatively conf irmed to be located at a nonbranching site in the supraclinoid portion of t he ICA. Neuroradiological and clinicopathological features and outcomes wer e studied. RESULTS: The aneurysms were divided into the "blister type," with a blood b lister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry an eurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative con ditions of the patients were the same, but the outcomes for patients with b lister-type aneurysms were worse, because of frequent intra- and postoperat ive aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treat ment of blister-type aneurysms by clipping on wrapping material achieved go od results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapp ing (P = 0.0110) were associated with much worse results. CONCLUSION: Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whe reas the blister type requires clipping on wrapping material. ICA trunk ane urysms may be a better designation to express the diversity of these aneury sms, rather than ICA blood blister-like or anterior or dorsal wall aneurysm s.