Surgical Consideration for Internal Carotid Superior Wall Aneurysm

Kim, Tae Sun; Lee, Je Hyuk; Lee, Jung Gil; Jung, Shin; Kang, Sam Suk

Abstract

Seven cases of aneurysm arising from the superior wall of the internal carotid artery were operated on from January 1993 through December 1997. They consist of 3.7% among 191 operated cases of the internal carotid artery aneurysms and 1.2% among 590 operated cases of total intracranial aneurysms. Aneurysmal adhesion to the optic nerve was observed in five cases and the arteriosclerotic change in two cases. Four aneurysms were blister-like and thin-walled, and the other two aneurysms were covered with thick hematoma. Premature rupture occurred in three cases, two cases during aneurysmal clipping and one case during aneurysmal dissection. In three cases the aneurysms were clipped, and in the other four cases the aneurysms were wrapped circumferentially with the dacron mesh silastic sheet and clipped. Among the four wrap-clipping cases, two cases were associated with very fragile aneurysmal walls. There were neither clip sliding nor the regrowth of aneurysms on the following angiograms. The Glasgow Outcome Scale at discharge showed good recovery in five cases, moderately disabled in one case, and severely disabled in one case. In conclusion, wrap-clipping with the silastic sheet is helpful for the superior wall aneurysms of internal carotid artery with very fragile and thin walls or avulsion of aneurysmal neck.