Analysis of Angiographically Unrecognized, Incidental Microaneurysm during Aneurysmal Operation

Kim, Yong Soo; Lee, Je Hyuk; Kim, Tae Sun; Jung, Shin; Lee, Jung Kil; Kim, Jae Hyoo; Kim, Soo Han; Kang, Sam Suk

Abstract

OBJECT: Microaneuryms were unvisible in angiograms and incidentaly detected during operation. Increasing the frequency of endovascular surgery, they have dangerous risk during procedure. So we analyzed the unvisible reason and report operation method. MATERIAL AND METHOD: Twenty-six cases of angiographically unrecognized microaneurysm were operated from January 1993 to May 1998. They consisted of 3.8% of 684 operated cases of intracranial aneurysms at the same period. The most common site of angiographically unrecognized microaneurysm was the internal carotid artery(11 cases): one arose from the posterior communicating artery, 9 from the anterior choroidal artery, 1 from the internal carotid artery bifurcation. RESULT: According to the intraoperative findings, we analyzed the possible reasons why these microaneurysms were not visible in the pre-operative angiograms; 19 cases in low type, 4 cases in hidden type, 3 cases in sandwiched type. We performed direct aneurysmal neck clippings in 9 cases and wrap-clip reinforcements in 8 cases, wrappings in 9 cases.
CONCLUSION
We have to consider that angiographically unrecognized microaneurysm may be found during the direct operation of intracranial aneurysm and also during the endovascular surgery. Also, the wrapping technique is found to be less secure and needs regular follow-up angiography.