scholarly journals Prediction of the difficulty of proximal vascular control using 3D-CTA for the surgical clipping of internal carotid artery–posterior communicating artery aneurysms

2020 ◽  
pp. 1-8
Author(s):  
Takeya Niibo ◽  
Katsumi Takizawa ◽  
Jurou Sakurai ◽  
Seizi Takebayashi ◽  
Hiroyasu Koizumi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Characteristic Curve ◽  
Posterior Communicating Artery ◽  
Maximum Diameter ◽  
Vascular Control ◽  
Surgical Clipping ◽  
Anterior Clinoid Process ◽  
Aneurysmal Neck

OBJECTIVEDuring surgical clipping of internal carotid artery (ICA)–posterior communicating artery (PCoA) aneurysms, proximal vascular control (PVC) is difficult to achieve in some cases because of variations in the anatomy of this type of aneurysm and its parent arteries. The authors investigated morphometric features that may be predictive for the necessity of anterior clinoidectomy (ACL) or cervical ICA exposure for PVC.METHODSThe authors retrospectively reviewed 65 patients with an ICA-PCoA aneurysm treated with clipping during the previous 3 years. The factors considered for assessing the difficulty of attaining PVC included the following: the maximum diameter of the aneurysm; the distance between the tip of the anterior clinoid process (ACP) and the proximal aneurysmal neck; the presence of calcification at the ophthalmic segment of the ICA; and the angles between the communicating segment of the ICA and the ophthalmic segment of the ICA and a line perpendicular to the cranial base, which reflect the tortuosity of the ICA. These parameters were measured based on preoperative CTA results.RESULTSIn a total of 21 patients (32.3%), PVC was difficult to perform with the usual pterional approach. In 6 patients, temporary artery occlusions (TAOs) were difficult to achieve because of severe atherosclerotic wall changes in the ophthalmic segment of the ICA. For 15 patients, the ACPs overhanging the ophthalmic segment of the ICA obstructed the ability to secure a space for TAO. In the 21 patients with PVC difficulty, ACL alone, cervical ICA exposure alone, and both ACL and cervical ICA exposure were conducted in 6, 8, and 7 patients, respectively. Multivariate analysis with binary logistic regression revealed that the maximum diameter of the aneurysm (p = 0.041), the distance between the proximal neck of the aneurysm and the ACP tip (p = 0.002), and calcification of the ICA ophthalmic segment (p = 0.001) were significant predictive factors for difficulties with PVC. A receiver operating characteristic curve analysis revealed that a distance between the proximal aneurysmal neck and the ACP tip of ≤ 5.4 mm was the best cutoff value for predicting the difficulty of attaining PVC (area under the curve 0.800, sensitivity 80.0%, specificity 80.0%).CONCLUSIONSA short distance between the proximal aneurysmal neck and the ACP tip and the presence of calcification at the ophthalmic segment of the ICA on preoperative CTA are helpful for predicting the difficulty of achieving PVC.

An Operative Complication in a Patient with a True Posterior Communicating Artery Aneurysm: Case report and Review of the Literature

Neurosurgery ◽  
1990 ◽  
Vol 27 (4) ◽  
pp. 650-653 ◽  
Author(s):  
Tadashi Kudo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Review Of The Literature ◽  
Operative Complications ◽  
Posterior Communicating Artery Aneurysm ◽  
Aneurysmal Neck

Abstract Intraoperative oculomotor nerve injury in a patient with a true posterior communicating artery aneurysm is reported in detail. A comparison of internal carotid artery aneurysms at the posterior communicating artery junction with true posterior communicating artery aneurysms deserves special attention, because the vascular relationships of the aneurysm are more complex. A clip along the internal carotid artery does not occlude blood flow to the aneurysm, and the aneurysmal neck and the distal posterior communicating artery are closer to the oculomotor nerve. This is the 27th reported case of a true posterior communicating artery aneurysm. The incidence of true posterior communicating artery aneurysms ranges from 0.1 to 2.8% of all aneurysm patients. Such aneurysms constitute 4.6 and 11% of so-called posterior communicating aneurysms in two series. Difficulty associated with a preoperative diagnosis has been documented in at least 4 cases. An awareness of this rare aneurysm is stressed in order to avoid operative complications.

scholarly journals Microsurgical Management for Aneurysm Arising from a Low-Lying Internal Carotid Artery-Posterior Communicating Artery Bifurcation through the Anterior Temporal Approach

2019 ◽  
Vol 10 (02) ◽  
pp. 331-333
Author(s):  
Taro Suzuki ◽  
Hiroshi Kashimura ◽  
Yosuke Akamatsu ◽  
Kenta Aso
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Three Dimensional ◽  
Lateral View ◽  
Posterior Communicating Artery ◽  
Transsylvian Approach ◽  
History Of ◽  
Aneurysmal Neck ◽  
Left Eyelid

ABSTRACTA low-lying internal carotid artery (ICA) running closer to the skull base than in usual cases prevents use of the standard transsylvian approach (TSA) to view an aneurysm through the retrocarotid space. A 75-year-old male had a 10-day history of headache and left eyelid ptosis. Initial computed tomography (CT) showed no evidence of subarachnoid hemorrhage. Emergency three-dimensional CT angiography showed a saccular aneurysm with bleb arising from the left horizontally projecting ICA. The aneurysm was approached through the TSA but could not be visualized well. We used the anterior temporal approach (ATA) followed by the TSA, offering a more lateral line of vision and allowing the surgeon to visualize the aneurysmal neck. The aneurysm was successfully obliterated. The ATA provided a better lateral view than the standard TSA for the ICA aneurysm. We emphasize the effectiveness of ATA for aneurysm arising from a low-lying IC-posterior communicating artery bifurcation.

Multiple Cerebral Aneurysm - Case Report

2014 ◽  
Vol 21 (3) ◽  
pp. 279-282 ◽  
Author(s):  
C. Kakucs ◽  
I. St. Florian
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Scan ◽  
Cerebral Aneurysm ◽  
Internal Carotid ◽  
Neurological Status ◽  
Posterior Communicating Artery ◽  
Nuchal Rigidity ◽  
Angio Ct

Abstract This 41-years-old female presented with somnolence, confusion and nuchal rigidity. Preoperative angio-CT scan showed two aneurysm located on both internal carotid artery (ICA) at the site of posterior communicating artery (PComA). During surgery we discovered another dilatation on the origin of left ophtalmic artery that proves to be an infundibullum. We clipped the two communicating posterior aneurysm from the left side and the ophtalmic infundibullum was wrapped. Seven days after surgery the neurological status was improved and she was transferred to the Neurological department.

Pipeline embolization device treatment of internal carotid artery terminus aneurysms

2018 ◽  
Vol 11 (5) ◽  
pp. 485-488 ◽  
Author(s):  
Amit Pujari ◽  
Brian Matthew Howard ◽  
Thomas P Madaelil ◽  
Susana Libhaber Skukalek ◽  
Anil K Roy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Maximum Diameter ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Proximal Internal Carotid Artery ◽  
The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

scholarly journals Enlarged Parent Artery Lumen at Aneurysmal-Neck Segment in Wide-Necked Distal Internal Carotid Artery Aneurysms

2015 ◽  
Vol 10 (2) ◽  
pp. 82 ◽  
Author(s):  
Jong Won Lee ◽  
Jung Min Woo ◽  
Ok Kyun Lim ◽  
Ye-eun Jo ◽  
Jae Kyun Kim ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Distal Internal Carotid Artery ◽  
Aneurysmal Neck

Direct Surgery for Posttraumatic Carotid-cavernous Fistula as a Result of an Intradural Pseudoaneurysm: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 1071-1074 ◽  
Author(s):  
Yoshihiko Fu ◽  
Kenji Ohata ◽  
Naohiro Tsuyuguchi ◽  
Mitsuhiro Hara
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Traffic Accident ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Posterior Communicating Artery ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
The Right ◽  
Embolization Procedure

Abstract OBJECTIVE AND IMPORTANCE Traumatic carotid-cavernous fistula (CCF) is currently treated with interventional neuroradiological embolization procedures. A rare case of posttraumatic CCF that resulted from an intradural pseudoaneurysm is presented. The patient was treated by direct surgery because an embolization procedure was not suitable. CLINICAL PRESENTATION A 16-year-old boy developed chemosis in the right eye 17 days after a traffic accident. Angiography revealed a pseudoaneurysm that arose from the site of origin of the posterior communicating artery, drained directly into the cavernous sinus, and formed a high-flow CCF. INTERVENTION Direct surgery was performed to repair the arterial laceration at the junction of the internal carotid artery and the posterior communicating artery. A clip was applied along the internal carotid artery. The posterior stump of the damaged posterior communicating artery was also included in the clip. Postoperatively, the CCF and pseudoaneurysm were completely obliterated, and the symptoms were cured. CONCLUSION Awareness of an unusual intradural origin of a CCF and the possibility of a direct surgical treatment should be kept in mind.

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