scholarly journals Case of step-by-step combined treatment of a patient with a ruptured aneurysm of the ophthalmic segment of the internal carotid artery

2021 ◽  
Author(s):  
D. V. Litvinenko ◽  
E. I. Zyablova ◽  
V. V. Tkachev ◽  
G. G. Muzlaev
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
Combined Treatment ◽  
Cerebral Aneurysms ◽  
Treatment Method ◽  
Endovascular Coiling ◽  
Paraclinoid Aneurysms ◽  
Angiographic Examination

Aneurysms of the internal carotid artery are the second most common among cerebral aneurysms. When an aneurysm is located in the ophthalmic segment of the internal carotid artery (ICA), the intravascular treatment method is a priority. At the same time, the treatment of recurrent and non-radially switched-off aneurysms of this localization remains a subject of discussion.Case report. We present a 42-year-old patient with a ruptured ICA aneurysm who was admitted in a serious condition. Initially, the patient underwent partial occlusion of the aneurysm cavity with endovascular coiling. In the control cerebral angiography 3 months after the haemorrhage, the recanalization of the aneurysm was verified, which served as an indication for repeated surgical intervention. We preferred the microsurgical method of treatment. A control angiographic study 1 year after the second operation confirmed the radical shutdown of the aneurysm.Discussion. The presented case illustrates the need for a flexible approach in the treatment of complex paraclinoid aneurysms. The choice of endovascular treatment of such aneurysms in the acute period of haemorrhage is justified as the most sparing, although less radical. Depending on the nature of the embolization performed, the timing of the control angiographic examination should be selected individually and can be reduced to 2 months. If there are indications for repeated surgical intervention, it should be performed by the safest method, providing total shutdown of the aneurysm and reducing the volumetric impact of the aneurysm dome on the optic nerve.

scholarly journals A Rare Case of Internal Carotid Artery Aneurysm Presenting as Total Ophthalmoplegia

2021 ◽  
Vol 10 (7) ◽  
pp. 454-457
Author(s):  
Sapan Jaiswal ◽  
Neha Bajpayee ◽  
Abhishek G.U.
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Posterior Communicating Artery ◽  
Cerebral Vasculature ◽  
Paraclinoid Aneurysms

Cerebral aneurysms are pathological focal dilatations of cerebral vasculature that are prone to rupture1. Pathogenesis involves aberrations of cerebral vasculature resulting in compromised integrity of internal elastic lamina with associated defects in adjacent media and adventia.1 Apart from posterior communicating artery aneurysm, internal carotid artery aneurysms account for 4 % of all cerebral aneurysms.2 Paraclinoid aneurysms are defined as those originating from the ICA between the infra clinoid portion (C3) and proximal of the posterior communicating artery. Their classification is given by Al Rodhan3 is as follows: Type Ia – superior hypophyseal, type Ib – ventral paraclinoid, type II – true ophthalmic, type III – carotid cave, type IV – transitional, type V – intra cavernous. In literature many cases of cerebral aneurysms presenting with visual symptoms have been reported 4 in which, aneurysms were located on internal carotid artery near ophthalmic artery called as paraclinoid aneurysms. The unruptured cerebral aneurysms cause mass effect hence producing symptoms of nausea, vomiting and severe headache and later on by compressing surrounding cranial nerves produce ocular symptoms like ophthalmoplegia and ptosis. The aneurysms may rupture and result in intracranial bleed which again by mass effect can produce the above told symptoms. We report a case of unruptured intracranial aneurysm presenting with total ophthalmoplegia with visual deficit as the primary symptom.

The Perforating Branches of the Internal Carotid Artery: The Microsurgical Anatomy of Their Extracerebral Segments

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 472-479 ◽  
Author(s):  
Slobodan V. Marinkovié ◽  
Milan M. Milisavljevié ◽  
Zorica D. Marinkovié
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Microsurgical Anatomy ◽  
Great Care ◽  
Anterior Choroidal Artery ◽  
Frequent Site ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

scholarly journals Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment

2006 ◽  
Vol 12 (1) ◽  
pp. 53-56 ◽  
Author(s):  
A.B. Yagci ◽  
F.N. Ardiç ◽  
I. Oran ◽  
F. Bir ◽  
N. Karabulut
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Unusual Case ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
Imaging Findings ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Artery Pseudoaneurysm

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.

scholarly journals 2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

2020 ◽  
Vol 26 (4) ◽  
pp. 468-475 ◽  
Author(s):  
Ahmed E Hussein ◽  
Meghana Shownkeen ◽  
Andre Thomas ◽  
Christopher Stapleton ◽  
Denise Brunozzi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Density Ratio ◽  
Area Under The Curve ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Time Density

Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.

Carotid paraclinoid aneurysms with intradural origin and intracavernous location

1978 ◽  
Vol 48 (4) ◽  
pp. 526-533 ◽  
Author(s):  
Stephen Nutik
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Precise Definition ◽  
Separate Entity ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Planning Treatment ◽  
Definition Of ◽  
Fine Print

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.

scholarly journals Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

2018 ◽  
Vol 24 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Christopher J Stapleton ◽  
Anoop P Patel ◽  
Brian P Walcott ◽  
Collin M Torok ◽  
Matthew J Koch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
High Rate ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Surgical Closure ◽  
Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

scholarly journals Staged Multimodality Treatment of a Large Ruptured Fusiform Supraclinoid Internal Carotid Artery Aneurysm: Microsurgical Clip.assisted Endovascular Coiling

2017 ◽  
Vol 08 (04) ◽  
pp. 668-671 ◽  
Author(s):  
Dale Ding ◽  
Thomas J. Buell ◽  
Ching-Jen Chen ◽  
Daniel M. Raper ◽  
Kenneth C. Liu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Multimodality Treatment ◽  
Endovascular Coiling ◽  
Fusiform Aneurysm ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Supraclinoid Internal Carotid Artery

ABSTRACTIn the contemporary era of aneurysm management, large fusiform aneurysms presenting with subarachnoid hemorrhage (SAH) remain particularly challenging lesions to successfully manage. We describe a staged, multimodal treatment strategy for a 71-year-old patient who presented with a large ruptured fusiform aneurysm of the supraclinoid internal carotid artery (ICA) and a fetal posterior communicating artery which originated from the inferomedial aspect of the aneurysm. In the first stage, we performed a partial microsurgical clip reconstruction of the fusiform aneurysm and secured its rupture site, which was identified intraoperatively. This left two residual saccular components of the aneurysm, which were targeted with endovascular coiling in the same hospitalization after the patient had convalesced from the SAH and was beyond the vasospasm window. We believe that this combined approach of clip-assisted coiling can be employed instead of endovascular flow diversion or microsurgical bypass for appropriately selected patients with ruptured fusiform ICA aneurysms.

Internal Carotid Artery Aneurysms Occurring at the Origin of Fetal Variant Posterior Cerebral Arteries: Surgical and Endovascular Experience

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS55-ONS62 ◽  
Author(s):  
Gabriel Zada ◽  
Julia Breault ◽  
Charles Y. Liu ◽  
Alexander A. Khalessi ◽  
Donald W. Larsen ◽  
...  
Keyword(s):  
Los Angeles ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Ischemic Injury ◽  
Endovascular Coiling ◽  
The Mean

Abstract Objective: A fetal variant posterior cerebral artery (fetal PCA) is an embryological remnant in which the PCA is primarily supplied via the anterior cerebral circulation. Internal carotid artery (ICA) aneurysms originating from the takeoff of fetal PCA vessels deserve special attention before surgical or endovascular obliteration because of a greater potential for ischemic injury. We present the first series of ICA-posterior communicating artery (PComA) aneurysms originating at the takeoff of fetal PCA vessels that were treated by surgical or endovascular intervention. Methods: A retrospective chart review was conducted for all patients who underwent surgical and endovascular treatment of an ICA-PComA aneurysm at Los Angeles County-University of Southern California Medical Center during a 15-year period (1991–2006) to identify cases with aneurysms originating from fetal variant PCAs. Data were retrospectively reviewed and analyzed. Results: During a 15-year period, 271 patients were treated for 273 ICA-PComA aneurysms. Aneurysms occurring at the origin of fetal PCAs were identified in 30 patients (11%). There were 23 women (77%) and seven men (23%) (sex difference, P = 0.0035). Twenty-four patients underwent surgical clipping, whereas six patients underwent endovascular coiling. The mean aneurysm size was 7 mm. The mean ischemia time with temporary clipping (12 cases) was 4.5 minutes. Intraoperative rupture occurred in four surgical cases (17%). Postoperative angiography demonstrated occlusion of the fetal PCA in one case after clip ligation (3%), with an ensuing occipital infarct yet no clinical symptoms. Conclusion: ICA-PComA aneurysms originating from fetal PCA vessels may pose a more substantial risk for infarction and subsequent neurological sequelae with surgical or endovascular obliteration. Fetal variant circulations were identified at the PComA origin in 11% of ICA-PComA aneurysm patients and were more commonly encountered in women. The decision of surgical versus endovascular treatment of fetal PCA aneurysms must be carefully considered, given the greater potential for ischemic injury with parent vessel occlusion.

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