Chapter-080 Internal Carotid Bifurcation Aneurysms

A case of an intracranial arterial aneurysm at internal carotid bifurcation in a 10-year-old girl is described with the special features of cerebral aneurysm which occur in children, comparing with the adults. We alert for the necessity of carefully operative technique in order to avoid damage and intraoperative rupture of the aneurysm due to the very thin vessel wall that this population can develop. Our recommendation is early surgery in these patients.

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Retrograde Suction Decompression for Clipping of a Giant Ophthalmic Internal Carotid Artery Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab349 ◽

2021 ◽

Author(s):

Visish M Srinivasan ◽

Michael Zhang ◽

Lea Scherschinski ◽

Alexander C Whiting ◽

Mohamed A Labib ◽

...

Keyword(s):

Visual Acuity ◽

Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Carotid Bifurcation ◽

Aneurysm Neck ◽

Microsurgical Clipping ◽

Complex Anatomy ◽

Internal Carotid Artery Aneurysm ◽

Paraclinoid Aneurysms

Abstract Microsurgical clipping of large paraclinoid aneurysms is challenging because of the complex anatomy of the dural rings, lack of easy proximal control, and wide aneurysm necks. Proximal retrograde suction decompression, or the Dallas technique, can reduce aneurysm turgor and, with aspiration of the trapped cervical and supraclinoid internal carotid arteries (ICAs), can collapse the aneurysm to aid microsurgical clipping.1-5 A woman in her late 30s presented with decreased right-eye visual acuity. Informed written consent was obtained for microsurgical management and publication. Upon cervical exposure of the carotid bifurcation, we performed a standard pterional craniotomy, trans-sylvian exposure, and intradural anterior clinoidectomy. After burst suppression and cross-clamping of the carotid, we inserted an angiocatheter at the common carotid artery (CCA). Distal temporary clips were placed on the posterior communicating artery and C7 ICA. With the cervical ICA unclamped, retrograde suction was continuously applied to deflate the aneurysm. We applied 2 pairs of fenestrated-booster clips to the aneurysm dome and a fifth clip to the aneurysm neck. After restoration of flow, indocyanine green angiography and Doppler assessments were performed. The proximal clip was converted into a curved clip to optimize ICA flow. Postoperative angiography confirmed complete occlusion of the aneurysm. The patient was discharged on postoperative day 3, with stable visual acuity.6 This video demonstrates that retrograde suction decompression via the cervical CCA can be safely performed to facilitate clipping of complex paraclinoid ICA aneurysms. Comprehensive planning of temporary aneurysm trapping for suction decompression and permanent clip construct for aneurysm occlusion are needed for effective aneurysm repair.

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Subarachnoid hemorrhage in childhood and adolescence

Journal of Neurosurgery ◽

10.3171/jns.1984.60.6.1163 ◽

1984 ◽

Vol 60 (6) ◽

pp. 1163-1166 ◽

Cited By ~ 49

Author(s):

Margaret D. Hourihan ◽

Peter C. Gates ◽

Victor L. McAllister

Keyword(s):

Subarachnoid Hemorrhage ◽

Internal Carotid ◽

Adult Population ◽

Carotid Bifurcation ◽

Childhood And Adolescence ◽

Age Group ◽

Content Type ◽

Male Predominance ◽

Ruptured Aneurysms ◽

Modes Of Presentation

✓ The authors have reviewed 167 cases of subarachnoid hemorrhage (SAH) occurring in patients aged 20 years and younger in a 23-year period. The modes of presentation and etiology of SAH are similar in childhood and adolescence and in the adult population, but there was a different incidence of the specific pathology producing the bleeding in this series. Twenty-six percent of cases were due to bleeding arteriovenous malformations, 52% were due to ruptured aneurysms, and in 19% no cause was found. Aneurysms in this young age group differed in several important respects from those in the adult population: there was a male predominance, a higher incidence of internal carotid bifurcation aneurysms was seen, and multiple aneurysms were encountered less commonly.

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Endovascular and Surgical Treatment of Internal Carotid Bifurcation Aneurysms

Neurosurgery ◽

10.1227/neu.0000000000000672 ◽

2015 ◽

Vol 76 (5) ◽

pp. 540-551 ◽

Cited By ~ 28

Author(s):

Juergen Konczalla ◽

Johannes Platz ◽

Nina Brawanski ◽

Erdem Güresir ◽

Stephanie Lescher ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Carotid ◽

Treatment Options ◽

Carotid Bifurcation ◽

Neurological Deficits ◽

Bleeding Complications ◽

Treatment Rate ◽

Surgical Clipping ◽

Aneurysm Neck

Abstract BACKGROUND: Aneurysms of the internal carotid artery (ICA) bifurcation are rare, and no studies have compared patient outcomes after endovascular vs surgical treatment. OBJECTIVE: To report the safety, efficacy, and follow-up outcome of these 2 treatment options for patients with ICA bifurcation aneurysms. METHODS: Patient and aneurysm characteristics, treatment results, and follow-up outcomes (at 30 months) were analyzed from patient records and review of imaging findings. RESULTS: A total of 58 patients with ICA bifurcation aneurysms were treated. By interdisciplinary consensus, 30 aneurysms were assigned for coiling and 28 for clipping. Patients who underwent surgical clipping were younger and had larger aneurysms. More patients were assigned to coiling if their aneurysms originated only from the ICA bifurcation or projected superiorly. For the combined angiographic endpoint, complete and nearly complete occlusion (Raymond-Roy I + II), similar rates of 96% (coiling) or 100% (clipping) could be achieved. Raymond-Roy I occlusion occurred more often after clipping (79% vs 41% coiling). Follow-up of the endovascular group showed minor recanalization of the aneurysm neck (Raymond-Roy II) in 42%. One patient (4%) showed a major recanalization (Raymond-Roy III) and needed re-treatment. For incidental findings, no bleeding complications or new persistent neurological deficits occurred during follow-up. CONCLUSION: Treatment of ICA bifurcation aneurysms after interdisciplinary assignment to clipping or coiling is effective and safe. Despite significantly more minor recanalizations after coiling, the re-treatment rate was very low, and no bleeding was observed during follow-up. Multivariate analysis revealed that origin only from the ICA bifurcation was an independent predictor of aneurysm recanalization after endovascular treatment.

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Persistent Cervical Intersegmental Artery as a Cause of Recurrence of a Traumatic Carotid-Cavernous Fistula

Neurosurgery ◽

10.1227/00006123-198204000-00014 ◽

1982 ◽

Vol 10 (4) ◽

pp. 492-498 ◽

Cited By ~ 4

Author(s):

Herbert M. Keller ◽

Hans-Georg Imhof ◽

Anton Valavanis

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Flow Direction ◽

Carotid Bifurcation ◽

Carotid Cavernous Sinus Fistula ◽

Increased Blood Flow

Abstract In a 16-year-old boy, minor symptoms of an arteriovenous shunt into the cavernous sinus recurred 3 months after the performance of a trapping operation of the internal carotid artery on the side of a traumatic carotid-cavernous sinus fistula. An arterial and venous cerebrovascular Doppler examination demonstrated increased blood flow in the periorbital veins of both sides, with a pathological flow direction, i.e., from intra- to extracranial. Furthermore, an internal-like artery was found at the level of the carotid bifurcation on the side of the trapped internal carotid artery, and increased blood flow was registered in the homolateral vertebral artery. Angiography confirmed occlusion of the internal carotid artery 0.5 cm distal to the carotid bifurcation, but showed blood flow from the homolateral vertebral artery through a persistent 3rd cervical intersegmental artery into the trapped portion of the internal carotid artery. The latter fed blood into the cavernous sinus through the still-existing arteriovenous fistula. Insufficient involution of the 3rd cervical intersegmental artery was assumed. Obviously, this collateral artery dilated in the presence of a major blood pressure gradient between the vertebral artery and the trapped segment of the internal carotid artery. Thus, a persistent cervical intersegmental artery can be a cause for a recurrent carotid-cavernous sinus fistula.

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Surgical outcome after microsurgical repair of internal carotid bifurcation aneurysm: review of 15 cases

10.1055/s-0038-1673113 ◽

2018 ◽

Author(s):

Antônio de Araújo Júnior ◽

Larissa Santos ◽

Mirella Fazzito ◽

Renata Simm ◽

Marcos de Lima Docema ◽

...

Keyword(s):

Surgical Outcome ◽

Internal Carotid ◽

Carotid Bifurcation ◽

Bifurcation Aneurysm

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Surgical Treatment of Internal Carotid Bifurcation and Pericallosal Artery Aneurysms with Unilatera

Journal of Clinical and Analytical Medicine ◽

10.4328/jcam.1351 ◽

2014 ◽

Vol 5 (4) ◽

Author(s):

Cengiz Cokluk

Keyword(s):

Surgical Treatment ◽

Internal Carotid ◽

Carotid Bifurcation ◽

Pericallosal Artery

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Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191311 ◽

2019 ◽

Vol 7 (4) ◽

pp. 1127

Author(s):

Anasuya Ghosh ◽

Subhramoy Chaudhury ◽

Atin Datta

Keyword(s):

Carotid Artery ◽

Carotid Arteries ◽

Internal Carotid ◽

Hypoglossal Nerve ◽

Carotid Bifurcation ◽

External Carotid Artery ◽

Arterial System ◽

External Carotid ◽

The Common ◽

Carotid Arterial

Background: The common carotid, internal and external carotid arteries and their branches serve as major source of blood supply in head-neck region of human and are often encountered during numerous surgical and clinical interventions of neck.Methods: We dissected and examined both sides of neck in 49 well embalmed cadavers (98 sides). We recorded the following anatomical parameters of carotid arterial system-level of bifurcation, the relation between internal and external carotid arteries, branching pattern of anterior branches of external carotid artery, tortuosity in carotid arterial system, and relation of hypoglossal nerve with the carotid arteries.Results: In 56.16 % cases, the common carotid arterial bifurcation took place at the upper border of thyroid cartilage though high bifurcation was quite common (43.88%). The external carotid artery was located antero-medial to internal carotid artery in most cases (93.87%). Abnormal tortuosity of carotid arterial system was detected in 2.04% cases only. In 86.73% cases, the hypoglossal nerve crossed the internal and external carotid artery superior to carotid bifurcation above the level of hyoid bone while in 1 case it crossed immediately inferior to carotid bifurcation. In branching pattern, following variations were observed- linguo-facial trunk in 15.3% cases, thyro-lingual trunk in 5.1% cases, origin of superior thyroid artery from common carotid in 10.02% cases and origin of superior thyroid from internal carotid in one case (1.02%).Conclusions: The carotid arterial system has complex and variable anatomy in neck and this information should be kept in mind to avoid unwanted damage during surgical procedures of neck.

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