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Unusual Aneurysms of the Distal Internal Carotid Artery

Published online by Cambridge University Press:  18 September 2015

Gary J. Redekop  and
Barrie Woodhurst
Gary J. Redekop*
Affiliation:
Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia.
Barrie Woodhurst
Affiliation:
Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia.
*
323-C, 700 West Tenth Avenue, Vancouver, British Columbia, Canada V5Z 4E5
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Abstract:

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Background:

Supraclinoid carotid aneurysms have traditionally been classified according to their relation to the major carotid branches, but considerable variation exists with respect to site of origin, projection, and relationship to the skull base. Distal internal carotid aneurysms with a superior or medial projection are uncommon vascular lesions, with an unusually high incidence of operative complications.

Methods:

Surgical experience with five patients suffering from subarachnoid hemorrhage due to ruptured aneurysms of the dorsomedial wall of the distal internal carotid artery is presented, with emphasis on their angiographic appearance, anatomical features, and operative management.

Results:

All five patients underwent surgical clipping. Intra-operative rupture occurred in two cases, with avulsion of the aneurysm from the internal carotid artery in both. A third patient experienced recurrent subarachnoid hemorrhage three days after uneventful surgery, due to the clip shearing off of the parent vessel.

Conclusions:

Distal internal carotid aneurysms do not conform to the usual principles of aneurysm formation and are unique in their dorsomedial location unrelated to an arterial bifurcation. Although their anatomy is straightforward and exposure is not restricted by bone or dural structures of the skull base, they possess extremely fragile necks which make surgical management particularly hazardous.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 3 , August 1998 , pp. 202 - 208
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

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