Clinical Study on Internal Carotid Bifucation Aneurysm: Clinical Analysis of 30 Cases.

Ko, Won Il; Jeon, Sin Su; Lee, Sang Won; Jeong, Chul Gu; Kim, Moon Chan; Kang, Joon Ki

Original Article

Journal of Korean Neurosurgical Society 1996;25(11): 2296-2302.

Won Il Ko, Sin Su Jeon, Sang Won Lee, Chul Gu Jeong, Moon Chan Kim, Joon Ki Kang

Department of Neurosurgery, College of Medicine, Catholic University, Seoul, Korea.

ABSTRACT

Aneurysms arising from ICA bifucation are relatively rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In an effort to determine their best management policy, and to improve their surgical outcome, a retrospective clinical analysis of 30 patients who underwent direct surgery from ICA bifucation aneurysm between January, 1984 and December, 1994 was performed. In the same period, total 990 patients with intracranial aneurysms were admitted in our department. The result of carotid bifucation aneurysm surgery was worse than the total surgical result. Motality and morbidity rates were 3/30(10%), 5/30(16%). Surgical complications in this group of aneurysms usually came from injury of perforating arteries, and the causes of death were intraoperative premature rupture and vasospasm. The surgical treatment of aneurysms of internal carotid bifucation is discussed, emphasizing the importance of avoiding damage to perforating vessels and premature rupture. A classification of these aneurysms, according to angiographic and anatomical considerations, is proposed. We suggest that four types of aneurysmal orientation at the bifucation of the internal carotid artery be distinguished:either projecting superiorly, anteriorly, inferiorly, or posteriorly. Posterior orientation was found in 13 cases(43.3%). Superior orientation was found in 11 cases(36.7%), inferior orientation was found in 4 cases(13.3%), and anterior orientation was found in 2 cases(6.7%). From an analysis of these cases and a review of the literature, some characteristics of these aneurysms and their surgical strategies are described.

Key Words: ICA bifucation aneurysm; Orientation of aneurysm; Arterial perforating branches; Intraoperative premature rupture