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崔源生 台中榮民總醫院神經外科

Surgical Treatment of Aneurysms of the Anterior Wall of the Internal Carotid Artery. 崔源生 台中榮民總醫院神經外科. Anatomy:. ICA:5 segments: Cervical Petrous Cavernous Clinoidal Supraclinoid. Morphology:. Pathology:. No internal elastic lamina and media

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崔源生 台中榮民總醫院神經外科

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  1. Surgical Treatment of Aneurysms of the Anterior Wall of the Internal Carotid Artery 崔源生 台中榮民總醫院神經外科

  2. Anatomy: • ICA:5 segments: • Cervical • Petrous • Cavernous • Clinoidal • Supraclinoid

  3. Morphology:

  4. Pathology: • No internal elastic lamina and media • The gap was covered with thin adventitia and fibrinous tissue, not composed of thick adventitia or collagenous tissue as ordinarily seen in an berry aneurysm wall

  5. Pathology:

  6. Pathogenesis: • Atherosclerosis: • (Stehbens,et al:The pathology of intracranial arterial aneurysms and their complications, Intracranial Aneursyms, 1983, Vol 1) • Dissecting:

  7. Anterior Wall Aneurysm • Dorsal type, Blister-like aneurysm • Low incidence • Small size • Thin wall • No neck • High intraoperative bleeding rate • High morbidity & mortality

  8. Diagnosis: • It’s difficult to detect anterior wall aneurysm on angiograms, in large part because of their small size and unusual location.(Shigeta et al, 6 (30%) negative in 20 pts) • It’s of great importance to evaluate collateral circulation because ICA sacrifice at surgery is relative common with these aneurysms.

  9. Case 1: angiogram (AP+Lat)

  10. Case 1: angiogram (oblique)

  11. Case 2: angiogram

  12. Case 2:

  13. Case 2: CTA

  14. OP Findings:Video

  15. Textbook-Management of Cerebral Aneurysms (2004)

  16. Poor outcome of Anterior Wall ICA Aneurysms:

  17. Aneurysm protruding from the dorsal wall of internal carotid arteryFukuo Nakagawa, et al.J of Neurosurgery 65:303-308, 1986 • 5 year period, 8 cases/460 ANs

  18. Blood blisterlike aneurysms of the internal carotid arteryMasamitsu Abe, et al.J of Neurosurgery 89:419-424,1998 • 1981-1997, 6 cases/488 ANs

  19. Abe series: Clipping on wrapping

  20. Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery:Internal carotid artery trunk aneurysmsAkira Ogawa, et al.Neurosurgery 47:578-586, 2000 • 5 year period, 48 cases/7408 ANs

  21. Ogawa series-outcome:

  22. New method for obliterative treatment of an anterior wall aneurysm in the internal carotid artery: Encircling silicone sheet clip procedure-Technical case reportYasutaka Kurokawa, et al.Neurosurgery 49:469-472, 2001

  23. Techinical note:

  24. Surgical management: • Possible trapping of parent artery • Exposure of cervical ICA for proximal control • Wide open of Sylvian fissure • Little frontal lobe traction • Clip placement parallel to the ICA axis • Necessary to catch the adjacent carotid artery wall with the neck • Temporary clipping to reduce aneurysm turgor • Clipping on wrapping • Endovascular may be an alternative option

  25. Thank you

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