2 786

Cited 73 times in

Surgical strategies for ruptured blister-like aneurysms arising from the internal carotid artery: a clinical analysis of 18 consecutive patients

Authors
 Jae-Whan Lee  ;  Hak-Gi Choi  ;  Jin-Young Jung  ;  Seung-Kon Huh  ;  Kyu-Chang Lee 
Citation
 ACTA NEUROCHIRURGICA, Vol.151(2) : 125-130, 2009 
Journal Title
ACTA NEUROCHIRURGICA
ISSN
 0001-6268 
Issue Date
2009
MeSH
Adult ; Aged ; Carotid Artery, Internal/diagnostic imaging ; Carotid Artery, Internal/pathology ; Carotid Artery, Internal/surgery ; Carotid Artery, Internal, Dissection/mortality ; Carotid Artery, Internal, Dissection/pathology ; Carotid Artery, Internal, Dissection/surgery* ; Female ; Humans ; Intracranial Aneurysm/mortality ; Intracranial Aneurysm/pathology ; Intracranial Aneurysm/surgery* ; Intraoperative Complications/etiology ; Intraoperative Complications/prevention & control ; Male ; Middle Aged ; Mortality ; Neurosurgical Procedures/methods* ; Neurosurgical Procedures/mortality ; Neurosurgical Procedures/statistics & numerical data ; Postoperative Hemorrhage/etiology ; Postoperative Hemorrhage/prevention & control ; Prostheses and Implants/standards ; Radiography ; Retrospective Studies ; Secondary Prevention ; Subarachnoid Hemorrhage/prevention & control ; Subarachnoid Hemorrhage/surgery ; Treatment Outcome ; Vascular Surgical Procedures/methods* ; Vascular Surgical Procedures/mortality ; Vascular Surgical Procedures/statistics & numerical data
Keywords
Blister-like aneurysms ; Internal carotid artery ; Surgical strategies
Abstract
BACKGROUND: Ruptured blister-like aneurysms arising at non-branching sites of the internal carotid artery (BLICAA's) sometimes cause disaster during aneurysm repair because of their characteristic configurations. Our study was designed to establish the best surgical strategies for such aneurysms.

METHOD: Eighteen BLICAA's (0.9% of all treated aneurysms) treated at our institute from January 1994 to July 2006 were retrospectively analysed using the database and imaging studies. We assessed the management outcome with the modified Rankin Scale (mRS). the average follow-up period was 17 months.

FINDINGS: Their ages ranged from 30 to 68 years with a mean age of 50. There were 16 females, and two males). the angiographic diameter of the aneurysmal sac sranged from 1.4 to 5 mm with a mean diameter of 2.5 mm. the common origins were dorso-medial (n = 7) or dorsal (n = 6) wall of the ICA. Fifteen patients underwent wrapping with cellulose fabric and clipping. of the remainder, each underwent direct clipping, suturing, or trapping. the overall outcome was mRS 1 in 11 patients (78.0%), two in three patients, three in one patient, one in one patient, and five in two patients. Intra-operative premature rupture occurred in six patients. There was no rebleeding during the follow-up period. Cerebral infarctions following carotid trapping after premature rupture and stenosis after suturing of perforated carotid wall were causes of mortality. the causes of morbidity included initial brain insult and vasospasm.

CONCLUSIONS: the surgeon should be ware of the high risk of premature rupture during dissection of BLICAA's. Wrapping with cellulose fabric (Bemsheet) and holding clipping technique could be chosen as the optimal surgical modality for prevention of rebleeding from these lesions.
Full Text
http://link.springer.com/article/10.1007%2Fs00701-008-0165-5
DOI
10.1007/s00701-008-0165-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Kyu Chang(이규창)
Lee, Jae Whan(이재환)
Choi, Hak Gi(최학기)
Huh, Seung Kon(허승곤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103763
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links