1997 Volume 57 Issue 6 Pages 551-556
We treated three patients with ruptured aneurysms protruding from the dorsal wall of the internal carotid artery in 1994. This type of aneurysm is rare but has a high risk of introoperative aneurysmal rupture. The problems in diagnosing and treating such aneurysms are disscussed. An acute stage operation was performed in each of the three patients. One problem in diagnosis is an absence of angiographic findings. A video disc recorder and digital subtraction angiography were useful in diagnosing this type of aneurysm. However, preoperative rerupture occurred in two patients with high-grade surgical risks. When the brain is markedly swollen, minimal cerebrotomy might allow the parent artery and the aneurysm to be safely approached during surgery. Special attention must be paid to clip application. We believe that dissection of the arachnoidal adhesion from the aneurysmal dome should be avoided.
