Abstract
The dorsal internal carotid artery aneurysm (IC-dorsal An) needs careful attention during clipping.
We report a case of a small ruptured IC-dorsal An in a 74-year-old woman, who presented with a subarachnoid hemorrhage. At surgery, the aneurysm looked clippable. When the dome was being fully exposed after clipping, the clip slipped out and massive bleeding occurred. With the bleeding point covered by a cotton patty and a tapered brain spatula, the anterior clinoid process was drilled and the dural ring was dissected to expose the proximal side of the internal carotid artery. The aneurysm was then wrap-clipped.
The IC-dorsal An, in many instances, should not be clipped, but wrap-clipped, as the wall of the aneurysm is quite thin, including the neck itself. We present a useful method—the reverse compression method—for an unexpected intraoperative rupture of the internal carotid artery.
