Abstract
Background: Traditionally, unruptured internal carotid-posterior communicating artery aneurysms (IC-PC ANs) with oculomotor nerve palsy (ONP) have been considered at a relatively high risk of future rupture. Therefore, surgical treatment is urgently indicated to prevent the presumed impending subarachnoid hemorrhage (SAH). In this article, we reviewed our experiences with IC-PC AN cases diagnosed as impending rupture.
Materials and Methods: We treated 10 patients from December 2012 to April 2017. We reviewed their clinical characteristics and aneurysm images.
Results: The initial symptoms were ptosis or double vision in 3 patients (30%), ipsilateral deep orbital or temporal pain in 5 (50%), and upset eye in 4 (40%). In their first visit to our hospital, 9 patients (90%) had ONP and 7 (70%) had ipsilateral deep orbital pain or temporal pain. All patients underwent successful microsurgical clipping or intravascular embolization and discharged with a modified Rankin scale score of 0 or 1. The mean IC-PC AN diameter was 6.9±2.9 mm. The ANs were irregular in shape and had multiple blebs in all the patients. Furthermore, many ANs had blebs projecting over the top of the ANs; hence, aspect ratios tended to be relatively high (mean, 2.8±1.0). In the surgical clipping cases, we confirmed that the AN blebs seemed extremely fragile and had very thin walls, and intraoperative aneurysm rupture occurred in 3 cases.
Conclusion: In addition to ONP, ipsilateral deep orbital pain or focal headache is an important sign of impending IC-PC AN rupture. Furthermore, the irregular shape, multiple blebs, and projecting bleb over the top of the AN may be characteristic features indicating impending rupture.
