Last year, we reported a 28-year-old female whose right internal carotid giant aneurysm was successfully treated with the detachable balloon technique with subsequent complete recovery both neurologically and socially.
At this time we investigated follow-up angiograms to evaluate the aneurysm and hemodynamic states.
On the 40th postoperative day, the angiogram showed a right internal carotid artery occluded at the point 1.5cm distal to the bifurcation, where an external carotid artery branched off an accessory meningeal artery and a twig of the internal maxillary artery, draining into an inferolateral trunk of the cavernous portion. Retrograde filling of an ophthalmic artery was seen from an anterior deep temporal artery.
The C2-C4 segment of the internal carotid artery was filled via these arteries, but was prominently elevated and compressed by giant aneurysm.
Approximately one year after the operation, these angiographic findings were almost unchanged except that collaterals and the C2-C4 segment were larger, and the latter took the normal course.
From these findings, we discussed the danger of rerupture because of retrograde or anterograde cerebral blood flow to an aneurysm of the cavernous and petrosal portion, and of delayed cerebral ischemic episodes.
