Abstract
Seventeen patients with aneurysms of the internal carotid bifurcation were treated by direct microsurgery.
Two patients had unruptured and asymptomatic aneurysms. Six patients were operated on in the acute stage, while the remaining 9 patients were operated on in the chronic stage. Fifteent (88%) of the 17 patients had a good result. There was no mortality.
However, 6 patients had postoperative neurological deficits, though 4 of them were transient. In 4 of the 6 patients, circulatory disturbance of the anterior choroidal artery or perforating arteries was responsible for such operative complications.
We stress that direct surgery should be performed for patients not only with ruptured aneurysms of the internal carotid bifurcation but also with unruptured, incidentally discovered ones, because they tend to bleed at a younger age, compared with aneurysms at other sites.
Furthermore, based on our experiences, surgical consideration for aneurysms at this location includes (1) wide opening of sylvian fissure, especially in patients with large aneurysms or long internal carotid artery, (2) dissection strategy pertinent to the projection of the aneurysm, (3) gentle but complete dissection of aneurysm neck, (4) temporary or tentative clipping in difficult cases, (5) careful and reasonable application of clip to aneurysm neck, and (6) preservation of perforating arteries of the anterior and middle cerebral, and posterior communicating arteries, Heubner's artery, and the anterior choroidal artery.
