1997 Volume 25 Issue 6 Pages 428-433
We report 17 cases of aneurysms at the bifurcation of the internal carotid artery (ICA bif). There were 10 males and 7 females. The age ranged from 30 to 70 years old (average of 48.3 years). Multiple aneurysms were seen in 8 cases (47%). Thirteen patients presented with subarachnoid hemorrhage (SAH). Nine of these 13 patients suffered from SAH due to the rupture of ICA bif aneurysms. Direct surgery for neck clipping of the ICA bif aneurysms was carried out in 15 patients. In 13 patients, the clip was applied from the space superior to the ICA bifurcation between the anterior cerebral artery (ACA) and middle cerebral artery (MCA). In 2 cases of posteriorly projecting aneurysms, 1 was clipped from the space inferior to the ACA and medial to the ICA. The other aneurysm was clipped using a right-angled ring clip with the ACA being included in the ring. In 6 cases with unruptured ICA bif aneurysms, 5 had good results and 1 had a mild deficit due to the occlusion of perforating artery from the MCA. In 9 ruptured ICA bif aneurysms, 4 had good recovery, 2 had moderate disability, 1 was severely disabled, 1 was vegetative and 1 died. The causes of poor outcomes in these 5 cases were the severity of SAH in 3 cases and occlusion of the perforating artery from the MCA in 1 case and vasospasm in 1 case.
Clinical characteristics of the ICA bif aneurysm include younger age at presentation, male predominancy, and high rate of multiple aneurysms. In the majority of aneurysms, neck clipping can be accomplished from the space superior to the ICA bifurcation, but it should be modified for those projecting posteriorly. Preservation of the perforating arteries behind the dome is important to obtain good outcomes.
