Abstract
Six patients with aneurysms arising from the anterior wall of the internal carotid artery were reviewed to investigate clinical and radiographic characteristics and operative findings. The role of 3D-CT angiography (3D-CTA) was also analyzed in 3 recent patients to determine clinical usefulness in the diagnosis and surgical management of this lesion. They were all females ranging in age from 25 to 62 years with a mean age of 47.5. Five patients presented with subarachnoid hemorrhage and the remaining had an unruptured aneurysm in association with another ruptured aneurysm. The aneurysms arose from the right carotid artery in 5 patients and from the left in 1 patient. The 3 recent patients underwent 3D-CTA immediately after they were transferred to our hospital following aneurysm rupture.
At surgery 2 of 4 saccular aneurysms, which adhered to and were buried in the frontal lobe, were dissected subpially. Two patients had a blister type of the aneurysms with a wide neck, and the remaining 4 patients had a saccular type of the aneurysms with a narrow and distinct neck. A small, blister-like aneurysm in 1 patient was wrapped with thin sheets of cottonoid together with the parent artery, followed by clip placement. In the remaining 5 patients a variety of angled clips were placed in parallel to the parent artery. The 3D images generated by 3D-CTA were of great value in assessing the exact site of the aneurysms, their growth projection, the shape and the size of the fundus, and their anatomical relationships to the adjacent arteries and other landmarks such as the anterior clinoid process and the optic canals. They were also a great help in surgical planning and simulation for aneurysm dissection and neck clipping.
