Internal carotid artery dorsal wall aneurysm with configurational change: Are they all false aneurysms?
BACKGROUND
Aneurysms arising from nonbranching sites of the ICA, so-called dorsal wall aneurysm, are rare entity, and present as blister type or saccular type. Occasionally configurational changes have been observed on serial cerebral angiography: a small blister-like bulge on ICA wall on initial angiography progressing to a saccular appearance within a few weeks. Such aneurysm showing configurational change has been regarded as a false aneurysm with fragile wall just like blister-type aneurysm, and direct surgical approach has been considered highly risky.


METHODS
A 42-year-old woman with a subarachnoid hemorrhage revealed small "blister-like" aneurysm at the medial wall of the ICA on initial angiography. After 12 days, the following angiograms demonstrated increased aneurysmal size and change of shape into a saccular configuration. Direct surgical approach was performed. The aneurysm had a relatively firm neck, and was successfully clipped without intraoperative rupture. The dome of aneurysm was resected after clipping and the histologic examination revealed it as a true aneurysm.


CONCLUSIONS
This case suggests that all dorsal wall aneurysms with configurational change are not false aneurysms, and that angiographic findings do not always correlate with the nature of the aneurysmal wall; therefore, we should give more credence to direct surgical observation rather than preoperative angiographic findings when considering the most suitable surgical option.
Kim
Jong-Hyun
JH
Department of Neurosurgery, College of Medicine, Korea University, Seoul 152-703, South Korea.
Kwon
Taek-Hyun
TH
Kim
Joo-Han
JH
Park
Youn-Kwan
YK
Chung
Hung-Seob
HS
D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D019635:Neurosurgical Procedures; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures