title: Internal carotid artery bifurcation aneurysms: surgical experience.
abstract: Internal carotid artery (ICA) bifurcation aneurysms are relatively uncommon and frequently rupture at a younger age compared to other intracranial aneurysms. We have treated a total of 999 patients for intracranial aneurysms, of whom 89 (8.9%) had ICA bifurcation aneurysms, and 42 of the 89 patients were 30 years of age or younger. The present study analyzed the clinical records of 70 patients with ICA bifurcation aneurysms treated from mid 1997 to mid 2003. Multiple aneurysms were present in 15 patients. Digital subtraction angiography films were studied in 55 patients to identify vasospasm and aneurysm projection. The aneurysm projected superiorly in most of these patients (37/55, 67.3%). We preferred to minimize frontal lobe retraction, so widely opened the sylvian fissure to approach the ICA bifurcation and aneurysm neck. Elective temporary clipping was employed before the final dissection and permanent clip application. Vasospasm was present in 24 (43.6%) of 55 patients. Forty-eight (68.6%) of the 70 patients had good outcome, 14 (20%) had poor outcome, and eight (11.4%) died. Patients with ICA bifurcation aneurysms tend to bleed at a much younger age compared to those with other intracranial aneurysms. Wide opening of the sylvian fissure and elective temporary clipping of the ICA reduces the risk of intraoperative rupture and perforator injury. Mortality was mainly due to poor clinical grade and intraoperative premature aneurysm rupture.
authors: Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drgupta_sk@yahoo.com
authors: Sunil Kumar
authors: SK
authors: Gupta
authors: Virender Kumar
authors: VK
authors: Khosla
authors: Rajesh
authors: R
authors: Chhabra
authors: Sandeep
authors: S
authors: Mohindra
authors: Jaipali Rajeev
authors: JR
authors: Bapuraj
authors: Niranjan
authors: N
authors: Khandelwal
authors: Kanchan Kumar
authors: KK
authors: Mukherjee
authors: Manoj Kumar
authors: MK
authors: Tewari
authors: Ashis
authors: A
authors: Pathak
authors: Suresh Naraian
authors: SN
authors: Mathuriya
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000175:diagnosis / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome