title: Combination treatment for rapid growth of a saccular aneurysm on the internal carotid artery dorsal wall: case report.
abstract: Aneurysms arising from non-branching sites of the supraclinoid internal carotid artery (ICA) are considered rare, accounting for only 0.9-6.5% of all ICA aneurysms. They are thin-walled, broad-based, can easily rupture during surgery, and are referred to as dorsal, superior, anterior, or ventral wall ICA aneurysms, as well as blister-like aneurysms. Various treatment modalities are available for blister-like aneurysms, but with varying success. Here, we report on two cases of saccular shaped dorsal wall aneurysms. Both patients were transferred to the emergency department with subarachnoid hemorrhage because of an aneurysmal rupture. Computed tomography angiography and transfemoral cerebral angiography (TFCA) showed a dorsal wall aneurysm in the distal ICA. We performed clipping on the wrapping material (Lyodura®, temporal fascia). Follow-up TFCA showed rapid configuration changes of the right distal ICA. Coil embolization was also performed as a booster treatment to prevent aneurysm regrowth. Both patients were discharged without neurologic deficit. No evidence of aneurysm regrowth was observed on follow-up TFCA at two years. Dorsal wall ICA aneurysms can change in size over a short period; therefore, follow-up angiography should be performed within the short-term. In cases of regrowth, coil embolization should be considered as a booster treatment.
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Tae Hong
authors.identifier: 0000-0002-7593-6546
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Sang Keun
authors.initials: SK
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Yong Soon
authors.initials: YS
authors.lastname: Hwang
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Hyung Shik
authors.initials: HS
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors.forename: Jun Jae
authors.initials: JJ
authors.lastname: Shin
keywords: Coiling; Dorsal wall aneurysm; Subarachnoid hemorrhage; Wrapping