Internal carotid artery dorsal wall aneurysm with configurational change: are they all false aneurysms?

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33 Citations (Scopus)

Abstract

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. Case Description: 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.

Original languageEnglish
Pages (from-to)441-443
Number of pages3
JournalSurgical Neurology
Volume66
Issue number4
DOIs
Publication statusPublished - 2006 Oct 1

Keywords

  • Dorsal wall aneurysm
  • Histologic examination
  • Internal carotid artery
  • Subarachnoid hemorrhage
  • True aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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