Document Detail


Microneurosurgical management of internal carotid artery bifurcation aneurysms.
MedLine Citation:
PMID:  19328524     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Internal carotid artery bifurcation aneurysms form 2% to 9% of all IAs. They are more frequent in younger patients than other IAs. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of ICAbifAs. METHODS: This review and the whole series on IAs are mainly based on the personal microneurosurgical experience of the senior author (JH) in 2 Finnish centers (Helsinki and Kuopio), which serve, without patient selection, the catchment area in Southern and Eastern Finland. RESULTS: These 2 centers have treated more than 11 000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 (28%) patients had altogether 980 ICA aneurysms, of whom 137 patients had 149 (4%) ICAbifAs. Ruptured ICAbifAs, found in 78 (52%) patients, with median size of 8 mm (range, 2-60 mm), were associated with ICH in 15 (19%) patients. Ten (7%) ICAbifAs were giant (> or = 25 mm). Multiple aneurysms were seen in 59 (43%) patients. The ICAbifAs represented 18% of all IAs ruptured before the age of 30 years. CONCLUSIONS: The main difficulty in microneurosurgical management of ICAbifAs is to preserve flow in all the perforators surrounding or adherent to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3D angioarchitecture and proper orientation during the microsurgical dissection.
Authors:
Martin Lehecka; Reza Dashti; Rossana Romani; Ozgür Celik; Ondrej Navratil; Leena Kivipelto; Riku Kivisaari; Hu Shen; Keisuke Ishii; Ayse Karatas; Hanna Lehto; Jouji Kokuzawa; Mika Niemelä; Jaakko Rinne; Antti Ronkainen; Timo Koivisto; Juha E Jääskelainen; Juha Hernesniemi
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-03-27
Journal Detail:
Title:  Surgical neurology     Volume:  71     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-11     Completed Date:  2009-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  649-67     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
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MeSH Terms
Descriptor/Qualifier:
Aneurysm / diagnosis,  etiology,  surgery*
Carotid Artery Diseases / diagnosis,  etiology,  surgery*
Carotid Artery, Internal*
Craniotomy
Diagnostic Imaging
Humans
Microsurgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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