Features of clinical manifestations and surgical treatment of arterial aneurysms of the internal carotid artery

Abstract

Objective — to identify the features of clinical manifestations and surgical treatment of arterial aneurysms (AA) of the internal carotid artery (ICA) to optimize their surgical treatment.
Materials and methods. 184 (100 %) patients have operated on for the AA of the ICA for the period from 01.01.2011 to 31.12.2017, women — 95 (51.6 %), men — 89 (48.4 %) with a slight prevalence of women at all age groups. The localization of AA ICA: the clinoid segment — 4
(2.2 %) cases, the ophthalmic artery — 16 (8.7 %), the superior pituitary artery — 2 (1.1 %), the posterior communicating artery — 82 (44.7 %), the anterior choroidal artery — 58 (31.4 %), the area of the ICA bifurcation — 22 (11.9 %). All patients were examined uniformly: physical, instrumental (neuroimaging, functional) and laboratory examinations.
Results. Clinical manifestations of AA ICA: AA rupture — 154 (83.7 %) cases, pseudotumor course — 26 (14.1 %), asymptomatic — 4 (2.2 %). In 58 (31.5 %) ruptured cases was intracerebral and/or intraventricular hemorrhages, in 82 (44.6 %) was a lesion of the cranial nerves. AA ICA was clipping in 102 (55.4 %) cases endovascular — in 82 (44.6 %). Emergency surgery — 51 (27.7 %) cases, urgent — 93 (50.5 %), planned — 40 (21.8 %). A good result was achieved in 111 (60.3 %) patients with a total mortality of 21 (11.4 %).
Conclusions. Before choose the optimal type and timing of the operation with AA ICA should be consider: the type of clinical course of the disease, the patient’s state, the morphometric characteristics of the aneurysm, ICA and its branches, the anatomical characteristics of the hemorrhage, the severity rate of angiospasm.