Imaging-anatomic Measurements of Carotid Artery Bifurcation

ABSTRACT Objective: To have anatomic measurements of carotid artery bifurcation (CAB) with 64-spiral computed tomography angiography (64-SCTA), and provide anatomic basis for related research. Methods: Imaging data of 92 subjects (45 males, 47 females, the age range 20-82 years and mean age 48.4 ± 6.1 years) without pathology of CAB, who underwent 64-SCTA in head and neck from June 1, 2008 to June 30, 2010, were selected from the Picture Archiving and Communication Systems in Zhongshan Hospital of Xiamen University, Fujian, China. On the 3D images, the angle and size of CAB were measured, and the statistical comparisons of measurements were made between the bilateral, sex and age groups. Results: The measurements of CAB were divided into young (≤ 40 years) and older (> 40 years) groups: bifurcation angle is 36.206° ± 10.210° and 49.343° ± 16.489°, respectively; the inner diameter of common carotid artery (CCA) is 6.820 ± 0.635 and 6.845 ± 0.838 mm, respectively; the proximal inner diameter of internal carotid artery (ICA) is 7.143 ± 0.992 and 7.476 ± 1.630 mm, of the enlargement is 7.568 ± 1.069 and 8.554 ± 1.733 mm, of the distal is 4.897 ± 0.508 and 5.123 ± 0.699 mm, respectively; the inner diameter of external carotid artery (ECA) is 4.324 ± 0.580 and 4.104 ± 0.638 mm, respectively. There were statistically significant differences in all the measurements between male and female groups, in the bifurcation angle, inner diameters of ICA and ECA between young and older groups, and in the bifurcation angle between the left and right (p < 0.05). Conclusion: A 64-SCTA with 3D image post-processing technique can clearly observe and show the CAB. All CAB measurements will provide the objective basis for applied anatomy, imaging diagnosis and surgery treatment.

Oculomotor Nerve Palsy in Association with a Ruptured Internal Carotid Artery Bifurcation Aneurysm: Case Report / 대한뇌혈관외과학회지

We report a rare case of third cranial nerve palsy due to a ruptured left internal carotid artery (ICA) bifurcation aneurysm. A 70-year-old man was stuporous with left ophthalmoplegia (unilaterally fixed dilated pupil, abducted eyes, and ptosis). A computed tomography demonstrated extensive hemorrhage spreading around the left sylvian fissure and basal cistern with a ipsilateral predominance, and intraventricular hemorrhage without focal mass effect. A computed tomographic angiography demonstrated a 3mm sized aneurysmal sac which arose from the left ICA bifurcation. The aneurysmal clipping was performed at 1 day after onset. In operative field, there was no direct compression of the oculomotor nerve by the aneurysmal fundus. Postoperatively, he recovered to alert mental status, but left ophthalmoplegia recovered partially at the 1 year follow-up.

Clinical Features and Surgical Results of ICA Bifurcation Aneurysms

OBJECTIVE: The aneurysms developed at internal carotid artery(ICA) bifurcation can be different from other aneurysms because there are many perforating arteries and the hemodynamic changes are characteristic. In this report, we present our cases of ICA bifurcation aneurysms and discuss the clinical features and surgical outcomes of these aneurysms. METHODS: From January 1989 to May 2001, total 808 patients(982 aneurysms) were operated for intracranial aneurysms at our hospital. Among them, twenty two patients(2.7%) had aneurysms at ICA bifurcation. We discussed clinical features according to mental status at admission, size, direction and multiplicity of aneurysms, presence of intracranial hemorrhage and rupture of ICA bifurcation aneurysms. And we also discussed the surgical results of operations depending on pre-operative Hunt-Hess grade and size of aneurysms. RESULTS: Mean age was 43.4 years old and 10 cases(45.5%) were below 40 years old. Six patients(27.2%) had large or giant aneurysms. Fifteen(68.2%) out of 22 patients had good results, 1 fair, 1 poor and 5 dead. CONCLUSION: In our ICA bifurcation aneurysm cases, we conclude that their onset is relative in younger age, and they has a higher incidence of multiple(34.6%) and larger aneurysm(27.2%) than other anterior circulatory aneurysm. And the surgical results of ICA bifurcation aneurysm are relatively poor.

ICA Bifurcation Aneurysm: Clinical Features and Surgical Outcome

OBJECTIVE: Aneurysms at the internal carotid artery(ICA) bifurcation are uncommon and account for about 3 to 5% of all intracranial aneurysms. Moreover, the surgical treatment of these aneurysms has been discussed in detail only by a few authors. In this report, we present our experienced cases, and discuss the clinical features and surgical outcome of these aneurysms. METHOD: In the last eight years, out of total of 672 patients operated for intracranial aneurysms at our hospital, 17 patients(2.5%) had aneurysms at the ICA bifurcation. The direction of aneurysms were distinguished based upon DaPian's classification; superior, anterior, or posterior. RESULT: There were female preponderance(M:F=1:1.8) and the left side predominance(11 of 17 cases). Nine patients had multiple aneurysms, and in that cases ICA bifurcation aneurysms were responsible for hemorrhage in most cases. All aneurysms were clipped via the standard pterional approach. Thirteen out of 17 patients had good results and 2 patients fair results; the surgical outcome was favorable in 88.2% of cases. One who had rebleeding before surgery died. CONCLUSION: It is presumed that the perforator occlusion and intraoperative aneurysmal rupture were the main factors aggravating the surgical outcome. In cases with anteriorly- or posteriorly-projecting aneurysm, more careful cautions would be necessary.

Paraplegia:An Initial Manifestation of a Ruptured ICA Bifurcation Aneurysm

A case of sudden paraplegia as the first symptom of a ruptured internal carotid artery bifurcation aneurysm is reported. Sudden appearance of paraparesis or paraplegia is an exceptional event in patients with intracranial aneurysms. The various pathogenic mechanisms are briefly discussed. Insufficient blood perfusion of both paracentral areas was the cause of paraplegia in this case.