Use of the Sundt Clip Graft in a Previously Coiled Internal Carotid Artery Blister-Like Aneurysm

Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).

Direct Repair of a Dorsal Wall Aneurysm on Supraclinoid Internal Carotid Artery

Aneurysms arising at locations other than arterial division are rare and the incidence of intraoperative bleeding is far higher in such aneurysms than in usual aneurysms. The authors report a case of intraoperative rupture and laceration on internal carotid artery(ICA) wall during dissecting a dorsal wall aneurysm on supraclinoid ICA and successful repair of the laceration on the parent ICA with microsuture and a Sundt clip-graft.