The research advancement of blood blister like aneurysms of the supraclinoid carotid artery / 中国医师进修杂志

Blood blister like aneurysms is very easy to rupture, especially during and after surgery. Once found, it should be treated promptly. Treatment includes direct clipping, suture artery reconstruction,aneurysm wrapping,internal carotid artery occlusion and endovascular treatment.In this article, we investigate the characteristics, clinical outcome and treatment strategy of blood blister like aneurysms of the supraclinoid carotid artery.

Ivy Sign on Fluid-Attenuated Inversion Recovery Images in Moyamoya Disease: Correlation with Clinical Severity and Old Brain Lesions

PURPOSE: Leptomeningeal collateral, in moyamoya disease (MMD), appears as an ivy sign on fluid-attenuated inversion-recovery (FLAIR) images. There has been little investigation into the relationship between presentation of ivy signs and old brain lesions. We aimed to evaluate clinical significance of ivy signs and whether they correlate with old brain lesions and the severity of clinical symptoms in patients with MMD. MATERIALS AND METHODS: FLAIR images of 83 patients were reviewed. Each cerebral hemisphere was divided into 4 regions and each region was scored based on the prominence of the ivy sign. Total ivy score (TIS) was defined as the sum of the scores from the eight regions and dominant hemispheric ivy sign (DHI) was determined by comparing the ivy scores from each hemisphere. According to the degree of ischemic symptoms, patients were classified into four subgroups: 1) nonspecific symptoms without motor weakness, 2) single transient ischemic attack (TIA), 3) recurrent TIA, or 4) complete stroke. RESULTS: TIS was significantly different as follows: 4.86+/-2.55 in patients with nonspecific symptoms, 5.89+/-3.10 in patients with single TIA, 9.60+/-3.98 in patients with recurrent TIA and 8.37+/-3.39 in patients with complete stroke (p=0.003). TIS associated with old lesions was significantly higher than those not associated with old lesions (9.35+/-4.22 vs. 7.49+/-3.37, p=0.032). We found a significant correlation between DHI and motor symptoms (p=0.001). CONCLUSION: Because TIS has a strong tendency with severity of ischemic motor symptom and the presence of old lesions, the ivy sign may be useful in predicting severity of disease progression.

Length of the Supraclinoid Internal Carotid Artery in Patients with Posterior Communicating Artery Aneurysm: Preliminary Study / 대한뇌혈관외과학회지

OBJECTIVES: When the supraclinoid portion of internal carotid artery (ICA) is shortened, the anterior clinoid process may have to be partially removed to secure adequate exposure and proximal control of the ICA in posterior communicating artery (P-com) aneurysm. The goal of this study is to investigate, with direct measurement, the relationship between the length of the supraclinoid ICA and aneurysm formation in P-com segment. MATERIAL AND METHODS: The author measured intraoperatively the length of the supraclinoid ICA of patients with P-com aneurysm and compared that of patients with anterior communicating artery (A-com) aneurysm and middle cerebral artery (MCA) bifurcation aneurysm (n=7 each). Additionally, the length of M1 portion of the MCA and A1 portion of the anterior cerebral artery was measured with image analyzer on CT angiogram and also compared that in the same patients. RESULTS: The length of the supraclinoid ICA was 11.6+/-.6 mm and it was similar to that reported at autopsy. The length of the supraclinoid ICA in patients with P-com aneurysm was shorter than that of A-com aneurysm (Student T test, p<0.001) and MCA aneurysm (Student T test, p<0.05). CONCLUSION: It is now generally accepted that aneurysm is acquired lesion, resulting from a complicated interplay of anatomical, hemodynamic, and degenerative factors. These preliminary results suggest when the supraclinoid portion of ICA is shortened, more hemodynamic stress may be produced to anatomically proximally located P-com segment at higher flow rates than other locations of anterior circulation, resulting in aneurysm formation of P-com segment.

The Clipping on Supraclinoid Internal Carotid Artery Aneurysms

OBJECTIVE: We present a clinical analysis to envision the difficulties in supraclinoid internal carotid artery(ICA) aneurysmal neck clippings to improve the postoperative outcome. METHODS: Two hundred and fifty aneurysm surgeries were undertaken at our hospital from 1997 to 1998. There were 52 patients(20.4% of the total) of supraclinoid ICA saccular aneurysmal patients. Eighteen cases(34.6%) were found with diverse difficulties in direct neck clippings. The authors analyzed the causes of surgical difficulties in the clipping on supraclinoid ICA aneurysms, in a clinical perspective. RESULTS: Perfect aneurysmal clippings were performed in 45 patients(86.5%) of the total 52 cases of supraclinoid ICA aneurysms. The clipping and wrapping were needed in five cases(9.6%), trapping in one(1.9%) with one case(1.9%) needed only for wrapping. The causes of difficulties in direct neck clipings were : aneurysm sac involving perforator in six cases(11.5%), too short an ICA proximal to posterior communicating artery for temporary clipping in 5(9.6%), posterior communicating artery aneurysm directed to the ventral side in three(5.8%), dorsal wall aneurysm in one, severe atheromatous ICA in one, a larger sac than in angiographic finding with partial thrombosis in one, severe adhesion of aneurysm to 3rd cranial nerve in one patient. CONCLUSION: For supraclinoid ICA aneurysm surgery, sufficient preoperative plans and careful inspection including angiographic findings to foresee the various difficulties of neck clippings are needed.