Internal Carotid Artery Bifurcation Aneurysm: Microsurgical Clipping of a Large Wide-Necked Internal Carotid Artery Bifurcation and Anterior Choroidal Artery Aneurysm After a Previous Failed Attempt at Flow Diverter Implantation
A 61-year-old female patient presented with a severe headache. MRI revealed a large aneurysm of the right-hand internal carotid artery (ICA). DSA showed a large wide-necked aneurysm on the right-hand ICA bifurcation, a microaneurysm in the right-hand anterior cerebral artery (ACA) at the A2–A3 segment, and another microaneurysm of the right-hand anterior choroidal artery (AchoA). The case was discussed within our dual-trained cerebrovascular neurosurgical team. The size and location of these aneurysms, the anatomy of the parent arteries, and the expected potential risks of the natural course were considered. Endovascular treatment was planned using a flow diverter stent. Because of the severe tortuosity of the ICA and aneurysm anatomy, it was not possible to navigate a suitable microcatheter to the right MCA through the ICA aneurysm. Therefore, the decision was made for microsurgical clipping of the aneurysms. The intraoperative findings and the treatment options for large and giant ICA bifurcation aneurysms are the main topics of this chapter.
KeywordsInternal carotid artery bifurcation Anterior choroidal artery Multiple cerebral aneurysms Large aneurysm Microsurgical clipping ICA bifurcation aneurysm Microaneurysm
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