Angiographic Results of Ruptured ICA Bleb Aneurysm Treated With Direct Clipping Method Only

초록

Introduction: ICA bleb aneurysms have been known to require special concerns for its management, and clipping on wrapping technique or segmental occlusion followed by bypass surgery has been reported as the optimal treatment. However, its pathophysiology has not been clarified and treatment has yet to be clearly established. We performed this study to evaluate the feasibility of direct clipping without any combined procedure and to investigate the natural course. Methods: The authors experienced 10 ICA bleb aneurysms during last ten years. We treated all of them with microsurgical clipping without wrapping or any combined procedure. We performed postoperative angiography for all as well as delayed cerebral angiography (more than 3 months after operation). We reviewed their medical records. Results: All aneurysms had been revealed in the distal ophthalmic segment or the proximal communicating segment of ICA. Eight developed on the dorsal and two developed on the ventral site. All dorsal wall aneurysms had a teat and diffuse bulbous lesion around teat as well and the ventral lesion did not have bulbous portion. There were no complications related with surgical procedures. The bulbous lesion around the teat had disappeared in the follow-up delayed angiography. Nine of ten patients have returned to normal life without neurologic complication. Conclusions: Dorsal aneurysms seem to be a variant of a dissecting aneurysm and ventral ones seem to originate from atherosclerotic lesion. Direct clipping could be the first-line of treatment for securing these types of aneurysms. Clipping on wrapping or segmental occlusion with bypass should be reserved for complicated cases.