직접 결찰만으로 치료한 파열성 ICA bleb aneurysm 의 추적 혈관 조영술 결과

초록

PURPOSE : ICA bleb aneurysm has been known to require the special concerns for its management, particularly, during surgery. 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 its treatment has yet to be clearly established. We performed this study to evaluate the effectiveness of direct clipping without any combined procedure and to investigate the natural course of these aneurysms. MATERIALS AND METHODS : Authors have experienced 10 ICA bleb aneurysms during last ten years. We treated all of them with microsurgical clipping without wrapping or any combined procedures. We performed postoperative angiography for all of them and did delayed cerebral angiography (more than 3months after operation) as well. We reviewed their medical and surgical records including imaging data RESULTS : All of them had been revealed in distal ophthalmic segment or proximal communicating segment of ICA and had atherosclerotic change around teat in operating field. Eight developed on the dorsal side of internal carotid artery and two developed on the ventral site. All dorsal wall aneurysms had a teat and diffuse bulbous lesion around teat as well and ventral lesion did not have bulbous portion. There was no complication related with surgical procedures. Bulbous lesion around teat had been disappeared in the follow-up delayed angiography. All patients has returned to normal life without neurologic complication. CONCLUSION : Dorsal wall bleb aneurysms seem to be a variant of dissecting aneurysm and ventral wall aneurysm seem to be originated from atherosclerotic lesion. Direct clipping could be the first-line treatment for securing these types of aneurysms. Clipping on wrapping or segmental occlusion with bypass should be reserved for complicated cases.