ORIGINAL

Surgical Outcome After Microsurgical Clipping of Internal Carotid Bifurcation Aneurysm. Series of 30 cases

Resultado Cirúrgico Após Clipagem Microcirúrgica de Aneurisma de Bifurcação de Carótida Interna. Série de 30 casos

  • Paulo Henrique Pires de Aguiar (2)(3)
  • Antônio Santos de Araújo Júnior (1)
  • Luiz Gabriel Dias Duarte Machado (4)
  • Marcos Perocco da Costa (1)(2)
  • Giovanna Zambo Galafassi (5)
  • Pedro Henrique Simm Pires de Aguiar (6)
  • Maria Clara Cardoso Seba (5)
  • Nadjila Gabriele Sidani (6)
  • Roberto Alexandre Dezena (7)
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Resumo

Introdução: Os aneurismas de bifurcação da artéria carótida interna (ICAbiAs) são pouco comuns. Têm uma incidência muito baixa em adultos, representando apenas 5% de todos os aneurismas intracranianos, e são ainda menos comuns entre os aneurismas da artéria carótida interna (ICA). As séries cirúrgicas relativas exclusivamente ao ICAbiAs são muito escassas. Métodos: Descrevemos 30 pacientes ICAbiAs tratados cirurgicamente de junho de 1995 a janeiro de 2020, num universo de 648 aneurismas operados pelo autor sênior deste artigo. Resultados: 46% (14/30) do ICAbiAs foram rompidos na apresentação. 73% dos 30 pacientes tiveram um bom resultado (escala de Glasgow com escore 5), enquanto oito pacientes (26,6%) morreram. Conclusão: Os aneurismas neste local,de grandes dimensões, com pescoço largo, incorporando a origem das artérias cerebrais médias ou anteriores, e especialmente no que diz respeito ao pulso de martelo d’água com efeito direto no fluxo carotídeo, favorecem frequentemente o tratamento cirúrgico, em detrimento do enrolamento endovascular ou de stent.

Palavras-chave

Aneurisma de bifurcação de carótida interna; Aneurisma cerebral; Neurocirurgia vascular

Abstract

Introduction: Internal carotid artery bifurcation aneurysms (ICAbiAs) are uncommon. They have a very low incidence in adults, accounting for only 5% of all intracranial aneurysms, and are even less common amongst aneurysms of the internal carotid artery (ICA). Surgical series regarding exclusively ICAbiAs are very scarce. Methods: We describe 30 ICAbiAs surgically treated patients from June 1995 to January 2020, in a universe of 648 aneurysms operated by the senior author in this paper. Results: At presentation 46% (14/30) of the ICAbiAs were ruptured. Good outcome was found in 73% of the 30 patients (Glasgow Outcome Scale score 5), whereas eight patients (26.6%) died. Conclusion: Aneurysms at this location, large sized, with broad neck, incorporating the origin of the middle cerebral or anterior cerebral arteries, and especially regarding the direct water hammer effect of flow at the carotid summit, often favor surgical treatment, in detriment of endovascular coiling or stenting.

Keywords

Internal carotid bifurcation aneurysm; Brain aneurysm; Vascular neurosurgery

References

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1 MD, PhD, Division of Neurosurgery, Sírio-Libanês Hospital, São Paulo, SP, Brazil.
2 MD, PhD, Division of Neurosurgery, Santa Paula Hospital, São Paulo, SP, Brazil.
3 MD, PhD, Department of Research and Innovation, Laboratory of Cellular and Molecular Biology, ABC School of Medicine – FMABC, Santo André, SP, Brazil.
4 Medical student, La Sapienza University of Rome, Rome, Italy.
5 Medical student, ABC Medical School – FMABC, Santo André, SP, Brazil.
6 Medical student, School of Medicine of Pontifical Catholic University of São Paulo – PUC-SP, Sorocaba, SP, Brazil.
7 MD, PhD, Division of Neurosurgery, Federal University of Triângulo Mineiro - UFTM, Uberaba, MG, Brazil.

 

Received Jan 30, 2022
Corrected Feb 4, 2022
Accepted Feb 7, 2022

JBNC  Brazilian Journal of Neurosurgery

  •   ISSN (print version): 0103-5118
  •   e-ISSN (online version): 2446-6786

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