Open Intervention for Giant Aneurysm of the Supraclinoid Segment of the Internal Carotid Artery

Podgornyak M.Yu.

(Neurosurgical Department of the Mariinsky Hospital)

Female patient Zh., aged 48, was in hospital since January 10, 2001 up to February 14, 2001. On admission she complained of severe diffuse headache. The patient fell ill on January 3, 2001. The disease onset was acute. The patient did not lose consciousness and was treated in an outpatient department without any improvement. Thus, she was taken to Hospital N 30 on January 8, 2001. The lumbar puncture results were indicative of subarachnoid hemorrhage. The patient was transferred to the Neurosurgical Department for further examination and probable surgical treatment. On admission the patient was in a state of moderate severity; her consciousness was clear; movements of the eyeballs were not limited, but caused pain; deep reflexes from the lower extremities were a bit prevalent on the right; Babinsky's symptom was unstable on the right. There was marked meningeal syndrome. CT (N 28817) showed no pathologic changes in a zone under examination. Carotid angiography was indicative of a large aneurysm of the supraclinoid segment of the right ICA (according to rentgenologic findings, its size was equal to 1.9x1.5 cm). A chest X-ray demonstrated no pathology. According to ECG findings, the rhythm was sinus with the heart rate of 69 beats/min; there were incomplete blockade of the first degree and impaired conduction in the right branch of His bundle.

The patient was operated on January 26, 2001. Osteoplastic trephination in the right frontotemporal area (5 burr holes) was made; the neck of aneurysm of the right ICA supraclinoid segment was clamped with a self-gripping clip. The wound healed by first intention. There was right-sided hemiparesis in a postoperative period. It regressed completely.

True dimensions of aneurysm, watched intraoperatively, were much larger, than those, determined with the help of X-ray examination. They approximated to standard dimensions of giant aneurysms (2.5 cm). May be, it was connected with angular localization of the aneurysm sac in relation to sagittal and horizontal planes.

Control angiography did not reveal any aneurysm; one could watch the self-gripping clip in projection of the aneurysm neck. CT examination showed signs of moderate edema of the brain and round formation in a zone of the clip (1.9x1.5 cm).

A postoperative period was characterized by regress of neurologic symptoms. The patient was discharged in a satisfactory state for further outpatient treatment.

The demonstration goal:

To emphasize possibility of successful direct surgical treatment of large aneurysms with dimensions, approximating to those of giant aneurysms.