Abstract:

Objective To investigate the technique in clipping of ventral aneurysms in internal carotid artery. Methods Ten cases of ventral aneurysms in internal carotid artery confirmed by 3D-CT angiography (3D-CTA) and digital subtraction angiography (DSA) were analysed. Preoperative virtual reality model of 3D-CTA, based on the body position during surgery, simulated the position of aneurysm and direction of doom and determine the existence of branching artery originating from the aneurysm or nearby parent artery. Somatosensory evoked potential monitoring, microvascular Doppler sonography, and neuroendoscopy were used before and after clipping to confirm the obliteration of aneurysms and patency of parent vessels and branching artery.If the branching artery was originating from the aneurysm, lateral side of internal carotid artery with nonring clip was recommended. Otherwise, it was often preferable to clip the aneurysm with ring or so-called fenestrated clip, whose clip-blades were placed parallel to internal carotid artery axis. If necessary, the combination use of several clips was recommended to reconstruct the parent artery. Results The scores of Glasgow Outcome Scale one month after operation were 5 points in 8 patients, 4 points in 1 patient and 3 points 1 patient. There was no case of death. Three months after operation,DSA and/or 3D-CTA revealed that there was no aneurysmal residue and no stenosis of parent and adjacent vessels. One patient suffered from permanent visual loss. Conclusion Detailed preoperative planning and proper intraoperative assisted methods and neuroendoscopy are important for clipping of ventral aneurysms in internal carotid artery.

Key words: internal carotid artery, ventral aneurysm, clipping, 3D-CT angiography, digital subtraction angiography