Results of surgical treatment of supraclinoid internal carotid artery aneurysms
Keywords:
craniotomy, intracranial aneurysm, microsurgery, subarachnoid hemorrhageAbstract
Introduction: Aneurysmal subarachnoid hemorrhage is one of the main conditions in vascular neurosurgery. Despite the multiple technological advances in the treatment of cerebral aneurysms, microsurgical clamping is a more widely used therapeutic modality.
Objective: To describe the surgical results of cerebral aneurysms of the internal carotid artery operated by microsurgical clipping.
Method: A descriptive, prospective study that included 79 patients from the Hermanos Ameijeiras Hospital operated on for cerebral aneurysm of the internal carotid artery using microsurgical clamping. A pterional, minipterional craniotomy and clipping of the aneurysm was performed. Clinical, cerebral aneurysm and postoperative variables were used with greater importance related to complications and the Glasgow Coma Scale for results. For data analysis, absolute and relative frequencies were used as summary measures.
Results: Carotid artery aneurysms in the posterior communicating segment were the most common (81.0%). Clamping of the aneurysmal neck was performed in 100%. Regarding the main complications, vasospasm (8.9%), cerebral infarction and hydrocephalus (5.1%) were reported respectively. According to the Glasgow Coma Scale for results, there was a greater presence of grade 5 immediately (43.1%) and late (57.0%).
Conclusions: Microsurgical clamping in patients with cerebral aneurysms of the internal carotid artery is a safe, efficient option with few complications.
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References
1. Claassen J, Park S. Spontaneous subarachnoid haemorrhage [Internet]. Lancet. 2022; 400(10355):846-62. DOI: 10.1016/S0140-6736(22)00938-2
2. Rumalla K, Lin M, Ding L, Gaddis M, Giannotta SL, Attenello FJ, et al. Risk Factors for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage: A Population-Based Study of 8346 Patients [Internet]. World Neurosurg. 2021; 145:e233-e241. DOI: 10.1016/j.wneu.2020.10.008
3. Karhunen V, Bakker MK, Ruigrok YM, Gill D, Larsson SC. Modifiable Risk Factors for Intracranial Aneurysm and Aneurysmal Subarachnoid Hemorrhage: A Mendelian Randomization Study [Internet]. J Am Heart Assoc. 2021; 10(22):e022277. DOI: 10.1161/JAHA.121.022277
4. Mourelo-Fariña M, Galeiras R, Pértega S, Aller AV. Clinical profile and course of patients with subarachnoid haemorrhage for 11 years [Internet]. Neurocirugia. 2021 (1):10-20. DOI: 10.1016/j.neucir.2020.03.007
5. Mead GE, Sposato LA, Sampaio Silva G, Yperzeele L, Wu S, Kutlubaev M, et al. Revisión sistemática y síntesis de las guías globales sobre ictus en nombre de la Organización Mundial del Ictus [Internet]. Int J Stroke. 2023; 18(5):499-531. DOI: 10.1177/17474930231156753
6. Xu P, Liu Y, Wang J, Zhang A, Wang K, Wang Z, et al. Los modelos de pronóstico específicos de género revelan diferencias en pacientes con hemorragia subaracnoidea entre sexos. CNS Neurosci Ther. 2024; 30(8):e14894. DOI: 10.1111/cns.14894
7. Caignard A, Leruez S, Milea D. Urgences en neuro-ophtalmologie [Neuro-ophthalmic emergencies] [Internet]. J Fr Ophtalmol. 2016; 39(8):716-728. French. DOI: 10.1016/j.jfo.2016.05.003
8. Rutledge C, Baranoski JF, Catapano JS, Lawton MT, Spetzler RF. Microsurgical Treatment of Cerebral Aneurysms [Internet]. World Neurosurg. 2022; 159:250-258. DOI: 10.1016/j.wneu.2021.12.079
9. Kesumayadi I, Sakamoto M, Hosoya T, Kambe A, Uno T, Yoshioka H, et al. Clinical Outcome of Pipeline Embolization Device with and without Coils to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis [Internet]. AJNR Am J Neuroradiol. 2025; 46(2):272-7. DOI: 10.3174/ajnr.A8443
10. Maroufi SF, Fallahi MS, Waqas M, Bin-Alamer O, Koneru M, Roy JM, et al. Comparison between pipeline embolization device (PED) versus flow redirection endoluminal device (FRED) for intracranial aneurysms: a comprehensive systematic review and meta-analysis[Internet]. Neurosurg Rev. 2025; 48(1):475. DOI: 10.1007/s10143-025-03595-x
11. Bsat S, Chanbour H, Alomari S, Moussalem C, Houshiemy MNE, Sunna T. Can we improve the prediction of complications and outcome in aneurysmal subarachnoid hemorrhage? The clinical implications of serum proteomics [Internet]. J Integr Neurosci. 2020; 19(4):711-17. DOI: 10.31083/j.jin.2020.04.370
12. Eisinger RS, Sorrentino ZA, Lucke-Wold B, Zhou S, Barlow B, Hoh B, et al Trayectoria de la cefalea intensa tras una hemorragia subaracnoidea aneurismática: asociación con niveles más bajos de sodio [Internet]. Brain Inj. 2022; 36(4):579-85. DOI: 10.1080/02699052.2022.2055146
13. Sano H, Satoh A, Murayama Y, Kato Y, Origasa H, Inamasu J, et al. Members of the 38 registered institutions and WFNS Cerebrovascular Disease & Treatment Committee. Modified World Federation of Neurosurgical Societies subarachnoid hemorrhage grading system [Internet]. World Neurosurg. 2015; 83(5):801-7. DOI: 10.1016/j.wneu.2014.12.032
14. Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES Jr, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale [Internet]. Neurosurgery. 2006; 59(1):21-7. DOI: 10.1227/01.neu.0000243277.86222.6cV
15. Jennett B, Snoek J, Bond MR, Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale [Internet]. J Neurol Neurosurg Psychiatry. 1981; 44(4):285-93. DOI: 10.1136/jnnp.44.4.285
16. Yasargil MG. Interfascial pterional (frontotemporosphenoidal) craniotomy. Vol. 1. In: Yasargil MG (ed): Microneurosurgery. Stuttgart: Georg Thieme Verlag; 1984.p. 215-20
17. Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, Spetzler RF, et al. Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms [Internet] . J Clin Neurosci. 2016; 27:34-9. DOI: 10.1016/j.jocn.2015.07.032
18. Möhlenbruch MA, Seker F, Özlük E, Kizilkilic O, Broussalis E, Killer-Oberpfalzer M, et al. Tratamiento de aneurismas vesiculares rotos con el desviador de flujo FRED: Una experiencia multicéntrica [Internet]. AJNR Am J Neuroradiol. 2020;41(12):2280-4. DOI: 10.3174/ajnr.A6849
19. Zhai XD, Hu P, He C, Feng YS, Li GL, Zhang HQ. Conocimientos actuales y perspectivas sobre la patogénesis de los aneurismas tipo ampolla de la arteria carótida interna: una revisión de la literatura [Internet]. Int J Med Sci. 2021;18(9):2017-22. DOI: 10.7150/ijms.53154
20. Orimoto R, Ebiharara K, Hayasaka M. Considerations and Literature Review for Treating Subarachnoid Hemorrhage due to Blood Blister-Like Aneurysms [Internet]. J Neuroendovasc Ther. 2024;18(7):183-90. DOI: 10.5797/jnet.oa.2024-0009
21. Chen S, Chen X, Ning B, Cao Y, Wang S. Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes [Internet]. Chin Neurosurg J. 2021; 7(1):10. DOI: 10.1186/s41016-020-00226-w
22. Eide PK, Sorteberg A, Nome T, Rønning PA, Sorteberg W. Reparación quirúrgica temprana versus endovascular de aneurisma de la arteria carótida interna roto con ampolla de sangre: experiencia de 20 años en un solo centro [Internet]. J Neurosurg. 2022; 137(6):1766-75. DOI: 10.3171/2022.3.JNS2216
23. Reidy J, Faulder K, Davidson K, Harrington T, Steinfort B, Assaad N, et al. Endovascular and microsurgical management of blister aneurysms: a multi-centre review [Internet]. Neurosurg Rev. 2023; 46(1):147. DOI: 10.1007/s10143-023-02065-6
24. Telles JPM, Solla DJF, Yamaki VN, Rabelo NN, da Silva SA, Caldas JGP, et al. Comparison of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual patient data meta-analysis [Internet]. Neurosurg Rev. 2021; 44(5):2405-14. DOI: 10.1007/s10143-020-01440-x
25. Vivanco-Suarez J, Rodriguez-Calienes A, Kan PT, Wakhloo AK, Pereira VM, Hanel R, et al. Flow Diverter Performance in Aneurysms Arising From the Posterior Communicating Artery: A Systematic Review and Meta-Analysis [Internet]. Neurosurgery. 2023; 93(4):764-72. DOI: 10.1227/neu.0000000000002517
26. Nasra M, Mitreski G, Kok HK, Maingard J, Slater LA, Russell JH, et al Contemporary Treatment of Intracranial Blood Blister Aneurysms - A Systematic Review [Internet]. J Stroke Cerebrovasc Dis. 2021; 30(9):105968. DOI: 10.1016/j.jstrokecerebrovasdis.2021.105968
27. Meling TR, Patet G. Envoltura con clip de aneurismas rotos de la arteria carótida interna con aspecto de ampollas sanguíneas [Internet]. Neurosurg Rev. 2020; 43(5):1365-71. DOI: 10.1007/s10143-019-01172-7
28. Kim S, Park KY, Chung J, Kim YB, Lee JW, Huh SK. Análisis comparativo de la viabilidad de la técnica de descompresión por succión retrógrada para el tratamiento microquirúrgico de aneurismas grandes y gigantes de la arteria carótida interna [Internet]. J Korean Neurosurg Soc. 2021; 64(5):740-50. DOI: 10.3340/jkns.2021.0066
29. Sriamornrattanakul K, Wongsuriyanan S. Anterior Temporal Approach for Clipping Posterior-Projecting Supraclinoid Carotid Artery Aneurysms: A More Lateral Corridor to Better Visualize the Aneurysm Neck and Related Branches [Internet]. World Neurosurg. 2021; 149:549-62. DOI: 10.1016/j.wneu.2021.01.136
30. Bae IS, Chun HJ, Choi KS, Yi HJ. Escala de coma de Glasgow modificada para predecir el pronóstico tras la cirugía de hemorragia subaracnoidea [Internet]. Medicine (Baltimore). 2021; 100(19):e25815. DOI: 10.1097/MD.0000000000025815
31. Nguyen TA, Vu LD, Mai TD, Dao CX, Ngo HM, Hoang HB, et al. Predictive validity of the prognosis on admission aneurysmal subarachnoid haemorrhage scale for the outcome of patients with aneurysmal subarachnoid haemorrhage [Internet]. Sci Rep. 2023; 13(1):6721. DOI: 10.1038/s41598-023-33798-5
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Copyright (c) 2025 Luis Manuel Elizondo Barriel, Eddy Mapolón Román, Omar López Arbolay , Carlos Roberto Vargas Gálvez, Marlon Manuel Ortiz Machín
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