Surgical outcome after microsurgical repair of internal carotid bifurcation aneurysm: review of 15 cases

Objectives: Internal carotid artery bifurcation aneurysms (ICAbAn) are uncommon. They have a very low incidence in adults, accounting for only 5% of all intracranial aneurysms, and are even less common among aneurysms of the ICA. In this paper, we aim to describe our surgical series regarding exclusively ICAbAn.

Patients and Methods: We describe 15 ICAbAn surgically treated patients from June 2007 to July 2017, in a universe of 512 aneurysms operated by the senior author in this period.

Results: Forty-six percent (7/15) of the ICAbAn were ruptured at presentation. Seventy-three percent of the 15 patients had good outcome (Glasgow Outcome Scale score 5), whereas 4 patients (26.6%) died.

Conclusion: Aneurysms at this location, large sized, with broad neck, incorporating the origin of the MCA or ACA, and specially regarding the direct water hammer effect of flow at the carotid summit, often favor surgical treatment, in detriment of endovascular treatment.