Abstract
Cerebral aneurysms are localized dilations occurring at weakened areas within the
brain's arterial circulation. They often occur at the branching points of smaller
vessels and are usually saccular in shape, but they can also have fusiform or blister-type
shapes. Internal carotid artery (ICA) aneurysms are believed to represent 30 to 50%
of all intracranial aneurysms. Most cerebral aneurysms are asymptomatic and are often
discovered incidentally during neuroimaging or autopsy. When rupture occurs, it often
leads to subarachnoid hemorrhage, which is associated with high morbidity and mortality.
Bouthillier's classification (1996) described seven parts of the ICA based on anatomy,
which was based on the original Fischer's classification: C1, cervical; C2, petrous;
C3, lacerum; C4, cavernous; C5, clinoid; C6, ophthalmic; and C7, communicating. Paraclinoid
aneurysms are complex intracranial aneurysms arising from the ICA proximal to the
posterior communicating artery and distal to the distal dural ring. They have complicated
anatomy and project surgical difficulty. The management of the ventral ICA aneurysm
can be broadly divided into two approaches: open surgical and endovascular approaches.
Anatomical factors—including size and location—and other shape-related characteristics
often play a crucial role in determining the most suitable treatment for a patient.
No gold standard technique can be used to treat all patients. Microsurgical approach:
the surgical management of cerebral aneurysms, involving the placement of a clip across
the aneurysm neck, can be used in both unruptured or ruptured aneurysms. Endovascular
approach: there is a majority of endovascular approaches, which include coil embolization
and newer techniques like stent-assisted coiling, balloon-assisted coiling, flow diverters,
disruptors, and new embolic materials.
The treatment options and techniques for managing ICA aneurysms are rapidly evolving.
This review article provides a brief overview of the current management strategies
and elaborates different techniques that are currently used. The information is available
on various internet databases like PubMed, UpToDate, and the National Institutes of
Health Web site, and the literature review is compiled to help the surgeon reach the
optimal management strategy tailored to the patient for easy decision-making.
Keywords
aneurysm rupture - cerebral aneurysms - embolization - endovascular - microsurgical
approach - stroke
