A Narrative Review in Managing Ventral Internal Carotid Artery Aneurysms

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.