Haemodynamic classification of symptomatic obstructive carotid artery disease

Intracranial aneurysms in patients with internal carotid artery occlusion: management and outcome in 22 cases

BACKGROUND

There is little information about clinical characteristics, management, and outcome of patients with intracranial aneurysms and internal carotid artery occlusion. We will describe clinical characteristics, treatment and outcome of patients with coexistent internal carotid artery occlusion and intracranial aneurysms.

METHODS

We conducted a retrospective chart review of 22 patients (eight males and 14 females) with coexistent internal carotid artery (ICA) occlusion and intracranial aneurysms.

RESULTS

This series includes 14 females and eight males with a mean age of 63 years (range, 49 to 80). These patients harbored a total of 35 aneurysms, which were located on the same side of the ICA occlusion in five cases, on the contralateral side in 20 cases, while in ten cases the aneurysm had a midline location (AcomA 9, Basilar tip 1). Treatment consisted of surgery for eight aneurysms and endovascular embolization for 13 aneurysms. No invasive treatment was recommended for 14 aneurysms (eight patients with single aneurysm). No permanent perioperative or periprocedural complications occurred in the selected group of patients undergoing invasive treatment. At a mean follow-up of 57 months (range, 3-203), no patient had a subarachnoid hemorrhage and three patients had died of causes not related to the aneurysm.

CONCLUSION

Surgical and endovascular treatment can be accomplished safely in selected patients with coexistent ICA occlusion and intracranial aneurysms. Conservative treatment is a valid alternative, especially in elderly patients or in patients with very small aneurysms, especially if not located along the collateral pathway.

A tribute to Helge Nornes

This supplement of the Acta Neurochirurgica is dedicated to professor Helge Nornes on the occasion of his retirement. Helge Nornes started his neurosurgical training in Oslo in 1965. In 1980 he was offered the neurosurgical chair of Bern, Switzerland, where he stayed until 1983 when his old university called him back to the chair at the National Hospital in Oslo, a position he filled until he retired last year. The present paper briefly reviews examples of his contributions to neurosurgery and to the understanding of intracranial pathophysiology, including the transcranial doppler, the miniature transducer for intracranial pressure monitoring, his observations on intracranial pressure and internal carotid blood flow during subarachnoid haemorrhage, intracranial arterial blood flow in patients undergoing aneurysm surgery, his studies of the pathophysiology of arteriovenous malformations, the introduction of intraoperative Doppler recordings during surgery for aneurysms and arteriovenous malformations, and his methods for evaluating collateral circulation prior to internal carotid artery occlusion.