Neurological Surgery No Shinkei Geka Volume 47, Issue 2 (February 2019)

A Rare Case of an Unruptured Aneurysm Arising from the Proximal End of the Fenestration of the Cavernous Segment of the Internal Carotid Artery Eri SHIOZAKI 1,2 , Takeshi HIU 2 , Genki CHIKAMATSU 1,2 , Hikaru NAKAMURA 1,2 , Keisuke OZONO 2 , Kazuya HONDA 3 , Tomoya MORITSUKA 3 , Ichiro KAWAHARA 2 , Tomonori ONO 2 , Wataru HARAGUCHI 2 , Ryujiro USHIJIMA 2 , Keisuke TSUTSUMI 2 1Residency Program, Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center 2Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center 3National Hospital Organization, Nagasaki Medical Center Keyword: internal carotid artery fenestration , cavernous segment , unruptured aneurysm , embryology , primitive plexiform arterial channel pp.217-223
Published Date 2019/2/10
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 We report an extremely rare case of a fenestration in the cavernous segment of the left internal carotid artery(ICA)associated with an unruptured aneurysm at the proximal end of the fenestrated portion.

 A 44-year-old woman with a dull headache was referred to our hospital for further evaluation of a suspected aneurysm in the right ICA on MR angiography(MRA). CT angiography and 3D-rotational angiography revealed no aneurysm in the right ICA;however, an intracavernous fenestration with an incidental aneurysm was observed in the left ICA. The aneurysm was small(5×3mm)with a wide neck arising from the origin of the ventral limb of the duplicated vessels, in association with a tiny bulge projecting medially. She requested conservative management and periodic follow-up with MRA. After 18 months, no structural change in the aneurysm was observed.

 To our knowledge, including our patient, only three cases of this type of ICA fenestration have been published, and this is the first report of an ICA fenestration with an unruptured aneurysm at the fenestrated segment. It is presently unknown whether the intracavernous fenestration has the potential to form an aneurysm within the proximal end of the duplicated segment, as reported in cases of supraclinoid ICA fenestrations.

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Neurological Surgery 脳神経外科
47巻2号 (2019年2月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院