Rupture of previously unruptured giant carotid aneurysm after superficial temporal-middle cerebral artery bypass and internal carotid occlusion

Area of Science:

• Neurosurgery
• Vascular Surgery
• Neurology

Background:

• Giant aneurysms of the internal carotid artery pose significant treatment challenges.
• Surgical intervention often involves complex procedures to manage these large vascular malformations.

Observation:

• A 51-year-old woman underwent gradual occlusion of the internal carotid artery with a superficial temporal artery to middle cerebral artery bypass.
• Post-operatively, visual field defects improved, and aneurysm thrombosis was confirmed via imaging.

Findings:

• Despite successful initial treatment and confirmed thrombosis, a fatal hemorrhage occurred 34 days post-procedure.
• The study discusses the potential mechanism for rupture of the seemingly thrombosed aneurysm.

Implications:

• Aneurysmal rupture remains a risk as long as any residual lumen persists after proximal ligation.
• This case underscores the critical need for complete aneurysm obliteration or long-term monitoring after surgical treatment.