Management of internal carotid artery bifurcation aneurysm- A clinicoradiological outcome assessment over the last seven years from a tertiary care centre

Background Internal Carotid Artery (ICA) bifurcation aneurysms are relatively an uncommon entity. These aneurysm contributes less than 5% of the total intracranial aneurysms in the available literature. They are noticed in relatively younger population and their surgical management poses challenges due to close relation to the terminal branches and perforators in the adjoining area. The present retrospective observational study aims to describe the clinical and radiological nuances in the management of ICA bifurcation aneurysms. Methodology: All the operated cases of aneurysmal subarachnoid hemorrhage (SAH) managed between January 2017 to December 2023 were included. The clinico-radiological scan, including their three-dimensional computerized tomography (3-D CT) of cerebral angiogram was recorded. The intraoperative details of these patients were collected from the neurosurgery operative records. The patients' follow up details were obtained either by the outpatient department or by telephone. Results A total of 33 patients were analysed with a mean age of 44.9 ± 16.5 yrs years. Sudden severe headache and vomiting were the most common presentation. The superomedial orientation 14 (42.4%) was the most common projection of the aneurysm fundus. 27 patients (81.8%) have good outcome (mRS:0–2), six patient (18.2%) had bad outcome (mRS:3–6) and there was no procedure related mortality in this study. The mean follow-up duration was 24.5 ± 4.5 months (range: 8 months to 82 months). Conclusions ICA bifurcation aneurysm are challenging subset of intracranial aneurysms and it requires a detailed neuroanatomical knowledge and 3-dimensional orientation of the ICA anatomy before successful clipping of these aneurysms.