Posterior projecting carotid-A1 junctional aneurysms

Abstract

The authors report on two types of carotid-A(1) junctional aneurysms projecting backwards. In the two A(1)-type examples, the aneurysm originated at the posterior wall of the proximal A(1) joining the carotid termination and could be clipped using an ipsilateral pterional approach. However, in the carotid-type example, the aneurysm originated at the posterior wall of the carotid termination just below the A(1) origin, and required a contralateral pterional approach to expose the aneurysm. Although the carotid-A(1) junctional aneurysms are rare, their exact location and size can affect the side of the operative approach.

Posterior projecting carotid bifurcation aneurysms

“…The authors suggest that it may not be possible to expose true posteriorly projecting carotid bifurcation aneurysms using a pterional approach and that this aneurysm is better approached using a contralateral craniotomy. 3 The distinction between these two patterns of aneurysms is readily made with CT angiography.…”