Fusiform dilatation of internal carotid artery after pterional but not subfrontal craniotomy in 6 patients.

Abstract

Our study aimed to evaluate potential risk factors for the development of FDICA after suprasellar tumor resection. After reviewing all cases of pediatric patients who benefited from a suprasellar lesion resection in our two medical institutions, we found 6 patients with a FDICA. Surgical approach strategy (pterional or subfrontal approaches) was noted. Postoperative cranial MRI was performed in each patient 3months after surgery and every year. When a FDICA occurred, MRI was performed 6months after the diagnosis and 1year later to detect any progression. There were 6 males with a mean age at treatment of 11years (6 to 15). Pterional approach was performed in these 6 patients. At the 2 institutions, we have done at least 50 pterional craniotomies for suprasellar lesion resection. No FDICA was reported after subfrontal approach in 27 consecutive pediatric patients operated on from a craniopharyngioma. The delay between the surgery and the diagnosis of the FDICA was 9months (3 to 17months). No symptoms related to the FDICA were recorded. The mean maximal diameter of the aneurysm was 14mm (10 to 21). ICA bifurcation was involved in 2 cases. Asymptomatic FDICA progression was noted in 2 cases but no treatment was proposed. The pathogenesis of FDICA is unclear, and might involve arterial wall necrosis caused by postoperative arachnoid fibrosis which might be worsened by the pterional approach.