[A case of bilateral absence of internal carotid with cerebral aneurysm]

A 52-year-old woman was referred to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital because of the abnormal findings on CT from a private hospital. She had previously had two attacks of severe headache. In May 1985, she noted severe headache with vomiting and was transported to a nearby hospital. She was hospitalized there until CT was performed. On admission, she was clear in consciousness and complained of headache of moderate degree. Neurological examination was normal except for mild nuchal rigidity. A standard series of roentgenograms of the skull revealed a round calcified area in the supraclinoidal region. CT revealed a calcified lesion which must be a vessel in the chiasma cistern just adjacent to the basilar artery which was relatively larger than normal. Furthermore, no carotid canal was visible in the bilateral petrous bone by means of bony algorythum. Selective internal carotid angiographies were attempted. There was no evidence of an internal carotid artery on either sides. Furthermore,the ophthalmic arteries were fed via external carotid systems. A vertebral angiography demonstrated bilateral hypertrophy of the vertebral artery with an aneurysmal shadow in the left P1 of the posterior cerebral artery. The supratentorial circulation was maintained via the right posterior communicating artery in the right middle cerebral artery and the bilateral anterior cerebral arteries. On the other hand, the circulation of the left middle cerebral artery was maintained by the retrograde filling from the right anterior and posterior cerebral arteries. Operation was performed by left sylvian approach followed by subtemporal approach.(ABSTRACT TRUNCATED AT 250 WORDS)