الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
The current study includes 50 patients with saccular aneurysms of supraclinoid part of internal carotid artery which were treated by microsurgical clipping of the neck of the aneurysm.
The age of the patients ranged from 26 – 72 years (Mean +SD = 51 + 11.83). The incidence was increasing with age, reaching a peak in the 6th decade 19 cases (38%, 19/50).
Twenty-nine patients (58%, 29/50) were females and twenty-one (42%, 21/50) were male. There was female predominance. Below the age of 40 years, F: M ratio was nearly 1:1; while at the age of 41-60 years, F: M ratio increases to 3:2; and finally above the age of 60 years it increases more to 2:1. This indicates rising of female incidence with age.
The aneurysm was present at ICA-PComA branch in 35 patients (70%, 35/50); ICA bifurcation in 6 patients (12%, 6/50); Opthalmic A. branch in 6 patients (12%, 6/50); AChA branch in 3 patients (6%, 3/50).
So, The commonest aneurysm location in the current study was the ICA-PComA aneurysm (70%, 35/50)
45 patients (90%, 45/50) presented with subarachnoid hemorrhage (SAH) while 5 patients presented with non-ruptured aneurysm; 4 patients (8%, 4/50) presented with chronic diffuse headache, one patient present with mass effect in the form of 3rd nerve palsy (2%, 1/50).
The clinical condition of the patients with SAH according to Hunt and Hess grading system (H&H) was as follows:
Grade 1 was present in 13 patients (28.89%, 13/45); grade II in 15 patients (33.33%, 15/45); grade III in 12 patients (26.67%, 12/45); grade IV in 5 patients (11.11%, 5/45)
Sudden onset of severe headache was present in all the 45 patients (100%, 45/45. Nausea and vomiting were reported in 36 cases with ruptured aneurysms (80%, 36/45). Neck stiffness and photophobia were present in 28 cases of ruptured aneurysms (62.2%, 28/45). Decreased level of consciousness happened in 17 cases with ruptured aneurysms (37.78%, 17/45). 2 patients with ruptured aneurysms suffered from epileptic seizure on admission (4.44%, 2/45).
Of the 5 patients presented with non-rupture of the aneurysm, 4 patients (8%, 4/50) presented with chronic diffuse headache, one patient present with mass effect in the form of 3rd nerve palsy (2%, 1/50).
In this study, 8 of the 35 patients with ICA-PComA aneurysms presented by partial third nerve palsy (22.86 %, 8/35); 7 cases were due to aneurysm rupture while one case was due to aneurysm mass effect. Neither of all other supraclinoid ICA aneurysms did present with 3rd nerve palsy.
Plain CT scan of the brain was done and showed subarachnoid hemorrhage (SAH) in all patients. CT scan can diagnose SAH in all the 45 cases (100%, 45/45). 33 patients (73.33 %, 33/45) had diffuse SAH while 12 patients (26.67%, 12/45) had localized SAH.