Retractorless combined pterional and interhemispheric approach to achieve proximal control in pericallosal artery aneurysm: how I do it

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

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Giant pericallosal artery aneurysm – Literature review and report of a rare case

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626013 ◽

2013 ◽

Vol 32 (03) ◽

pp. 195-199

Author(s):

José Fernando Guedes Corrêa ◽

Ari Boulanger Sucussel Junior ◽

Rogério Martins Pires Amorim ◽

Lucas Santos Loiola ◽

Maristella Reis ◽

...

Keyword(s):

Surgical Treatment ◽

Cerebral Arteries ◽

Clinical Status ◽

Artery Aneurysm ◽

Mass Effect ◽

Imaging Studies ◽

Falx Cerebri ◽

Aneurysm Neck ◽

Pericallosal Artery ◽

Medial Surfaces

AbstractGiant pericallosal artery aneurysms are extremely rare. Aneurismatic lesions involving this artery are usually small, tend to early bleeding and might be associated with other lesions. Differential diagnosis of giant aneurysms are not easy and includes tumoral, infectious and vascular mass effect lesions. We report a case of a giant and partially thrombosed left pericallosal artery aneurysm. A 58-year-old man, presented with progressive headaches, seizures and speech alterations initially misdiagnosed as a falx cerebri meningioma. As clinical status continue to worsen, magnetic resonance imaging and digital cerebral angiography were performed and a vascular etiology was considered. The patient was then referred to our hospital for surgical treatment. The peculiarity of this case concerns the difficulty of surgical treatment once the surgeon was not able to obtain control of the afferent artery and the aneurysm neck could not be visualized. Also, the aneurysm adhered to the medial surfaces of the frontal lobes and covered the anterior cerebral arteries. Treatment by means of microsurgical thrombectomy, clipping and resection of the lesion was successfully performed. Microsurgical treatment may provide good results when carefully planned with the help of imaging studies of the lesion. It is essential to keep in mind that flexible approach is of great importance when dealing with giant aneurysmatic lesions of pericallosal artery due to its variety of intraoperative presentation.

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De novo formation and rupture of an azygos pericallosal artery aneurysm

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.1062 ◽

2000 ◽

Vol 93 (6) ◽

pp. 1062-1064 ◽

Cited By ~ 10

Author(s):

Wolfgang Dietrich ◽

Andrea Reinprecht ◽

Andreas Gruber ◽

Thomas Czech

Keyword(s):

De Novo ◽

Artery Aneurysm ◽

Vascular Anomaly ◽

Content Type ◽

Pericallosal Artery ◽

Bifurcation Aneurysm ◽

Anterior Cerebral Artery Aneurysm ◽

Cerebral Artery Aneurysm ◽

Familial Aneurysms

✓ An azygos pericallosal artery (APCA) aneurysm is a rare anomaly that is closely associated with saccular aneurysms. This is the earliest report to document de novo formation and rupture of an aneurysm at the bifurcation of an unpaired pericallosal trunk. The authors report the case of a woman who presented at the age of 52 years with subarachnoid hemorrhage (SAH) from the rupture of a newly formed APCA bifurcation aneurysm, 7 years after she had undergone surgery to clip a ruptured anterior cerebral artery aneurysm. De novo formation of aneurysms after SAH rarely occurs and certain risk factors like multiple and familial aneurysms, arterial hypertension, or smoking have been postulated. Late follow-up examination with angiography to detect de novo aneurysms should be considered in patients with this vascular anomaly after SAH.

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Pterional or Subfrontal Access for Proximal Vascular Control in Anterior Interhemispheric Approach for Ruptured Pericallosal Artery Aneurysms at Risk of Premature Rupture

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2016.0910.009 ◽

2017 ◽

Vol 60 (2) ◽

pp. 250-256 ◽

Cited By ~ 2

Author(s):

Jaechan Park

Keyword(s):

At Risk ◽

Vascular Control ◽

Premature Rupture ◽

Pericallosal Artery ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach

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Posterior Interhemispheric Approach: Surgical Technique, Application to Vascular Lesions, and Benefits of Gravity Retraction

Operative Neurosurgery ◽

10.1227/01.neu.0000219880.66309.85 ◽

2006 ◽

Vol 59 (suppl_1) ◽

pp. ONS-41-ONS-49 ◽

Cited By ~ 6

Author(s):

John H. Chi ◽

Michael T. Lawton

Keyword(s):

Arteriovenous Malformations ◽

Artery Aneurysm ◽

Occipital Lobe ◽

Vascular Lesions ◽

Arteriovenous Fistulae ◽

Cavernous Malformations ◽

Neurological Outcomes ◽

Interhemispheric Approach ◽

Occipital Lobes ◽

Posterior Midline

Abstract OBJECTIVE: To review an experience with the posterior interhemispheric approach applied to vascular lesions in the posterior midline, to examine the effects of patient position and gravity retraction of the occipital lobe, and to identify circumstances requiring increased exposure by sectioning the falx and tentorium. METHODS: During a 6.5-year period, 46 posterior interhemispheric approaches were performed to treat 28 arteriovenous malformations, 10 dural arteriovenous fistulae, seven cavernous malformations, and one posterior cerebral artery aneurysm. Twenty-three patients were positioned prone and 23 patient were positioned laterally. RESULTS: A standard posterior interhemispheric approach was used in 38 patients, and the occipital bitranstentorial/falcine approach was used in seven patients. A contralateral occipital transfalcine approach was used with one thalamic cavernous malformation. All lesions were resected completely and/or obliterated angiographically, with good neurological outcomes in 83% of patients and no operative mortality. Blood loss was lower, operative durations were shorter, postoperative cerebral edema was decreased, and visual outcomes were improved in patients positioned laterally. CONCLUSION: The posterior interhemispheric approach, without additional dural cuts, is appropriate for most vascular lesions in the posterior midline. Gravity retracts the occipital lobes when patients are positioned laterally, enhancing operative exposure and reducing morbidity. Extension of the posterior interhemispheric approach to a transtentorial or transfalcine approach is required for falcotentorial dural arteriovenous fistulae and vein of Galen arteriovenous malformations, but is not usually necessary with cavernous malformations or other arteriovenous malformations.

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Traumatic pericallosal artery aneurysm: a rare complication of transcallosal surgery

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2007.106.2.153 ◽

2007 ◽

Vol 106 (2) ◽

pp. 153-157 ◽

Cited By ~ 5

Author(s):

Ian F. Dunn ◽

Graeme F. Woodworth ◽

Adnan H. Siddiqui ◽

Edward R. Smith ◽

G. Edward Vates ◽

...

Keyword(s):

Rare Complication ◽

Artery Aneurysm ◽

Pericallosal Artery

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Pipeline Embolization Device for Pericallosal Artery Aneurysms: A Retrospective Single Center Safety and Efficacy Study

Operative Neurosurgery ◽

10.1093/ons/opx111 ◽

2017 ◽

Vol 14 (4) ◽

pp. 351-358 ◽

Cited By ~ 7

Author(s):

Katyucia De Macedo Rodrigues ◽

Anna Luisa Kühn ◽

Takamitsu Tamura ◽

Guilherme Dabus ◽

Peter Kan ◽

...

Keyword(s):

Artery Aneurysm ◽

Flow Diverter ◽

Pipeline Embolization Device ◽

Pericallosal Artery ◽

Flow Diverter Stent ◽

Procedural Complication ◽

Aneurysm Occlusion ◽

Flow Diverters

Abstract BACKGROUND Pericallosal artery aneurysm treatment may be challenging using traditional endovascular techniques. OBJECTIVE To demonstrate the feasibility, efficacy, and safety of endovascular treatment of pericallosal artery aneurysm using flow diverters. METHODS We performed a retrospective review of our institutional database from July 2013 through July 2016 and identified 7 subjects with a pericallosal artery aneurysm treated with the Pipeline embolization device (ev3 Neurovascular, Medtronic, Dublin, Ireland) and at least 1 follow-up angiogram. Technical feasibility, procedural complication, angiographic results, and clinical outcome were evaluated. RESULTS Placement of the Pipeline embolization device was successful in all cases without evidence of procedural complication. Five out of 7 subjects showed a complete aneurysm occlusion at 6- to 12-mo follow-up angiogram. The 2 subjects with persistent aneurysm filling showed decreased aneurysm sac volume on follow-up angiograms (96% and 60%). There was no evidence of in-implant stenosis or intimal hyperplasia. No thromboembolic or hemorrhagic complications were seen during the follow-up period. Only 1 patient had a transient change in Modified Rankin scale score from baseline as a result of different unrelated procedure. CONCLUSION Our preliminary results demonstrate feasibility of the use of flow diverter stent for treatment of aneurysms of the pericallosal artery with rate of aneurysm occlusion comparable to literature and without evidence of increased procedural or short-term morbidity. A long-term and larger cohort study is needed to validate our findings.

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