Smaller caliber of the internal carotid artery in patients with ipsilateral aplasia of the A1 segment of the anterior cerebral artery: a study with CTA

2018 ◽  
Vol 118 (2) ◽  
pp. 297-302
Author(s):  
Kenneth Carels ◽  
Sandra A. Cornelissen ◽  
David Robben ◽  
Walter Coudyzer ◽  
Philippe Demaerel ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery

Bilateral Internal Carotid to Anterior Cerebral Artery Anastomosis with Anterior Communicating Artery Aneurysm: Technical Case Report

2005 ◽  
Vol 57 (suppl_4) ◽  
pp. ONS-E400-ONS-E400 ◽  
Author(s):  
Kaya Kılıç ◽  
Metin Orakdöğen ◽  
Aram Bakırcı ◽  
Zafer Berkman
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery

Abstract OBJECTIVE AND IMPORTANCE: The present case report is the first one to report a bilateral anastomotic artery between the internal carotid artery and the anterior communicating artery in the presence of a bilateral A1 segment, fenestrated anterior communicating artery (AComA), and associated aneurysm of the AComA, which was discovered by magnetic resonance angiography and treated surgically. CLINICAL PRESENTATION: A 38-year-old man who was previously in good health experienced a sudden onset of nuchal headache, vomiting, and confusion. Computed tomography revealed a subarachnoid hemorrhage. Magnetic resonance angiography and four-vessel angiography documented an aneurysm of the AComA and two anastomotic vessels of common origin with the ophthalmic artery, between the internal carotid artery and AComA. INTERVENTION: A fenestrated clip, introduced by a left pterional craniotomy, leaving in its loop the left A1 segment, sparing the perforating and hypothalamic arteries, excluded the aneurysm. CONCLUSION: The postoperative course was uneventful, with complete recovery. Follow-up angiograms documented the successful exclusion of the aneurysm. Defining this particular internal carotid-anterior cerebral artery anastomosis as an infraoptic anterior cerebral artery is not appropriate because there is already an A1 segment in its habitual localization. Therefore, it is also thought that, embryologically, this anomaly is not a misplaced A1 segment but the persistence of an embryological vessel such as the variation of the primitive prechiasmatic arterial anastomosis. The favorable outcome for our patient suggests that surgical treatment may be appropriate for many patients with this anomaly because it provides a complete and definitive occlusion of the aneurysm.

Critical neurovascular brain anatomy

2010 ◽  
pp. 504-517
Author(s):  
George Samandouras
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Brain Anatomy ◽  
Vertebral Arteries ◽  
System P

Chapter 9.1 covers critical neurovascular brain anatomy, including internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the vertebral arteries (VAs), the basilar artery (BA), and the venous system.

Sphenopalatine ganglion stimulation for vasospasm after experimental subarachnoid hemorrhage

2011 ◽  
Vol 114 (4) ◽  
pp. 1104-1109 ◽  
Author(s):  
Masataka Takahashi ◽  
Zhen-Du Zhang ◽  
R. Loch Macdonald
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Evans Blue ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Sphenopalatine Ganglion ◽  
Doppler Flowmetry ◽  
The Right

Object Sphenopalatine ganglion stimulation activates perivascular vasodilatory nerves in the ipsilateral anterior circle of Willis. This experiment tested whether stimulation of the ganglion could reverse vasospasm and improve cerebral perfusion after subarachnoid hemorrhage (SAH) in monkeys. Methods Thirteen cynomolgus monkeys underwent baseline angiography followed by creation of SAH by placement of autologous blood against the right intradural internal carotid artery, the middle cerebral artery (MCA), and the anterior cerebral artery. Seven days later, angiography was repeated, and the right sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was stimulated electrically 3 times, and angiography was repeated during and 15 and 30 minutes after stimulation. Cerebral blood flow (CBF) was monitored using laser Doppler flowmetry, and intracranial pressure (ICP) was measured throughout. The protocol was repeated again. Evans blue was injected and the animals were killed. The brains were removed for analysis of water and Evans blue content and histology. Results Subarachnoid hemorrhage was associated with significant vasospasm of the ipsilateral major cerebral arteries (23% ± 10% to 39% ± 4%; p < 0.05, paired t-tests). Exposure of the ganglion and sham stimulation had no significant effects on arterial diameters, ICP, or CBF (4 monkeys, ANOVA and paired t-tests). Sphenopalatine ganglion stimulation dilated the ipsilateral extracranial and intracranial internal carotid artery, MCA, and anterior cerebral artery compared with the contralateral arteries (9 monkeys, 7% ± 9% to 15% ± 19%; p < 0.05, ANOVA). There was a significant increase in ipsilateral CBF. Stimulation had no effect on ICP or brain histology. Brain water content did not increase but Evans blue content was significantly elevated in the MCA territory of the stimulated hemisphere. Conclusions Sphenopalatine ganglion stimulation decreased vasospasm and increased CBF after SAH in monkeys. This was associated with opening of the blood-brain barrier.

ANTERIOR CEREBRAL ARTERY AMPUTATION AND SALVAGE REPAIR OF INTERNAL CAROTID ARTERY TEAR

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. E820-E822 ◽  
Author(s):  
Scott D. Wait ◽  
Steven W. Chang ◽  
Brendan D. Killory ◽  
William L. White ◽  
Robert F. Spetzler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Primary Repair ◽  
Suture Repair ◽  
Collateral Flow ◽  
The Impact

Abstract OBJECTIVE We describe a novel technique used to repair an unanticipated tear of the internal carotid artery (ICA) requiring anterior cerebral artery (ACA) amputation to allow primary repair of the arteriotomy. CLINICAL PRESENTATION A 59-year-old woman underwent an orbitozygomatic craniotomy to treat a large, suprasellar, thyroid-stimulating hormone-secreting adenoma. During resection, an incidental ICA tear occurred opposite the exit of the middle cerebral artery. TECHNIQUE After an ICA tear on the wall opposite the middle cerebral artery occurred, clips were placed on the ICA, middle cerebral artery, and ACA. Primary closure was not feasible without critically stenosing the ICA. The ipsilateral ACA was clipped and amputated just distal to its origin. The relaxation afforded by amputating the ACA allowed primary suture repair of the arteriotomy. A clip was placed on the proximal ACA stump. The distal ACA stump revealed good backflow and was also clipped. CONCLUSION When an arteriotomy of a large intracranial artery cannot be repaired primarily, creative alternatives must be considered. Amputation of a branch artery with sufficient collateral flow is a method to afford adequate relaxation for primary repair of an arteriotomy. This novel method should be considered in the armamentarium of neurosurgeons to minimize the impact of potentially disastrous vascular complications.

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