Perioperative Management and Outcome after Surgical Treatment of Anterior Cerebral Artery Aneurysms

ABSTRACT:The authors present clinical experience with 28 cases of ruptured anterior cerebral artery (ACA) aneurysms managed personally during a 36 month period, and 10 unruptured ACA aneurysms. The cases included five giant aneurysms and four distal ACA aneurysms. Management strategy was uniform and included early operative intervention (except in the setting of deteriorating neurologic deficit, not attributable to hydrocephalus or hematoma), and vasospasm prophylaxis including calcium channel blockers and hypervolemic hemodilution and arterial hypertension. Modern diagnostic adjuncts including transcranial doppler were used as they became available. Good outcome (outcome grade 1 or 2) was observed at 6 months in 71% (20/28) of ruptured cases and in 90% (9/10) of unruptured cases; fair outcome (outcome grade 3) was observed in 14% (4/28) of ruptured cases and in 10% of unruptured cases; bad outcome (outcome grade 4 or 5) was observed in 14% (4/28) of ruptured cases. There were no instances of rebleeding after admission to the hospital. There was a single mortality in a patient moribund on admission. Delayed ischemic deterioration (DID) was documented in 46% (13 of 28) of the ruptured cases, and was a major source of morbidity in 7 of the 9 instances of fair or poor outcome in the series. Management outcome, including the occurrence of subtle neuropsychological difficulties commonly described in cases with ACA aneurysms, is discussed with relation to the incidence of DID, the clinical course of DID, and the possible impact of various therapeutic strategies.

Download Full-text

Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991301900109 ◽

2013 ◽

Vol 19 (1) ◽

pp. 60-66 ◽

Cited By ~ 11

Author(s):

A.C.G.M. Van Es ◽

P.A. Brouwer ◽

P.W.A. Willems

Keyword(s):

Surgical Treatment ◽

Management Strategy ◽

Clinical Course ◽

Treatment Strategies ◽

The Other ◽

Posterior Spinal Artery ◽

Appropriate Treatment ◽

History Of ◽

Clinical Paradigm ◽

Slight Growth

Little is known on the natural history of ruptured isolated aneurysms of the posterior spinal artery (PSA). To date, only a few of such cases have been described in the literature. This paper aims to assess the most appropriate management strategy, based on the available literature and two new cases. In one of these, treatment was postponed until day 33, when angiography showed slight growth of the aneurysm. In the other, conservative treatment, requested by the patient, was successful. From these data, we conclude that treatment strategies for ruptured PSA aneurysms may vary. Aside from the recommendation by others to perform prompt surgical treatment, we suggest an alternative clinical paradigm allowing for the evaluation of the early clinical course. This may preclude the unnecessary treatment of spontaneously regressing lesions and still allows for appropriate treatment for persistent lesions.

Download Full-text

Surgical Treatment for Aneurysms at the Proximal Segment of the Anterior Cerebral Artery (A1) : A Report of Six Cases

Japanese Journal of Neurosurgery ◽

10.7887/jcns.22.467 ◽

2013 ◽

Vol 22 (6) ◽

pp. 467-473

Author(s):

Tsuyoshi Izumo ◽

Takayuki Matsuo ◽

Kentaro Hayashi ◽

Nobutaka Horie ◽

Hiroaki Yokoyama ◽

...

Keyword(s):

Surgical Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Proximal Segment

Download Full-text

Republished: Retreatment of a choroidal vein of Galen malformation with embolization 42 years after open surgical treatment in the neonatal period

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012709.rep ◽

2016 ◽

Vol 9 (5) ◽

pp. e19-e19

Author(s):

Lucas Elijovich ◽

Asim F Choudhri ◽

Adam S Arthur ◽

Paul Klimo ◽

Frederick A Boop ◽

...

Keyword(s):

Surgical Treatment ◽

Cerebral Artery ◽

Intraventricular Hemorrhage ◽

Open Surgery ◽

Anterior Cerebral Artery ◽

Neonatal Period ◽

Venous Hypertension ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Open Surgical Treatment

In 1976 an infant boy initially presented with a choroidal vein of Galen malformation (cVOGM). Craniotomy and clipping of the anterior cerebral artery and posterior choroidal arteries was performed, which was reported in the literature 40 years ago. The patient remained asymptomatic until age 42 when he re-presented with an isolated intraventricular hemorrhage. Angiography demonstrated cVOGM with venous sinus occlusive disease leading to venous hypertension and subsequent intraventricular hemorrhage. The angiogram also demonstrated a ‘pseudo-nidus’ composed of multiple arterial-to-arterial anastomoses that had developed as a result of the original surgical treatment. We embolized a portion of the lesion to reduce the venous hypertension. The patient has been asymptomatic for more than 2 years. To our knowledge, this is the first reported case of a symptomatic neonatal VOGM treated with open surgery that required embolization as an adult for a delayed hemorrhagic presentation.

Download Full-text

Dissecting Aneurysm of the Anterior Cerebral Artery Requiring Surgical Treatment. Case Report.

Neurologia medico-chirurgica ◽

10.2176/nmc.40.624 ◽

2000 ◽

Vol 40 (12) ◽

pp. 624-627 ◽

Cited By ~ 24

Author(s):

Yukihiro WAKABAYASHI ◽

Toshihisa NAKANO ◽

Mitsuo ISONO ◽

Tsuyoshi SHIMOMURA ◽

Shigeaki HORI

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Dissecting Aneurysm

Download Full-text

Superficial Temporal Artery to Anterior Cerebral Artery Hemi-bonnet Bypass Using Radial Artery Graft for Prevention of Complications after Surgical Treatment of Partially Thrombosed Large/Giant Anterior Cerebral Artery Aneurysm

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2018.08.020 ◽

2018 ◽

Vol 27 (12) ◽

pp. 3505-3510 ◽

Cited By ~ 3

Author(s):

Kojiro Wada ◽

Naoki Otani ◽

Terushige Toyooka ◽

Satoru Takeuchi ◽

Arata Tomiyama ◽

...

Keyword(s):

Surgical Treatment ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Superficial Temporal Artery ◽

Artery Aneurysm ◽

Temporal Artery ◽

Radial Artery Graft ◽

Artery Graft ◽

Anterior Cerebral Artery Aneurysm ◽

Cerebral Artery Aneurysm

Download Full-text

Arteriovenous malformation with associated multiple flow-related distal anterior cerebral artery aneurysms: A case report with poor outcomes

Surgical Neurology International ◽

10.25259/sni_27_2019 ◽

2020 ◽

Vol 11 ◽

pp. 232

Author(s):

Ummey Hani ◽

Muhammad Ehsan Bari ◽

Syed Sarmad Bukhari

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Clinical Course ◽

Altered Mental Status ◽

Neurological Status ◽

External Ventricular Drainage ◽

Acute Onset ◽

Low Grade ◽

Poor Outcomes ◽

Distal Anterior Cerebral Artery

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder. Case Description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his Glasgow Coma Scale dropped and he underwent emergency embolization with Onyx. This was followed by external ventricular drainage. The patient’s neurological status did not improve, and he died following a complicated clinical course. Conclusion: Multiple DACA aneurysms are a case of both clinical and anatomical rarity and to avoid complications in the clinical course, one must be judicious about the time spent between symptom onset and embolization.

Download Full-text