scholarly journals Clip Reconstruction of a Previously Leaked Large Complex Posterior Communicating Segment Aneurysm with Extradural Anterior Clinoidectomy

2021 ◽  
Author(s):  
Duygu Baykal ◽  
Burak Ozaydin ◽  
Ufuk Erginoglu ◽  
Mustafa K. Baskaya
Keyword(s):  
Vessel Wall ◽  
Internal Carotid ◽  
Anterior Choroidal Artery ◽  
Short Segment ◽  
Anterior Clinoidectomy ◽  
Complex Aneurysm ◽  
Complete Obliteration ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Supraclinoid Internal Carotid Artery

AbstractFusiform or near-fusiform aneurysms that involve the long segment of the supraclinoid internal carotid artery (ICA) pose significant challenges to neurovascular surgeons. Involvement of the origin of vital branching arteries in this segment may preclude safe treatment with flow diverting stents. In addition, clip reconstruction may also not be possible in this region due to entire or near-entire involvement of the circumference of the ICA (Fig. 1). In this video article, we present a case of a complex and previously leaked, (visualized with hemosiderin) aneurysm of the posterior communicating segment of the ICA, in a 60-year-old female. Multiple complexities made this aneurysm challenging to treat. These included (1) a 270-degree encirclement of the ICA with multiple lobulations that left only a small section of nondiseased vessel wall, (2) a relatively short segment of the supraclinoidal ICA that made proximal control challenging thus requiring an extradural anterior clinoidectomy, (3) a fetal posterior communicating artery that originated immediately proximal to the beginning of the aneurysm, and lastly, (4) an anterior choroidal artery that was firmly adherent over the aneurysm dome. In this video, we present the microsurgical steps for dealing with this complex aneurysm, including extradural clinoidectomy and clip reconstruction (Fig. 2). Postoperatively, the patient woke up without any deficits. Angiography showed complete obliteration of the aneurysm.The link to the video can be found at: https://youtu.be/C3Vc0maWChc.

scholarly journals Supraclinoid Internal Carotid Artery Aneurysm Clipping Complicated by Aneurysm Dome Origin of the Anterior Choroidal Artery: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (1) ◽  
pp. E41-E41
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Video Recording ◽  
Artery Aneurysm ◽  
High Morbidity ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Supraclinoid Internal Carotid Artery

Abstract Supraclinoid internal carotid artery (ICA) aneurysms most commonly arise at the origin of the posterior communicating or anterior choroidal artery. The unique angioarchitecture presented in this case involved the anterior choroidal artery (AChA) originating from the dome of a supraclinoid ICA aneurysm. Treatment is associated with high morbidity because of the eloquent parenchyma perfused by the AChA. Therefore, the preservation of flow within the AChA during clipping is paramount. Anterior choroidal syndrome, comprising hemiplegia, hemianesthesia, and hemianopsia, conveys a significant morbidity. This syndrome is observed in the setting of AChA sacrifice and can be observed in a delayed manner after clipping. Anterior choroidal syndrome is of uncertain etiology but is associated with AChA infarction. This patient presented with tinnitus and was found to have an incidental supraclinoid ICA aneurysm with AChA originating from the aneurysmal dome. A right orbitozygomatic craniotomy was performed for a transsylvian approach to the aneurysm. A fenestrated clip was applied to occlude the aneurysmal portion of the ICA up to the point of AChA origin. A curved clip was then used to occlude the AChA segment of the aneurysm, providing patency to the AChA takeoff along the ICA. Patency of the AChA and ICA was confirmed with intraoperative angiography, and the patient had a favorable clinical outcome. This case exemplified an excellent surgical clipping of a challenging supraclinoid ICA aneurysm involving the need to preserve a vessel off the aneurysm dome. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

The Perforating Branches of the Internal Carotid Artery: The Microsurgical Anatomy of Their Extracerebral Segments

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 472-479 ◽  
Author(s):  
Slobodan V. Marinkovié ◽  
Milan M. Milisavljevié ◽  
Zorica D. Marinkovié
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Microsurgical Anatomy ◽  
Great Care ◽  
Anterior Choroidal Artery ◽  
Frequent Site ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

scholarly journals Anterior Choroidal Artery Territory Infarction due to Internal Carotid Artery Dissection Presumably Caused by Scuba Diving

2020 ◽  
Vol 38 (4) ◽  
pp. 298-300
Author(s):  
Daeun Shin ◽  
Yang-Ha Hwang ◽  
Dong-Hyun Shim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Scuba Diving ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Anterior Choroidal Artery ◽  
Internal Carotid Artery Dissection ◽  
Anterior Choroidal ◽  
Choroidal Artery

We report a case of anterior choroidal artery territory infarction due to internal carotid artery dissection presumably caused by scuba diving. A 44-year-old man presented with left facial palsy and hemiparesis. He had a history of scuba diving for 18 months. His last dive was 7 days ago, and he skipped decompression practice at that dive. We assumed that repetitive traumas and microbubbles during scuba diving, which made endothelium vulnerable to damage may have caused a carotid dissection.

Anterior Choroidal Artery Syndrome after Surgery for Internal Carotid Artery Aneurysms

Neurosurgery ◽  
1992 ◽  
Vol 31 (1) ◽  
pp. 132-136 ◽  
Author(s):  
Hisahiko Suzuki ◽  
Katsuzo Fujita ◽  
Kazumasa Ehara ◽  
Norihiko Tamaki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery

De Novo Development of an Aneurysm: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 756-759 ◽  
Author(s):  
Robin F. Koeleveld ◽  
Carl B. Heilman ◽  
Richard P. Klucznik ◽  
William A. Shucart
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
De Novo ◽  
Young Patients ◽  
Left Internal Carotid Artery ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract A case of the de novo formation of an aneurysm in a young woman is presented. At age 13 years, she had a spontaneous subarachnoid hemorrhage. Cerebral angiography showed an aneurysm of the bifurcation of the left internal carotid artery and a small aneurysm of the left anterior choroidal artery. At surgery, the aneurysm of the internal carotid artery was clipped, and the aneurysm of the left anterior choroidal artery was wrapped with muslin. Thirteen years later, the patient had another subarachnoid hemorrhage. Cerebral arteriography showed four aneurysms that had developed at previously angiographically normal sites. This case suggests that young patients with aneurysms might benefit from follow-up angiography in search of late aneurysm formation.

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