scholarly journals Contemporary Management of Distal Anterior Cerebral Artery Aneurysms: A Dual-Trained Neurosurgeon's Perspective

2021 ◽  
Author(s):  
Sunil V. Furtado ◽  
Dravya Jayakumar ◽  
Parichay J. Perikal ◽  
Dilip Mohan
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Statistical Significance ◽  
Endovascular Coiling ◽  
World Federation ◽  
Anterior Circulation ◽  
Chi Square ◽  
Good Outcome ◽  
Fisher Grade ◽  
Distal Anterior Cerebral Artery

Abstract Objectives Distal anterior cerebral artery (DACA) aneurysms are a subset of aneurysms located in the anterior circulation but away from the circle of Willis. We analyze the clinical presentation and outcomes of two treatment groups—surgical and endovascular—for DACA aneurysms managed by a dual-trained neurosurgeon. Material and Methods A retrospective evaluation of radiological and operative/interventional data of 34 patients with 35 DACA aneurysms over a 12-year period was analyzed. Twenty-seven patients underwent surgery, whereas seven underwent endovascular coiling of the aneurysms. Modified Fisher grade and World Federation of Neurosurgical Societies scale (WFNS) were used to note the subarachnoid hemorrhage (SAH) severity. Statistical Analysis Categorical data were presented as frequency and percentage, while noncategorical data were represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using Chi-square test, and p < 0.05 was considered statistically significant. Results Of 34 patients, 33 presented with a bleed and 23.5% patients were noted to have another aneurysm in addition to the DACA aneurysm. Patients who underwent clipping for another aneurysm along with the DACA aneurysm in a single surgical exercise had a poor outcome compared with those who underwent surgery for the lone DACA aneurysm (7 vs. 20, p = 0.015). Most patients in both surgical (70.37%) and endovascular (85.71%) groups had good outcome (mRS ≤ 2). Conclusions A good outcome can be achieved with either surgery or endovascular coiling in the management of DACA aneurysms. In patients with multiple aneurysms, SAH with aneurysmal rupture of DACA should be managed first; the other unruptured aneurysm may be operated after an interval to avoid morbidity.

Superficial Temporal Artery Extended Interposition Graft to Anterior Cerebral Artery Bypass for the Treatment of a Large Fusiform Distal Anterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Bhanu Jayanand Sudhir ◽  
Sanjay Honavalli Murali ◽  
Mohamed Amjad Jamaluddin ◽  
Easwer Hariharan Venkat
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Uneventful Recovery ◽  
Interposition Graft ◽  
Marginal Artery ◽  
Fisher Grade ◽  
Distal Anterior Cerebral Artery

Abstract Fusiform aneurysms of the distal anterior cerebral artery (DACA) are infrequent. Clip reconstruction and sequential progressive clipping have been described in the management of giant thrombosed DACA aneurysms.1,2 Customized revascularization with bypass, side-to-side anastomosis, and trapping of the aneurysmal segment have also been performed for treating DACA aneurysms.3-12 We present a 2-dimensional operative video of superficial temporal artery (STA) to distal anterior cerebral artery bypass, followed by trapping of the aneurysm-bearing segment. A 57-yr-old lady presented with a large ruptured subcallosal fusiform DACA aneurysm (WFNS grade 1, Fisher grade 1). Angiography revealed a 1.3 × 0.9 cm fusiform aneurysm in the DACA.  Informed consent was secured from the patient and her family for the surgery and permission was obtained for the publication of the patient's image/surgical video. The frontal and parietal branches of the STA were dissected. The parietal branch was explanted and used as a free interposition graft between the frontal branch (end-to-end anastomosis) and calloso-marginal artery (end-to-side anastomosis). After confirming blood flow through the bypass using Doppler, the aneurysm was trapped and excised.  The patient had an uneventful recovery. Her postoperative computed tomography (CT) head revealed no evidence of neurological insult. The patency of the bypass conduit and the complete removal of the aneurysm were confirmed using a digital subtraction angiogram. Histopathological examination revealed an eccentric atheromatous plaque with a lipid core. There was no evidence of intraplaque hemorrhage. This extended STA graft utilizing the frontal and parietal branches of the STA, and its implantation into the distal ACA, offers a novel bypass strategy for tackling fusiform aneurysms of the DACA. Anastomosis to the calloso-marginal artery ensured perfusion of the ACA territory through the pericallosal artery during temporary occlusion.

ANEURYSMS OF THE DISTAL ANTERIORCEREBRAL ARTERY

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 227-234 ◽  
Author(s):  
David A. Steven ◽  
Stephen P. Lownie ◽  
Gary G. Ferguson
Keyword(s):  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Circulation ◽  
Operative Morbidity ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Grade Ii ◽  
The Mean ◽  
Distal Anterior Cerebral Artery ◽  
Anterior Circulation Aneurysms

Abstract OBJECTIVE The aim of this study was to present the clinical and radiological characteristics, surgical management, and outcome in a large series of patients with aneurysms of the distal anterior cerebral artery (DACA) managed in the microsurgical era. METHODS The records of 1109 patients with anterior circulation aneurysms managed at the authors' institution between 1970 and 1998 were reviewed. RESULTS Fifty-nine patients (5.3%) were identified with 67 DACA aneurysms. Seventy-three percent of the patients were women. The mean age of all patients was 47 years. Multiple aneurysms were identified in 51% of all patients, most commonly on the middle cerebral artery. Thirty-six patients had ruptured DACA aneurysms and 23 had unruptured aneurysms. In those with ruptured aneurysms, the admission grade was Grade I in 10 patients (27.8%), Grade II in three patients (8.3%), Grade III in 10 patients (27.8%), Grade IV in seven patients (19.4%), and Grade V in six patients (16.7%). Frontal lobe hematomas occurred in 28% of the patients with ruptured aneurysms and carried a poor prognosis. In those with unruptured aneurysms, 11 were incidental and 12 were identified after a subarachnoid hemorrhage from another aneurysm. The mean diameter was 10 mm in ruptured aneurysms and 5.8 mm in unruptured aneurysms. Fifty-eight patients underwent surgery and one patient was treated with endovascular coiling. Six patients, all with ruptured aneurysms, died. Seventy percent of survivors with ruptured aneurysms had a favorable outcome. CONCLUSION DACA aneurysms possess a number of characteristics that distinguish them from the more common intracranial aneurysms. With modern neurosurgical and endovascular techniques, an acceptable operative morbidity and mortality can be achieved.

scholarly journals Right Orbitozygomatic Craniotomy for Clip Wrapping of an A2 Fusiform Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E155-E156
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Video Recording ◽  
Fusiform Aneurysm ◽  
Anterior Circulation ◽  
Institutional Review ◽  
Aneurysmal Dilation ◽  
Interhemispheric Fissure ◽  
Flow Through ◽  
Distal Anterior Cerebral Artery

Abstract Distal anterior cerebral artery aneurysms often rupture at a small size and are associated with overall higher operative morbidity relative to other anterior circulation aneurysms. This patient had an incidentally identified anterior cerebral artery proximal A2 segment fusiform aneurysm that did not respond to endovascular treatment and required open surgical management. The fusiform dilation was mobilized and isolated circumferentially within the interhemispheric fissure, and a Gore-Tex clip-wrapping was planned. A permanent clip was applied along the aneurysmal dilation parallel to the vessel directly prior to completing the wrapping to attempt to establish native flow dynamics through the aneurysmal segment. The clip-wrapping was then completed, and intraoperative indocyanine green fluoroscopy demonstrated good distal flow through the aneurysmal segment. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute, Phoenix, Arizona.

Abstract TP428: Microsurgical and Endovascular Treatment of Ruptured Distal Anterior Cerebral Artery Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Keun Young Park ◽  
Yoon Ho Lee ◽  
Eun Hyun Ihm ◽  
Yong Cheol Lim ◽  
Joonho Chung ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Ct Scanning ◽  
Endovascular Coiling ◽  
Surgical Morbidity ◽  
Technical Success Rate ◽  
Microsurgical Clipping ◽  
Maximal Diameter ◽  
Distal Anterior Cerebral Artery

Introduction: Distal anterior cerebral artery (DACA) aneurysms are less common and surgical morbidity has been reported relatively high due to intraoperative rupture and narrow surgical field. Endovascular treatment can be alternative to surgery. This study investigated the efficacy and safety of endovascular coiling for ruptured DACA aneurysms comparing with microsurgical clipping. Patients and Methods: Between January 1999 and March 2012, consecutive 94 patients with ruptured DACA aneurysm were treated by surgical clipping (n=52, 55.3%) and endovascular coiling (n=42, 44.7%) in five institutions including only 2 cases of recurrence (2.1%, 1 in clip and 1 in coil). The clinical outcomes of patients and procedure-related complications (intraprocedural rupture and any infarction) were evaluated and compared between two groups. Results: There were 38 males and 56 females (mean age; 55.1 years). Initial Hunt-Hess grade was GII in 25 patients (37.2%), GIII in 36 patients (38.3%), GIV in 12 patients (12.8%), and GV in 11 patients (11.7%), which was significantly higher in coil group (2.77 in clip vs 3.26 in coil, p=0.016). Initial CT scanning showed ruptured DACA aneurysm with ICH (n=35; 37.2%) and hydrocephalus (n=25; 26.6%). Maximal diameter of aneurysm was less than 5mm in 36 (38.3%), 5~10mm in 53 (56.4%), and 10mm and more than in 5 (5.3%). Technical success rate was 100% and complete occlusion or neck remnant of aneurysm was achieved in 87 [92.6%, 49 (96.1%) in clip vs 38 (90.5%) in coil, p=0.404] and incomplete in 6 (6.4%). At discharge, favorable outcome (modified GOS; good and fair) was obtained in 70 [77.8%, 44 (84.6%) in clip vs 26 (68.4%) in coil, p=0.078]. Intraprocedural rupture occurred only in clipping group [6 cases (11.5%), p=0.031]. Any procedure-related infarction occurred in 7 [7.4%, 6 (11.5%) in clip vs 1 (2.4%) in coil, p=0.126]. Intraprocedural thrombus was detected in 5 cases of coil group and most of them were restored by thrombolytic therapy. There was one case of acute rebleeding in coiling group and this patient died. Conclusions: Endovascular coiling was comparable treatment with clipping for ruptured DACA aneurysms.

scholarly journals 126 Neurosurgical Clipping Versus Endovascular Coiling for Unruptured and Ruptured Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K S Lee ◽  
J Zhang ◽  
M Teo
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Primary Outcome Measure ◽  
Endovascular Coiling ◽  
Final Decision ◽  
Acute Hydrocephalus ◽  
Distal Anterior Cerebral Artery ◽  
Intraoperative Rupture

Abstract Aim To assess outcomes after clipping or coiling of distal anterior cerebral artery (DACA) aneurysms via a meta-analysis. Method Systematic searches of Medline, Embase and Cochrane Central were undertaken from 1st January 1973 until 1st May 2020 for published studies reporting microsurgical clipping and endovascular coiling of DACA aneurysms. Primary outcome measure was independent functional outcome (modified Rankin scale (mRS) 0–2, or Glasgow Outcome Scale (GOS) 4–5). Secondary outcomes were poor clinical outcome and mortality, perioperative complications, aneurysm occlusion rates, rebleeding and recurrence. Results 938 and 223 patients with ruptured and unruptured DACA aneurysms, respectively, were reported across 28 studies. Pooled rate of procedure-related morbidity was 6.8% (95%CI: 3.2 – 11.2) and 1.3% (95%CI: 0.0 – 9.1) for clipped and coiling ruptured DACA aneurysms respectively. Pooled rate of intraoperative rupture for clipped and coiled ruptured DACA aneurysms was 10.0% (95%CI: 2.5 – 20.6) and 5.7% (95%CI: 1.1 – 12.5) respectively. Pooled rate of acute hydrocephalus for clipped and coiled ruptured DACA aneurysms was 7.8% (95%CI: 0.5 – 19.7) and 1.4% (95% CI: 0.0 – 11.3) respectively. Pooled rate of perioperative mortality was 0.002% (95% CI: 0.0 – 0.7) ruptured DACA aneurysms treated by clipping. For clipped unruptured DACA aneurysms, pooled rates of procedure-related morbidity, intraoperative rupture, acute hydrocephalus were 2.5% (95%CI: 0.0 – 7.5), 0.002% (95%CI: 0.0 – 3.1) and 0.5% (95%CI: 0.0 – 5.1) respectively. Conclusions Clipping results in poorer short-term outcomes when compared to coiling. However, the final decision-making should be shared with the patient and be performed on a selective, case-by-case basis in order to maximize patient benefits.

Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 133-135 ◽  
Author(s):  
Kevin Gibbons ◽  
Leo N. Hopkins ◽  
Roberto C. Heros
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Case Histories ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Artery Segment ◽  
Distal Anterior Cerebral Artery ◽  
Clip Occlusion ◽  
Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

scholarly journals Predictors of Poor Outcome after Successful Mechanical Thrombectomy in Patients with Acute Anterior Circulation Stroke

2017 ◽  
Vol 01 (03) ◽  
pp. 139-143 ◽  
Author(s):  
Yosuke Tajima ◽  
Michihiro Hayasaka ◽  
Koichi Ebihara ◽  
Masaaki Kubota ◽  
Sumio Suda
Keyword(s):  
Clinical Outcome ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Infarct Volume ◽  
Complete Revascularization ◽  
Anterior Circulation ◽  
Clinical Imaging ◽  
Good Outcome ◽  
Poor Outcome ◽  
Favorable Clinical Outcome

AbstractSuccessful revascularization is one of the main predictors of a favorable clinical outcome after mechanical thrombectomy. However, even if mechanical thrombectomy is successful, some patients have a poor clinical outcome. This study aimed to investigate the clinical, imaging, and procedural factors that are predictive of poor clinical outcomes despite successful revascularization after mechanical thrombectomy in patients with acute anterior circulation stroke. The authors evaluated 69 consecutive patients (mean age, 74.6 years, 29 women) who presented with acute ischemic stroke due to internal cerebral artery or middle cerebral artery occlusions and who were successfully treated with mechanical thrombectomy between July 2014 and November 2016. A good outcome was defined as a modified Rankin Scale score of 0 to 2 at 3 months after treatment. The associations between the clinical, imaging, and procedural factors and poor outcome were evaluated using logistic regression analyses. Using multivariate analyses, the authors found that the preoperative National Institute of Health Stroke Scale (NIHSS) score (odds ratio [OR], 1.152; 95% confidence interval [CI], 1.004–1.325; p = 0.028), the diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) (OR, 0.604; 95% CI, 0.412–0.882; p = 0.003), and a Thrombolysis in Cerebral Infarction (TICI) 2b classification (OR, 4.521; 95% CI, 1.140–17.885; p = 0.026) were independent predictors of poor outcome. Complete revascularization to reduce the infarct volume should be performed, especially in patients with a high DWI-ASPECTS, to increase the likelihood of a good outcome.

Aneurysm of distal anterior cerebral artery associated with azygos anterior cerebral artery

1981 ◽  
Vol 59 (1-2) ◽  
pp. 65-69 ◽  
Author(s):  
K. Fujimoto ◽  
S. Waga ◽  
T. Kojima ◽  
S. Shimosaka
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Distal Anterior Cerebral Artery
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