A3-A3 Bypass for Giant Anterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video

Abstract Large fusiform anterior cerebral artery aneurysms often require revascularization to allow for the treatment of the aneurysm and preservation of distal perfusion. The A3-A3 side-to-side anastomosis maintains ipsilateral distal perfusion. The inflow to the fusiform segment can then be clip occluded to treat the diseased vessel segment. This procedure is illustrated by the case in this video. The patient had a large right anterior cerebral artery fusiform aneurysm. An anterior interhemispheric craniotomy with the right side down was utilized for the approach. Postprocedural angiography demonstrated occlusion of the aneurysmal segment and patent distal perfusion within the ipsilateral distal segment. 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.

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Treatment of a Fusiform Anterior Cerebral Artery Aneurysm With an A3-A3 Bypass: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa143 ◽

2020 ◽

Vol 19 (4) ◽

pp. E385-E385

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Video Recording ◽

Artery Aneurysm ◽

Neurological Status ◽

Institutional Review ◽

Bypass Patency ◽

Surgical Field ◽

Distal Anterior Cerebral Artery ◽

Cerebral Artery Aneurysm

Abstract Distal anterior cerebral artery (ACA) aneurysms remain a relatively rare and challenging entity for both open microsurgical and endovascular treatments. These lesions provide a significant surgical challenge because of the narrow interhemispheric surgical field, limited proximal control, common fixation of the aneurysm to the adjacent cingulate gyrus, and possible involvement of an unpaired azygos A2. These challenges result in a known association between distal ACA aneurysms and higher operative morbidity. This video demonstrates indirect obliteration of a prior ruptured fusiform right A2 aneurysm utilizing an A3-to-A3 side-to-side anastomotic bypass with aneurysm trapping. An anterior interhemispheric approach was used for exposure of bilateral ACAs, arteriotomies, microanastomosis, and trapping of the aneurysmal right A2 segment. Postoperatively, the patient's neurological status returned to baseline, and imaging demonstrated evidence of bypass patency with no residual filling of the fusiform aneurysmal segment. This video verifies the feasibility and efficacy of the A3-to-A3 anastomotic bypass for treatment of distal ACA aneurysms. 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.

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Complete Recovery from Blindness in Case of Compressive Optic Neuropathy due to Unruptured Anterior Cerebral Artery Aneurysm

Case Reports in Ophthalmology ◽

10.1159/000458753 ◽

2017 ◽

Vol 8 (1) ◽

pp. 157-162

Author(s):

Yurie Fukiyama ◽

Hidehiro Oku ◽

Yusuke Hashimoto ◽

Yuko Nishikawa ◽

Masahiro Tonari ◽

...

Keyword(s):

Visual Field ◽

Optic Neuropathy ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Complete Recovery ◽

Visual Field Defects ◽

Anterior Cerebral Artery Aneurysm ◽

The Right ◽

Cerebral Artery Aneurysm

It is not common for an isolated visual symptom to be the first indication of an aneurysm compressing the optic nerve. The compression can lead to blindness, and a recovery from the blindness is rare. We report a female with a left painless optic neuropathy caused by an unruptured anterior cerebral artery aneurysm. The patient had a temporal hemianopic visual field defect, which progressed to blindness in the left eye, while the right visual function was not affected. A coil embolization of the aneurysm completely restored her visual acuity to 20/20. These findings suggest that aneurysmal lesions should be ruled out in case of unilateral optic neuropathy with hemianopic visual field defects and progressive visual loss.

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Surgical Management of a Ruptured Dissecting Anterior Cerebral Artery (A2) Aneurysm Utilizing Contralateral Frontopolar for Reconstruction: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz405 ◽

2019 ◽

Vol 18 (3) ◽

pp. E76-E77

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Video Recording ◽

Dissecting Aneurysm ◽

Institutional Review ◽

Interhemispheric Fissure ◽

Diseased Vessel ◽

Temporary Clip ◽

Rupture Site ◽

Fibrin Thrombus

Abstract Dissecting aneurysms can pose an immense surgical challenge, and intervention often involves high risk for rerupture because of the volatile nature of the fibrin thrombus overlying the rupture site. This patient presented following rupture of a dissecting aneurysm along the A2 segment of the anterior cerebral artery (ACA). The patient underwent a right orbitozygomatic craniotomy, and the aneurysm was approached within the interhemispheric fissure. Manipulation of the aneurysm dome resulted in intraoperative rerupture of the aneurysm, which was controlled by the application of a temporary clip on the parent A2 proximally and distally. Aneurysmectomy of the thin diseased vessel wall was performed. The defect was filled by transecting the frontopolar branch of the ACA and sewing the frontopolar branch onto the aneurysmectomy defect. This provided a suitable patch for the ACA defect. Postprocedural indocyanine green angiography demonstrated patency of the A2 and the anastomosed frontopolar branch. 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.

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Aneurysm of the distal anterior cerebral artery radiologically mimicking a ventricular mass

Journal of Neurosurgery ◽

10.3171/2010.6.jns10370 ◽

2011 ◽

Vol 114 (4) ◽

pp. 1061-1064 ◽

Cited By ~ 1

Author(s):

A. Metin Şanlι ◽

Saruhan Çekirge ◽

Zeki Şekerci

Keyword(s):

Cerebral Artery ◽

Lateral Ventricle ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Ventricular Mass ◽

Frontal Horn ◽

Major Branch ◽

The Right ◽

Distal Anterior Cerebral Artery ◽

Cerebral Artery Aneurysm

The ventricular system is a rare localization for intracranial aneurysms. Most ventricular aneurysms arise from a distal branch of the choroidal arteries and a major branch point of the circle of Willis. A 41-year-old-man suffering from dizziness of 2 weeks' duration was admitted to the clinic. On radiological examination, he had a well-circumscribed mass involving the frontal horn of the right lateral ventricle without radiological evidence of a prior or recent hemorrhage. Localization and radiological appearance were not typical of a ventricular mass and did not allow diagnosis. After cerebral angiography, an aneurysm arising from the distal anterior cerebral artery was incidentally found in an intraventricular location. This unruptured aneurysm was successfully treated via the endovascular route. The authors describe the unusual case of a distal anterior cerebral artery aneurysm with a dome extending into the right lateral ventricle, which appears to be the first such case in the literature. Angiography may be helpful to neurosurgeons in avoiding the disastrous complications of a biopsy procedure in such unusual cases.

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