Indocyanine Green Videoangiography for Surgery of a Ruptured Dissecting Aneurysm in the Precommunicating Anterior Cerebral Artery: A Technical Case Report

Abstract BACKGROUND AND IMPORTANCE: Indocyanine green videoangiography (ICG-VA) is an important intraoperative adjunct for saccular aneurysm surgery, but its efficacy in surgery for dissecting aneurysms has rarely been reported. The authors describe the usefulness of preclipping ICG-VA in a rare case of a ruptured dissecting aneurysm located at the precommunicating (A1) segment of the anterior cerebral artery. CLINICAL PRESENTATION: A 52-year-old woman, with no history of connective tissue diseases or vascular disorders, presented with sudden headache and convulsion. The CT scan showed that the patient had subarachnoid hemorrhage. Angiography showed a dissecting aneurysm in the left A1 segment of the anterior cerebral artery. Thus, the patient underwent trapping of the dissecting aneurysm. ICG-VA was used as an intraoperative adjunct before and after clipping. The preclipping ICG-VA showed the heterogeneously bright dissecting aneurysm and branching arteries even in the presence of hematoma. CONCLUSION: Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms.

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Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage after Cerebral Infarction: A Case Report

Clinical Medicine Case Reports ◽

10.4137/ccrep.s833 ◽

2008 ◽

Vol 1 ◽

pp. CCRep.S833

Author(s):

Akihiro Kurosu ◽

Shizuo Hatashita ◽

Hideo Ueno

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Vascular Reconstruction ◽

Dissecting Aneurysm ◽

Vascular Anastomosis ◽

Left Lower Extremity ◽

The Right ◽

Dissecting Aneurysms

Introduction Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result. Case presentation A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient's postoperative course was uneventful. Conclusion A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient's functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty.

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Idiopathic dissecting cerebral aneurysm of the distal anterior cerebral artery in an infant successfully treated with aneurysmectomy: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case20142 ◽

2021 ◽

Vol 1 (9) ◽

Author(s):

Suguru Nagamitsu ◽

Natsue Kaneko ◽

Toshikazu Nagatsuna ◽

Hiroaki Yasuda ◽

Manabu Urakawa ◽

...

Keyword(s):

Blood Flow ◽

Indocyanine Green ◽

Cerebral Artery ◽

Peripheral Blood ◽

Anterior Cerebral Artery ◽

Pathological Examination ◽

Peripheral Blood Flow ◽

Indocyanine Green Videoangiography ◽

Imaging Results ◽

Distal Anterior Cerebral Artery

BACKGROUNDIdiopathic dissecting cerebral aneurysms (IDCAs) are male dominant but are extremely rare in children. Many IDCAs in children are located in the posterior cerebral artery and the supraclinoid internal cervical artery. No cases of IDCA of the distal anterior cerebral artery (ACA) have been reported.OBSERVATIONSA previously healthy 7-month-old boy experienced afebrile seizures and presented at the authors’ hospital 1 week after the first seizure. He was not feeling well but had no neurological deficits. The authors diagnosed a ruptured aneurysm of the right distal ACA based on imaging results. He underwent emergency craniotomy to prevent re-rupture of the aneurysm. Using intraoperative indocyanine green videoangiography, the authors confirmed peripheral blood flow and then performed aneurysmectomy. Pathological examination of the aneurysm revealed a thickened intima, fragmentation of the internal elastic lamina, and a hematoma in the aneurysmal wall. The authors ultimately diagnosed IDCA because no cause was indicated, including a history of trauma. The boy recovered after surgery and was subsequently discharged with no complications.LESSONSThe authors reported, for the first time, IDCA of the distal ACA in an infant. The trapping technique is often used for giant fusiform aneurysms in infants. Indocyanine green videoangiography is useful for evaluating peripheral blood flow during trapping in this case.

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Intraoperative Matas Test Using Microscope-Integrated Intraoperative Indocyanine Green Videoangiography with Temporary Unilateral Occlusion of the A1 Segment of the Anterior Cerebral Artery

World Neurosurgery ◽

10.1016/j.wneu.2011.03.044 ◽

2011 ◽

Vol 76 (5) ◽

pp. 477.e7-477.e10 ◽

Cited By ~ 12

Author(s):

Yasuo Murai ◽

Koji Adachi ◽

Ryo Takagi ◽

Kenta Koketsu ◽

Fumihiro Matano ◽

...

Keyword(s):

Indocyanine Green ◽

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Indocyanine Green Videoangiography ◽

Matas Test

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Evaluation for Perfusion Areas of Bypass Flow by Intraoperative Near-infrared Indocyanine Green Videoangiography in Superficial Temporal Artery-middle Cerebral Artery Bypass Surgery

Surgery for Cerebral Stroke ◽

10.2335/scs.37.233 ◽

2009 ◽

Vol 37 (4) ◽

pp. 233-239 ◽

Cited By ~ 2

Author(s):

Yuji KODAMA ◽

Hideyuki OHNISHI ◽

Katsushi TAOMOTO ◽

Yoshihiro KUGA ◽

Kazuya NAKASHIMA ◽

...

Keyword(s):

Indocyanine Green ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Near Infrared ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Bypass Flow ◽

Indocyanine Green Videoangiography

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Ruptured Dissecting Aneurysm of the Anterior Cerebral Artery A1 Segment Associated with Multiple Intracranial Aneurysms

Surgery for Cerebral Stroke ◽

10.2335/scs.46.40 ◽

2018 ◽

Vol 46 (1) ◽

pp. 40-44 ◽

Cited By ~ 1

Author(s):

Michio NAKAMURA ◽

Tadashi MIYAZAKI ◽

Hiroshi KIKUCHI ◽

Yoshihiko FUSE

Keyword(s):

Cerebral Artery ◽

Intracranial Aneurysms ◽

Anterior Cerebral Artery ◽

Dissecting Aneurysm ◽

Multiple Intracranial Aneurysms

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Dissecting aneurysm of the anterior cerebral artery causing hemorrhagic infarction

Surgical Neurology ◽

10.1016/0090-3019(95)00405-x ◽

1996 ◽

Vol 45 (1) ◽

pp. 25-29 ◽

Cited By ~ 20

Author(s):

Shuzo Okuno ◽

Chikayuki Ochiai ◽

Masakatsu Nagai

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Dissecting Aneurysm ◽

Hemorrhagic Infarction

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Dissecting aneurysm confined to the anterior cerebral artery

British Journal of Neurosurgery ◽

10.1080/02688690220131787 ◽

2002 ◽

Vol 16 (2) ◽

pp. 158-164 ◽

Cited By ~ 16

Author(s):

K. Mori ◽

T. Yamamoto ◽

M. Maeda

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Dissecting Aneurysm

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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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