A3-A3 Bypass Surgery for Aneurysm: Technical Nuances

2018 ◽  
Vol 17 (3) ◽  
pp. 277-285 ◽  
Author(s):  
Florina-Nicoleta Grigore ◽  
Sepideh Amin-Hanjani
Keyword(s):  
Bypass Surgery ◽  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Patient Positioning ◽  
Technical Difficulty ◽  
Senior Author ◽  
Anterior Communicating Artery ◽  
Relative Depth ◽  
Bypass Procedure

Abstract BACKGROUND Cerebral bypass remains important for the treatment of complex cerebral aneurysms including dissecting, giant, and fusiform aneurysms not amenable to endovascular treatment or simple clip ligation. For such aneurysms involving the anterior communicating artery complex or its branches, distal anterior cerebral artery (ACA) A3-A3 side-to-side bypass represents a valuable treatment option. Distal ACA in situ anastomosis is recognized to be technically demanding mainly due to the relative depth and narrowness of the interhemispheric surgical corridor and type of anastomosis. OBJECTIVE To demonstrate technical nuances of A3-A3 side-to-side in situ bypass surgery through case illustrations and operative videos. METHODS Elements of the procedure relating to positioning, approach, and anastomosis which have evolved in the operative technique of the senior author were collated based on review of clinical case material, imaging and video recordings of ACA aneurysms treated with side-to-side in situ A3-A3 bypass procedure. Technical elements were contrasted with relevant literature. RESULTS Nuances relative to patient positioning, selection of craniotomy variants, adjunctive intraoperative tools and microsurgical nuances of the side-to-side bypass procedure are reviewed. Three illustrative operative video cases, along with illustrations, are provided to complement the description of the nuances. CONCLUSION In the light of the inherent technical difficulty, as well as the rather limited case volumes, the technical tips provided may contribute to bringing additional refinement and simplicity to the A3-A3 bypass procedure.

scholarly journals Microsurgical clipping of the anterior circulation aneurysms

2018 ◽  
Vol 20 (4) ◽  
pp. 409-414
Author(s):  
Carlos Eduardo Da Silva ◽  
Paulo Eduardo Peixoto De Freitas ◽  
Alicia Del Carmen Becerra Romero ◽  
Fáberson João Mocelin Oliveira ◽  
Márcio Aloisio Bezerra Cavalcanti Rockenbach ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Cerebral Aneurysms ◽  
Series Data ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Microsurgical Clipping ◽  
The Mean ◽  
Anterior Circulation Aneurysms

Introduction: The authors present the analysis of the microsurgical clipping of 100 cerebral aneurysms of the anterior circulation and compare the series data with the literature. Methods: Eighty-eight patients presenting with 100 anterior circulation aneurysms operated on microsurgical techniques between 2002 and 2008 by the first author (CES) were retrospectively reviewed. Results: A total of 88 patients with 100 aneurysms of the anterior circulation were treated in a six years period. Fifty eight female (66%) and thirty male (34%) with nine patients (10.2%) presenting with multiple aneurysms. The mean age was 52 years (range from 26 to 76 years). Eighty five percent of the cases were ruptured aneurysms. The mean follow-up was 52.4 months (range from 5 to 76 months). The topography of the aneurysms was distributed as it follows: Anterior communicating artery (ACoA) 25%; posterior communicating artery (p-comm) 29%; middle cerebral artery (MCA) 27%; paraclinoidal aneurysms 8%; pericallosal artery 6% and internal carotid artery (ICA) tip 5%. The mortality was 7.9%, and such cases presenting with Hunt Hess graduation 3 and 4. The permanent morbidity was 4.5%, cases with Hunt Hess graduation 3 and 4. Perioperative rupture occurred in 17% of the cases, only in previous ruptured aneurysms. There was no clinical evidence of rebleeding during the follow-up period of the series. Conclusions: The microsurgical clipping of cerebral aneurysms of the anterior circulation is a safe and curative treatment for most of such lesions. At present, studies suggest evidences of superior results of surgery compared to the endovascular techniques in the rates of total occlusion of the aneurysms, lesser rates of rebleeding of the treated cases. The results of the present series are similar to the rates of the most relevant literature.

scholarly journals A Location-Based Outcome Analysis of the Most Common Microsurgically Clipped Cerebral Aneurysms: A Single-Center Experience

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Peyton L Nisson ◽  
Ali Tayebi Meybodi ◽  
Garrett K Berger ◽  
Austen Thompson ◽  
Ramin A Morshed ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Cerebral Aneurysms ◽  
Neurological Status ◽  
Senior Author ◽  
Ruptured Aneurysm ◽  
Outcome Analysis ◽  
Anterior Communicating Artery ◽  
Single Center Experience ◽  
Microsurgical Clipping

ABSTRACT BACKGROUND Intracranial aneurysms of the anterior communicating artery (AComA), posterior communicating artery (PComA), and the middle cerebral artery (MCA) comprise the majority of all aneurysms encountered and treated by vascular neurosurgeons. OBJECTIVE To analyze and compare outcomes between these locations using multivariable logistic regression and to assess what clinical features may differ between them. METHODS Solitary aneurysms microsurgically clipped by the senior author were included from a prospective database of patients treated between January 2010 and April 2013 at a tertiary academic medical center. Neurological status was assessed using the modified Rankin Scale (mRS). Neurological outcomes were dichotomized, with mRS scores 0-2 considered “good” and 3-6 considered “poor.” RESULTS A total of 196 patients were treated; 69 aneurysms were located at the MCA, 77 at the AComA, and 50 at the PComA. A total of 48% (97/196) of patients presented with a ruptured aneurysm and 14% (25/180) were considered large. PComA was more commonly presented as a ruptured aneurysm (64%) compared to AComA (56%) and MCA (28%) (P ≤ .001), and when ruptured, PComA aneurysms were 1.6 times more likely to experience a favorable outcome compared to MCA aneurysms (P = .01). Regression analysis revealed PComA was associated with a lower risk for poor outcomes (odds ratio [OR] 0.19, P = .01) controlling for age, presentation type, and vasospasm. CONCLUSION Patients who underwent microsurgical clipping of ruptured PComA aneurysms experienced significantly better outcomes, while those with MCA aneurysms suffered the worst. Further investigation on this topic and the potential reasons that may account for these differences is warranted.

Tailored Communicating Bypass for the Management of Complex Anterior Communicating Artery Aneurysms: “Flow-Counteraction” In Situ Bypass and Interposition Bypass Using Contralateral A2 Orifice as Donor Site

2020 ◽  
Vol 19 (2) ◽  
pp. 117-125
Author(s):  
Xuan Wang ◽  
Xiaoguang Tong ◽  
Jie Liu ◽  
Minggang Shi ◽  
Yanguo Shang ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Donor Site ◽  
Anterior Communicating Artery ◽  
Bypass Patency ◽  
Complete Obliteration ◽  
Practical Algorithm ◽  
In Situ Bypass ◽  
The Sacrifice ◽  
Reconstruction Option

Abstract BACKGROUND The use of bypass surgery for anterior communicating artery (ACOM) aneurysms is technically challenging. Communicating bypass (COMB), such as pericallosal artery side-to-side anastomosis, is the most frequently used and anatomically directed reconstruction option. However, in many complex cases, this technique may not afford a sufficient blood supply or necessitate sacrificing the ACOM and the eloquent perforators arising from it. OBJECTIVE To evaluate tailored COMB and propose a practical algorithm for the management of complex ACOM aneurysms. METHODS For 1 patient with an aneurysm incorporating the entire ACOM, conventional in Situ A3-A3 bypass was performed as the sole treatment in order to create competing flow for aneurysm obliteration, sparing the sacrifice of eloquent perforators. In situations in which A2s were asymmetric in the other case, the contralateral A2 orifice was selected as the donor site to provide adequate blood flow by employing a short segment of the interposition graft. RESULTS The aneurysm was not visualized in patients with in Situ A3-A3 bypass because of the “flow-counteraction” strategy. The second patient, who underwent implementation of the contralateral A2 orifice for ipsilateral A3 interposition bypass, demonstrated sufficient bypass patency and complete obliteration of the aneurysm. CONCLUSION The feasibility of conventional COMB combined with complete trapping may only be constrained to selected ideal cases for the treatment of complex ACOM aneurysms. Innovative modifications should be designed in order to create individualized strategies for each patient because of the complexity of hemodynamics and the vascular architecture. Flow-counteraction in Situ bypass and interposition bypass using the contralateral A2 orifice as the donor site are 2 novel modalities for optimizing the advantages and broadening the applications of COMB for the treatment of complex ACOM aneurysms.

Cyanosis and Clipping: Noninfectious Aneurysm in a Patient with 22q11.2 Deletion Syndrome

2021 ◽  
pp. 1-5
Author(s):  
Bhanu Jayanand Sudhir ◽  
Sanjay Honavalli Murali ◽  
Jaypalsinh Gohil ◽  
Rajalakshmi Poyuran ◽  
Manikantan Sethuraman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
22Q11.2 Deletion Syndrome ◽  
Neurological Deficits ◽  
Deletion Syndrome ◽  
Anterior Communicating Artery ◽  
Cyanotic Heart Disease ◽  
22Q11.2 Deletion ◽  
Congenital Cyanotic Heart Disease

Noninfectious cerebral aneurysms are rare in patients with congenital cyanotic heart disease. We present a patient with DiGeorge/velocardiofacial syndrome with a complex congenital cyanotic heart disease with a ruptured anterior communicating artery aneurysm. The 10-year-old child was managed by surgical clipping of the aneurysm. Surgical challenges included prominent veins in the Sylvian fissure, difficulty in differentiating arterial and venous bleed, and anesthetic risks. The patient recovered without any neurological deficits. This is the first report of a patient with 22q11.2 deletion syndrome, with a noninfectious cerebral aneurysm.

scholarly journals Totally thrombosed giant anterior communicating artery aneurysm

2015 ◽  
Vol 6 (02) ◽  
pp. 245-247
Author(s):  
V. R. Roopesh Kumar ◽  
Venkatesh S. Madhugiri ◽  
Gopalakrishnan M. Sasidharan ◽  
Sudheer Kumar Gundamaneni ◽  
Awdhesh Kumar Yadav ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Preoperative Diagnosis ◽  
Relevant Literature ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Gait Ataxia ◽  
Visual Dysfunction ◽  
Anterior Communicating Artery Aneurysm

ABSTRACTGiant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

Annual Meeting of the Section on Pediatric Urology

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 449-452
Author(s):  
EDMOND T. GONZALES
Keyword(s):  
New Orleans ◽  
Annual Meeting ◽  
Technical Difficulty ◽  
Senior Author ◽  
Position Paper ◽  
Specific Topic ◽  
Young Infants ◽  
American Academy Of Pediatrics ◽  
Mutual Interest ◽  
Current Concern

The Section on Urology of the American Academy of Pediatrics met in association with the 50th annual meeting of the Academy in New Orleans. Several topics of interest to both pediatricians and pediatric urologists were discussed. Inasmuch as members are unable to attend subspecialty sessions when they occur simultaneously with other scheduled programs, this summary is prepared to offer an overview of the content of the meeting of our Section. Readers interested in a specific topic should feel free to contact the senior author of papers of special interest to them. The meeting was organized into topic-oriented sessions including hypospadias, reconstructive surgery, anomalies of the testis and scrotum, myelodysoplasia, principles of urinary undiversion, ureteral obstruction and techniques to assess the severity of obstruction, urinary incontinence, and vesicouretenal reflux. Miscellaneous papers of interest to both pediatricians and pediatric urologists were also discussed. This summary will focus on those papers of mutual interest to urologists and pediatricians. HYPOSPADIAS Several years ago, the Sections on Urology and Child Development issued a position paper on timing for elective genital surgery in children.1 This paper suggested that, for psychological reasons, surgery at less than 1 year of age was preferable. However, for technical reasons, especially regarding hypospadias repairs, surgery was often best delayed until 2 years of age. More recently, Manley and Epstein2 reported a series of very young infants undergoing major hypospadias reconstructions (as young as age 6 months), with no apparent technical difficulty, no increase in complications, and lessened postoperative anxiety. Two papers at this meeting addressed this topic of current concern.

Surgery for angiographically occult cerebral aneurysms

1993 ◽  
Vol 79 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Jafar J. Jafar ◽  
Howard L. Weiner
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Interpeduncular Cistern ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Exploratory Surgery

✓ In 15% of patients with spontaneous subarachnoid hemorrhage (SAH), the source of bleeding cannot be determined despite repeated cerebral angiography. However, some patients diagnosed as having “SAH of unknown cause” actually harbor undetected aneurysms. The authors report six patients with SAH who, despite multiple negative cerebral angiograms, underwent exploratory surgery due to a high clinical and radiographic suspicion for the presence of an aneurysm. Brain computerized tomography (CT) scans revealed blood located mainly in the basal frontal interhemispheric fissure in four patients, in the sylvian fissure in one patient, and in the interpeduncular cistern in one patient. The patients were evaluated as Hunt and Hess Grades I to III, and had undergone at least two high-quality cerebral angiograms that did not reveal an aneurysm. Vasospasm was visualized in two patients. Three patients rebled while in the hospital. Exploratory surgery was performed at an average of 12 days post-SAH. Five aneurysms were discovered at surgery and were successfully clipped. All four patients with interhemispheric blood were found to have an anterior communicating artery (ACoA) aneurysm. The patient with blood in the sylvian fissure was found to have a middle cerebral artery aneurysm. These aneurysms were partially thrombosed. No aneurysm was detected in the patient with interpeduncular SAH, despite extensive basilar artery exploration. Five patients had an excellent outcome and one patient developed diabetes insipidus. These results show that exploratory aneurysm surgery is warranted, despite repeated negative cerebral angiograms, if the patient manifests the classical signs of SAH with CT scans localizing blood to a specific cerebral blood vessel (particularly the ACoA) and if a second SAH is documented at the same site.

OLFACTORY DYSFUNCTION AFTER IPSILATERAL AND CONTRALATERAL PTERIONAL APPROACHES FOR CEREBRAL ANEURYSMS

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. 727-732 ◽  
Author(s):  
Jaechan Park ◽  
Sun-Ho Lee ◽  
Dong-Hun Kang ◽  
Jung-Soo Kim
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Olfactory Dysfunction ◽  
Anterior Communicating Artery ◽  
Pterional Approach ◽  
Anterior Circulation ◽  
Related Risk ◽  
Lateral Distance ◽  
Contralateral Pterional Approach ◽  
Anterior Circulation Aneurysms

Abstract OBJECTIVE This study investigated olfactory dysfunction after using a contralateral or ipsilateral pterional approach for anterior circulation aneurysms and related risk factors. METHODS This study included 189 patients who experienced an aneurysmal subarachnoid hemorrhage and in whom a pterional approach was used, including a contralateral pterional approach (12 patients), a pterional approach for an anterior communicating artery (AComA) aneurysm (70 patients), and an ipsilateral pterional approach for aneurysms of the anterior circulation, excluding the AComA (107 patients). In addition to questionnaires on olfactory function, Sniffin' Sticks tests were performed 12 to 38 months after the operation. RESULTS The incidence of olfactory dysfunction was high: 58% (7 of 12) with a contralateral pterional approach, 14% (10 of 70) with a pterional approach for an AComA aneurysm, and 4% (4 of 107) with an ipsilateral pterional approach for aneurysms of the anterior circulation, except for the AComA. In addition, patients 55 years and older had a higher incidence of olfactory dysfunction. Among the 12 patients in whom the contralateral pterional approach was used, 5 (42%) were anosmic and 2 (17%) were hyposmic. The incidence of olfactory dysfunction was also significantly higher at ages 55 years and older. The size and location of the contralateral aneurysm, if small (<1 cm) and located within a 3-cm lateral distance from the midline, were not found to influence the incidence. CONCLUSION A higher incidence of olfactory dysfunction was found in those patients in whom a contralateral pterional approach and a pterional approach for an AComA aneurysm were used. Another major risk factor was an age of 55 years and older.

scholarly journals MICROSURGICAL CLIPPING IN THE RUPTURED AN ANEURYSM OF ANTERIOR COMMUNICATING ARTERY: A CASE REPORT

2017 ◽  
Vol 10 (10) ◽  
pp. 7
Author(s):  
Wayan Niryana ◽  
Aslesa Wangpathi Pagehgiri ◽  
Putu Eka Widyadharma
Keyword(s):  
Case Report ◽  
Intraoperative Monitoring ◽  
Cerebral Aneurysms ◽  
Medical Problem ◽  
Definitive Treatment ◽  
Anterior Communicating Artery ◽  
Microsurgical Technique ◽  
The Third ◽  
Microsurgical Clipping ◽  
Saccular Aneurysms

Objective: Ruptured saccular aneurysms are a common and serious medical problem. The prevalence of aneurysms is low during the first two decades of life and increases steadily after the third decade. Anterior communicating artery (AComA) aneurysms are regarded as the most complex of all intracranial aneurysms.Methods: Here, we report a case of an aneurysm of AComA patient with the development of microsurgical technique and intraoperative monitoring technique.Results: Permanent clipping was successfully performed in the neck of an aneurysm of AComA.Conclusion: Microsurgical clipping still remains a definitive treatment of ruptured cerebral aneurysms.

Cement within Cement Revision Hip Arthroplasty a Minimum 5 Year Follow-Up Study

1998 ◽  
Vol 8 (3) ◽  
pp. 129-137 ◽  
Author(s):  
J.P. Holland ◽  
F.A. Weber
Keyword(s):  
Femoral Stem ◽  
Femoral Shaft ◽  
Complete Removal ◽  
Senior Author ◽  
Long Term Results ◽  
Cemented Stem ◽  
Revision Hip Surgery

Complete removal of femoral shaft cement during revision hip surgery is a difficult task prone to complications. If the cement bone interface is intact however, is there a place for its preservation and re-use with a new cemented stem? The results are reported of 51 cement within cement femoral stem revisions carried out between 1984 and 1991 with a minimum of 5 years’ follow-up, and a mean of 7.8 years. Excluding patients lost or deceased, 39 hips in 38 patients were reviewed clinically and radiologically. Eighty-two percent of these were still functioning in situ, 72% were excellent or good using the HSS scoring system and 97% had no radiological evidence of loosening. Femoral stem failure due to aseptic loosening occurred in 4 cases (10%) between 4 and 12 years after revision. Comparing this series to a previous revision hip series by the senior author, there appears to be no deterioration in long term results using this technique, and a better long term radiological outcome.

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