Surgical Treatment of a Large Fusiform Distal Anterior Cerebral Artery Aneurysm With In Situ End-to-Side A3—A3 Bypass Graft and Aneurysm Trapping

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E587-E591 ◽  
Author(s):  
Gavin P. Dunn ◽  
Jason L. Gerrard ◽  
David H. Jho ◽  
Christopher S. Ogilvy
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Bypass Graft ◽  
The Body ◽  
Parent Artery ◽  
Vessel Flow ◽  
Distal Anterior Cerebral Artery ◽  
Distal Vessel

Abstract BACKGROUND AND IMPORTANCE: Large fusiform aneurysms of the distal anterior cerebral territory are extremely rare and can be particularly challenging to treat. The circumferential pathology of fusiform lesions renders stand-alone clip or coil ablation unsatisfactory, and the deep, narrow corridor augments the difficulty of surgical approaches. In this setting, bypass procedures may be used to both treat the aneurysm definitively and preserve distal parent artery flow. We report a rare case of a large fusiform A3 aneurysm treated with trapping and concomitant end-to-side A3:A3 bypass. CLINICAL PRESENTATION: A 52-year-old man was evaluated after losing consciousness and experiencing a fall. A noncontrast computed tomography scan revealed a focal area of hemorrhage above the body of the corpus callosum, and computed tomography angiography showed a fusiform aneurysm of the right A3 artery. To treat the aneurysm definitively and preserve distal vessel flow, the patient was taken to surgery in anticipation of aneurysm ablation and cerebrovascular bypass. A large, fusiform right A3 aneurysm was identified. Intraoperative flow measurement demonstrated poor collateral circulation. The aneurysm was trapped with clips, and a right-to-left A3:A3 end-to-side in situ bypass was performed. Aneurysm occlusion and preserved distal vessel flow were confirmed with intraoperative angiography. CONCLUSION: Large fusiform aneurysms in the distal anterior cerebral artery region are rare, and the anatomy of these lesions and their vascular location render stand-alone surgical management technically challenging. End-to-side A3:A3 bypass combined with aneurysm trapping represents a feasible treatment strategy for lesions in this location.

Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature

2020 ◽  
Vol 13 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Federico Cagnazzo ◽  
Andrea Fanti ◽  
Pierre-Henri Lefevre ◽  
Imad Derraz ◽  
Cyril Dargazanli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stent Thrombosis ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Univariate Analysis ◽  
Flow Diversion ◽  
Parent Artery ◽  
Review Of The Literature ◽  
Significant Difference ◽  
Distal Anterior Cerebral Artery

BackgroundEvidence about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms is scant. To provide further insight into flow diversion for aneurysms located at, or distal to, the A2 segment.MethodsConsecutive patients receiving flow diversion for DACA aneurysms were retrieved from our prospective database (2014–2020). A PRISMA guidelines-based systematic review of the literature was performed. Aneurysm occlusion (O’Kelly–Marotta=OKM) and clinical outcomes were evaluated.ResultsTwenty-three patients and 25 unruptured saccular DACA aneurysms treated with flow diversion were included. Aneurysm size ranged from 2 mm to 9 mm (mean size 4.5 mm, SD ±1.6). Mean parent artery diameter was 1.8 mm (range, 1.2–3 mm, SD ±0.39). Successful stent deployment was achieved in all cases. Angiographic adequate occlusion (OKM C–D) at follow-up (14 months) was 79% (19/24 available aneurysms). No cases of aneurysm rupture or retreatment were reported. Univariate analysis showed a significant difference in diameter among aneurysms with adequate (4 mm) vs incomplete occlusion (7 mm) (P=0.006).There was one transient perioperative in-stent thrombosis, and three major events causing neurological morbidity: two stent thromboses (one attributable to the non-adherence of the patient to the antiplatelet therapy); and one acute occlusion of a covered calloso-marginal artery.Results from systematic review (12 studies and 107 A2–A3 aneurysms) showed 78.6% (95% CI=70–86) adequate occlusion, 7.5% (95% CI=3.6–14) complications, and 2.8%, (3/107, 95% CI=0.6–8.2) morbidity.ConclusionsFlow diversion among DACA aneurysms is effective, especially among small lesions. However, potential morbidity related to in-stent thrombosis and covered side branches should be considered when planning this strategy.

Microsurgical Treatment of Distal Anterior Cerebral Artery Aneurysms: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E16-E16
Author(s):  
Vijay Agarwal ◽  
Daniel L Barrow
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Vascular Anomaly ◽  
Vertical Position ◽  
Parent Artery ◽  
Developmental Venous Anomaly ◽  
Intraoperative Angiography ◽  
The Right ◽  
Distal Anterior Cerebral Artery

Abstract Selecting appropriate patient position for surgery must take into consideration a variety of factors. For an interhemispheric approach to distal anterior cerebral artery (DACA) aneurysms, the patient may be positioned with the head either horizontal or vertical with respect to the floor. We preferentially place the patient in the supine position with the shoulder elevated and the head turned parallel to the floor with the side of the approach down and the vertex tilted 45° up. In this way, gravity is utilized to allow the right frontal lobe to fall away from the falx, eliminating the need for retraction. To demonstrate the importance of individualizing the choice of position to each patient, we present here 2 illustrative cases of DACA aneurysms in which different positioning was selected. One patient presented with a 7-mm bilobed pericallosal artery aneurysm; the aneurysm was approached with the head horizontal with respect to the floor. The second patient had a 3-mm DACA aneurysm and a right frontal proliferative angiopathy and developmental venous anomaly with evidence of prior hemorrhage. Due to the vascular anomaly, we positioned the head in a vertical position for surgery to clip the aneurysm, which was thought to be the source of hemorrhage. The videos illustrate the approach to DACA aneurysms, which typically exposes the aneurysm before complete exposure of the proximal parent artery is obtained. In one case, the use of both frameless guidance and intraoperative angiography was useful in identifying a small previously ruptured aneurysm.  All appropriate patient consents were obtained for this submission.  Video and Figures (0:57-1:16 and 6:30-6:37), © 2017 Department of Neurosurgery, Emory University. Used with permission.

Ruptured Pericallosal Artery Aneurysm

2019 ◽  
pp. 97-108
Author(s):  
Kristine Ravina ◽  
Jonathan J. Russin ◽  
Steven L. Giannotta
Keyword(s):  
Surgical Technique ◽  
Surgical Management ◽  
Cerebral Artery ◽  
Postoperative Care ◽  
Preoperative Planning ◽  
Anterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Key Points ◽  
Distal Anterior Cerebral Artery

Abstract: Distal anterior cerebral artery aneurysms are rare, tend to rupture at a smaller size than other aneurysms, and are associated with unique challenges posed by their anatomic location. These aneurysms tend to be broad-necked, and this morphology, combined with the relatively small size of the parent artery, tends to favor open surgical management. The interhemispheric approach, typically required for the open surgical management of these aneurysms, can yield favorable outcomes, comparable to those of other intracranial location aneurysms. The presented case of a patient with a ruptured A3 segment aneurysm illustrates key points in diagnosis, preoperative planning, management, surgical technique, and postoperative care.

Surgical treatment of distal anterior cerebral artery aneurysms

1979 ◽  
Vol 50 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Takashi Yoshimoto ◽  
Keita Uchida ◽  
Jiro Suzuki
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Content Type ◽  
Aneurysm Neck ◽  
Horizontal Portion ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

✓ Between June, 1961, and September, 1975, the authors operated on 60 patients with aneurysms of the anterior cerebral artery distal to the anterior communicating artery (ACoA) by a direct intracranial approach. It is of utmost importance in the treatment of aneurysms to have control of the parent artery of the aneurysm. This makes it easier and safer to approach the aneurysm neck and to handle possible premature aneurysm rupture. The aneurysms were classified into two types, ascending and horizontal. Aneurysms arising from the origin of the ACoA and including the entire portion of the knee of the corpus callosum were designated as aneurysms of the ascending portion, whereas aneurysms beyond the genu were designated as aneurysms of the horizontal portion. For aneurysms of the ascending portion, bifrontal craniotomy was considered the safest approach. For aneurysms of the horizontal portion, a small parasagittal craniotomy was determined to be sufficient.

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.

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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