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

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.

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Endovascular flow diversion for treatment of anterior communicating artery region cerebral aneurysms: a single-center cohort of 50 cases

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012946 ◽

2017 ◽

Vol 9 (7) ◽

pp. 679-685 ◽

Cited By ~ 37

Author(s):

Geoffrey P Colby ◽

Matthew T Bender ◽

Li-Mei Lin ◽

Narlin Beaty ◽

Judy Huang ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Good Alternative ◽

Flow Diversion ◽

Definitive Treatment ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

Microsurgical Clipping ◽

Alternative Treatment Option ◽

Procedural Success

BackgroundFlow diversion represents a novel but definitive treatment for recurrent and difficult-to-coil aneurysms of the anterior communicating artery (ACoA) region, of which reports are limited.ObjectiveTo determine the effectiveness of the Pipeline embolization device (PED) in treating aneurysms in the ACoA region.MethodsWe retrospectively reviewed an IRB-approved database of patients with an aneurysm at a single institution for patients with ACoA or A1–A2 aneurysms treated with PED. Data analyzed included demographics, aneurysm characteristics, procedural details, follow-up results, and outcomes.ResultsA total of 50 procedures were performed on 41 patients, including seven patients who underwent bilateral ‘H-pipe’ PED placement. The average age was 56 years and 46% of the patients were female. The average aneurysm size was 4.5 mm, and two large (>10 mm) aneurysms were treated. The vessel of origin was either the ACoA (26 aneurysms, 63%) or the A1–A2 junction (15 aneurysms, 37%). Eighteen patients (44%) had prior subarachnoid hemorrhage and 20 had previously been treated either with clipping (6 aneurysms, 15%) or coiling (14 aneurysms, 34%). Procedural success was achieved in 48/50 cases (96%) and two cases were aborted. Coils were deployed adjunctively in two cases (4%). Procedural outcomes included no deaths, one major ischemic stroke (2%), and two patients with intracranial hemorrhage (4%). Complete aneurysm occlusion was achieved in 81% of patients at 6 months and 85% of patients at last follow-up digital subtraction angiography.ConclusionsThe PED can be used safely and effectively in the treatment of aneurysms of the ACoA region. This represents a good alternative treatment option to microsurgical clipping and endovascular coiling.

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Microsurgical clipping of the anterior circulation aneurysms

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i4.1001 ◽

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.

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Definitive Treatment With Microsurgical Clipping After Recurrence and Rerupture of Coiled Anterior Cerebral Artery Aneurysms

Operative Neurosurgery ◽

10.1093/ons/opaa103 ◽

2020 ◽

Vol 19 (4) ◽

pp. 393-402

Author(s):

Daniel M S Raper ◽

Caleb Rutledge ◽

Ethan A Winkler ◽

Adib A Abla

Keyword(s):

Cerebral Artery ◽

Intracranial Aneurysms ◽

Anterior Cerebral Artery ◽

Significant Risk ◽

Subsequent Treatment ◽

Definitive Treatment ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

Recent Experience ◽

Microsurgical Clipping

Abstract BACKGROUND The extent of obliteration of ruptured intracranial aneurysms treated with coil embolization has been correlated with the risk of rerupture. However, many practitioners consider that a small neck remnant is unlikely to result in significant risk after coiling. OBJECTIVE To report our recent experience with ruptured anterior cerebral artery aneurysms treated with endovascular coiling, which recurred or reruptured, requiring microsurgical clipping for subsequent treatment. METHODS Retrospective review of patients with intracranial aneurysms treated at our institution since August 2018. Patient and aneurysm characteristics, initial and subsequent treatment approaches, and outcomes were reviewed. RESULTS Six patients were included. Out of those 6 patients, 5 patients had anterior communicating artery aneurysms, and 1 patient had a pericallosal aneurysm. All initially presented with subarachnoid hemorrhage (SAH) and were treated with coiling. Recurrence occurred at a median of 7.5 mo. In 2 cases, retreatment was initially performed with repeat endovascular coiling, but further recurrence was observed. Rerupture from the residual or recurrent aneurysm occurred in 3 cases. In 2 cases, the aneurysm dome recurred; in 1 case, rerupture occurred from the neck. All 6 patients underwent treatment with microsurgical clipping. Follow-up catheter angiography demonstrated a complete occlusion of the aneurysm in all cases with the preservation of the parent vessel. CONCLUSION Anterior cerebral artery aneurysms may recur after endovascular treatment, and even small neck remnants present a risk of rerupture after an initial SAH. Complete treatment requires a complete exclusion of the aneurysm from the circulation. Even in cases that have been previously coiled, microsurgical clipping can represent a safe and effective treatment option.

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

Neurosurgery Open ◽

10.1093/neuopn/okaa028 ◽

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.

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Microsurgery for Multiple Intracranial Aneurysms

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v32i1.1944 ◽

2021 ◽

Vol 32 (1) ◽

pp. 81-88

Author(s):

Laís Miotta Simoncello ◽

Hsuan Hua Chen ◽

Lucas do Amaral Genta Mansano ◽

Manauela Iglesias Borges ◽

Sophia Fuentes Rosa ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Single Stage ◽

Anterior Communicating Artery ◽

Multiple Intracranial Aneurysms ◽

Complex Aneurysms ◽

Microsurgical Clipping ◽

Microsurgical Approach ◽

The Right ◽

Age Range

Background: A total of 23 patients with 52 aneurysms were surgically treated in single surgery at a Neurosurgical Service of the Health Service of the State of São Paulo from 2009 to 2011. Method: Retrospective analysis of patients undergoing clipping of two or more cerebral aneurysms in a single stage, from January 2007 to July 2012. Results: Twenty-nine patients underwent two or more clipping cerebral aneurysms in a single surgery – 28 with a single craniotomy and one through two craniotomies. Of these, 20, 7, 1 and 1 were submitted to the clipping of 2, 3, 4 and 5 cerebral aneurysms, respectively. Five were male and 24 were female, and the age range was 40 to 66-years-old. Eight left craniotomies were performed to approach 17 lateralized brain aneurysms to the left and five to the right, as well as three anterior communicating complex aneurysms. Twelve craniotomies were performed on the right to approach 23 intracranial aneurysms lateralized to the right and six on the left, as well as 15 anterior communicating artery complex aneurysms and 1 on the basilar artery. Of the 29 patients, 28 evolved with 1-3 pts and only one with 4-5 pts on the Rankin scale, six months after surgery. Conclusion: We advocate microsurgical approach for most of the cases of multiple intracranial aneurysms aiming the microsurgical clipping of all intracranial aneurysms if feasible through a single stage and a single craniotomy.

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Early Intracranial Aneurysm Recurrence after Microsurgical Clip Ligation: Case Report and Review of the Literature

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1676454 ◽

2018 ◽

Vol 79 (04) ◽

pp. e93-e97

Author(s):

Serge Marbacher ◽

Alexander Spiessberger ◽

Michael Diepers ◽

Luca Remonda ◽

Javier Fandino

Keyword(s):

Case Report ◽

Intracranial Aneurysm ◽

Latency Period ◽

Early Recurrence ◽

Biological Behavior ◽

Definitive Treatment ◽

Anterior Communicating Artery ◽

Pubmed Database ◽

Early Imaging

AbstractMicrosurgical clip ligation is considered a definitive treatment for intracranial aneurysms (IAs), resulting in low rates of local recurrence that range from 0.2 to 0.5% and a latency period that averages about a decade. Our case report describes an early asymptomatic recurrence (i.e., without sentinel headache or seizure) less than 1 year after this 20-year-old woman underwent clip ligation of a ruptured anterior communicating artery (AComA) aneurysm. At recurrence, the patient underwent coiling of the regrowth; follow-up imaging at 6 and 18 months demonstrated complete IA occlusion. To review the putative risk factors of this rare phenomenon, the authors searched the PubMed database using the keywords “intracranial aneurysm,” “recurrence,” and “clipping” in various combinations. In the seven cases identified, all occurred in initially ruptured IA, which was often at the AComA, and six of seven patients were younger than 50 years old. Although most IA remnants grow slowly, early recurrence may represent a more aggressive biological behavior that warrants special attention in younger patients, positive rupture status, and unintended remnant of any size. In such a constellation, early imaging follow-up within the first 6 months may be warranted to rule out early IA recurrence

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MICROSURGICAL CLIPPING ANTERIOR COMMUNICATING ARTERY ANEURYSM AFTER ENDOVASCULAR COILING. CASE REPORT.

Современные проблемы науки и образования (Modern Problems of Science and Education) ◽

10.17513/spno.30693 ◽

2021 ◽

pp. 1-1

Author(s):

V.V Bobinov ◽

A.E. Petrov ◽

L.V. Rozhchenko ◽

S.A. Goroschenko ◽

E.G. Kolomin

Keyword(s):

Case Report ◽

Artery Aneurysm ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

Anterior Communicating Artery Aneurysm ◽

Microsurgical Clipping

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Rate of Recanalization and Safety of Endovascular Embolization of Intracranial Saccular Aneurysms Framed with GDC 360 Coils

Interventional Neuroradiology ◽

10.1177/159101990801400405 ◽

2008 ◽

Vol 14 (4) ◽

pp. 397-401 ◽

Cited By ~ 2

Author(s):

R. Ortiz ◽

J. Song ◽

Y. Niimi ◽

A. Berenstein

Keyword(s):

Subarachnoid Hemorrhage ◽

Coil Embolization ◽

Thrombus Formation ◽

Case Series ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Saccular Aneurysms

Coil compaction and recanalization of cerebral aneurysms treated with coil embolization continue to be of great concern, especially in patients that presented with subarachnoid hemorrhage. The incidence of recanalization reported by previous studies ranges from 12 to 40 percent in experienced centers. We reviewed the incidence of recanalization requiring retreatment in patients treated with GDC 360 framing coils. A retrospective review of every patient who underwent coil embolization with GDC 360 coils for saccular aneurysms at our institution from December 2004 to March 2008 was performed. We studied the patients' demographics, clinical presentation, aneurysm size and configuration, type of coils used to embolize the aneurysm, the percentage of coils that were GDC 360 in any given aneurysm, the need for remodeling techniques like stent and/or balloon for embolization, immediate complications, cases in which we were unable to frame with the GDC 360 coil, and rate of recanalization on follow-up. A total of 110 patients (33 men, 77 women) and 114 aneurysms were treated with GDC 360 coils. Ninety-eight aneurysms were framed with the GDC 360 coils. There were two patients in whom the initial GDC 360 coil intended for framing had to be pulled out and exchanged for another type of coil. There were five procedure related complications (4.4%). Four patients required intra-arterial abciximab due to thrombus formation. One patient that presented with a grade III subarachnoid hemorrhage had aneurysm rupture while the coil was being advanced. A total of 50 patients (15 men and 35 women) underwent follow-up femoral cerebral angiograms at least six months after coiling (mean follow-up was 15 months). Forty-four of the patients with follow-up had the GDC 360 coil used as a framing coil. Three patients (6%) required retreatment due to recanalization. Every patient with recanalization requiring treatment had aneurysms of the anterior communicating complex that presented with subarachnoid hemorrhage. The rate of recanalization of cerebral aneurysms embolized with GDC 360 framing coils was lower in our case series compared to the existing literature reports. Patients with aneurysms of the anterior communicating artery were at increased incidence of recanalization in our patient cohort.

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