Hematoma expansion unrelated to rebleeding in ruptured anterior cerebral artery aneurysms treated by early endovascular embolization

Background: Whether hematoma expansion after aneurysmal rupture is always a sign of rerupture remains unclear. Hence, the present study aimed to assess the incidence and risk factors of hematoma expansion unrelated to aneurysmal rerupture after endovascular embolization for ruptured cerebral aneurysms. Methods: We included patients who underwent endovascular embolization for ruptured cerebral aneurysms within 48 h after onset at our institution between January 2009 and February 2014. The medical records of 70 consecutive patients were reviewed and analyzed retrospectively. Results: Hematoma expansion unrelated to aneurysmal rerupture occurred in 7 (10%) of 70 patients. Interestingly, four of seven patients had distal anterior cerebral artery (ACA) aneurysms. The interval from onset to aneurysm coiling was shorter in patients with hematoma expansion than in those without (P = 0.040). Conclusion: Early embolization of ruptured ACA aneurysms might increase the risk of hematoma expansion unrelated to aneurysmal rerupture because the procedures were conducted under systemic anticoagulation. It would be better to refer the patient for direct clipping if the patient has a distal ACA aneurysm with parenchymal hematoma at interhemispheric fissure. Delayed coil embolization, which means around 12–18 h delayed, might be another option for ruptured distal ACA aneurysms to prevent hematoma expansion.

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In Situ Side-to-Side Pericallosal-Pericallosal Artery and Callosomarginal-Callosomarginal Artery Bypasses for Complex Distal Anterior Cerebral Artery Aneurysms: A Technical Note

Operative Neurosurgery ◽

10.1093/ons/opaa236 ◽

2020 ◽

Vol 19 (5) ◽

pp. E487-E495

Author(s):

Francesco Acerbi ◽

Ignazio G Vetrano ◽

Jacopo Falco ◽

Andrea Gioppo ◽

Andrea Ciuffi ◽

...

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Clinical Status ◽

Endovascular Embolization ◽

Technical Note ◽

Neurological Deficits ◽

Complex Aneurysms ◽

Innovative Solution ◽

Interhemispheric Fissure ◽

Distal Anterior Cerebral Artery

Abstract BACKGROUND Despite surgical and endovascular technical improvements over the last decades, the treatment of complex aneurysms of the distal anterior cerebral artery (ACA) is very challenging for both vascular neurosurgeons and interventional neuroradiologists. Furthermore, the interpersonal anatomic variability requires, most of the time, a tailored planning. OBJECTIVE To describe a novel technique of bypasses in the territory of ACA to protect the brain territory distal to the aneurysm. METHODS A 53-yr-old male with a large complex fusiform aneurysm of the left distal A2 segment of the ACA, involving the origin of the callosomarginal and pericallosal arteries, was judged not suitable for a single procedure (endovascular or neurosurgical). Two side-to-side bypasses were performed in a single surgery to connect the pericallosal and callosomarginal arteries of both sides, distally to the aneurysm. Subsequently, an endovascular embolization of the aneurysm was achieved with coils. RESULTS The patency of the microanastomoses, performed in the anterior interhemispheric fissure, was positively evaluated intraoperatively with indocyanine green and fluorescein videoangiography. The aneurysm sac, together with proximal A2 segment, was completely occluded with platinum coils. At the last follow-up, computed tomography angiography confirmed the patency of both bypasses, without any sign of aneurysm recanalization. The patients never complained of any focal neurological deficits or worsening of clinical status. CONCLUSION We present an elegant and innovative solution to completely protect the distal ACA territory in cases of complex aneurysm involving the origin of both callosomarginal and pericallosal arteries.

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Saccular aneurysms of the distal anterior cerebral artery

Journal of Neurosurgery ◽

10.3171/jns.1974.40.2.0218 ◽

1974 ◽

Vol 40 (2) ◽

pp. 218-223 ◽

Cited By ~ 94

Author(s):

M. Gazi Yaşargil ◽

L. Philip Carter

Keyword(s):

Cerebral Artery ◽

Subarachnoid Space ◽

Operative Mortality ◽

Anterior Cerebral Artery ◽

Operative Morbidity ◽

Content Type ◽

Interhemispheric Fissure ◽

Distal Anterior Cerebral Artery ◽

Fine Print ◽

Saccular Aneurysms

✓ A series of 13 patients with saccular aneurysms of the distal anterior cerebral artery, operated on by the same surgeon with microtechniques, is reviewed. The incidence of aneurysms in this location was 3.4%, the median age of the patients 44 years, and the median time from most recent hemorrhage to surgery 13 days. There were five cases of multiple aneurysms. No operative mortality occurred; the operative morbidity was 15%. Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.

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Right Orbitozygomatic Craniotomy for Clip Wrapping of an A2 Fusiform Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz222 ◽

2019 ◽

Vol 17 (4) ◽

pp. E155-E156

Author(s):

Benjamin K Hendricks ◽

Robert F Spetzler

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Video Recording ◽

Fusiform Aneurysm ◽

Anterior Circulation ◽

Institutional Review ◽

Aneurysmal Dilation ◽

Interhemispheric Fissure ◽

Flow Through ◽

Distal Anterior Cerebral Artery

Abstract Distal anterior cerebral artery aneurysms often rupture at a small size and are associated with overall higher operative morbidity relative to other anterior circulation aneurysms. This patient had an incidentally identified anterior cerebral artery proximal A2 segment fusiform aneurysm that did not respond to endovascular treatment and required open surgical management. The fusiform dilation was mobilized and isolated circumferentially within the interhemispheric fissure, and a Gore-Tex clip-wrapping was planned. A permanent clip was applied along the aneurysmal dilation parallel to the vessel directly prior to completing the wrapping to attempt to establish native flow dynamics through the aneurysmal segment. The clip-wrapping was then completed, and intraoperative indocyanine green fluoroscopy demonstrated good distal flow through the aneurysmal segment. The patient gave informed consent for surgery and video recording. The institutional review board approval was deemed unnecessary. Used with permission from the Barrow Neurological Institute, Phoenix, Arizona.

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Interhemispheric approach with callosal resection for distal anterior cerebral artery aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1992.77.3.0481 ◽

1992 ◽

Vol 77 (3) ◽

pp. 481-483 ◽

Cited By ~ 23

Author(s):

Vincent C. Traynelis ◽

Ralph O. Dunker

Keyword(s):

Corpus Callosum ◽

Cerebral Artery ◽

Early Identification ◽

Anterior Cerebral Artery ◽

Feeding Artery ◽

Content Type ◽

Interhemispheric Approach ◽

Interhemispheric Fissure ◽

Distal Anterior Cerebral Artery ◽

Fine Print

✓ Distal anterior cerebral artery aneurysms are commonly found near the genu of the corpus callosum. While these aneurysms may be surgically obliterated through a variety of approaches, exposure via the interhemispheric fissure is used by many surgeons. Early identification of the afferent artery may be difficult with this approach, however, particularly if the aneurysm lies just beneath the genu of the corpus callosum. The authors have modified the interhemispheric approach to distal anterior cerebral artery aneurysms by electively exposing the feeding artery through a small anterior callosotomy. While this maneuver is not necessary for all distal anterior cerebral artery aneurysms, it can greatly enhance exposure in the region just below the genu of the corpus callosum. Experience with this technique in five patients is reported. In all cases, the limited anterior callosotomy enhanced surgical exposure. No morbidity could be attributed to the callosotomy in any patient. It is concluded that, when the interhemispheric approach is used, anterior callosotomy improves exposure of the region just below the genu of the corpus callosum and may be a useful maneuver when treating distal anterior cerebral artery aneurysms.

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Distal Anterior Cerebral Artery Aneurysms: Advantages of Bifrontal Basal Anterior Interhemispheric Approach Over Unilateral Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336206 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Rajesh Chhabra ◽

Sunil Gupta ◽

Sandeep Mohindra ◽

N. Khandelwal

Keyword(s):

Cerebral Artery ◽

Anterior Cerebral Artery ◽

Unilateral Approach ◽

Interhemispheric Approach ◽

Anterior Interhemispheric Approach ◽

Distal Anterior Cerebral Artery

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Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

Journal of Neurosurgery ◽

10.3171/jns.1991.74.1.0133 ◽

1991 ◽

Vol 74 (1) ◽

pp. 133-135 ◽

Cited By ~ 5

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.

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