Surgical Strategy for Complex Anterior Cerebral Artery Aneurysms: Retrospective Case Series and Literature Review

Ota, Nakao; Miyama, Masataka; Matsumoto, Takashi; Miyazaki, Takanori; Matsukawa, Hidetoshi; Yanagisawa, Takeshi; Suzuki, Go; Maeda, Shiro; Noda, Kosumo; Tsuboi, Toshiyuki; Takeda, Ryo; Kamiyama, Hiroyasu; Tokuda, Sadahisa

doi:10.1016/j.wneu.2015.10.079

Cited by 33 publications

(7 citation statements)

References 37 publications

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“…Revascularization techniques involving bypass surgery are typical treatment options for these aneurysms [ 1 , 5 , 6 ]. Bypass techniques can be divided into two large fields: extracranial-intracranial (EC-IC) and intracranial-intracranial (IC-IC) bypass.…”

Section: Discussionmentioning

confidence: 99%

Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

Kim

Lee

Choi

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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The treatment of complicated anterior cerebral artery aneurysms remains challenging.Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-toside A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.

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Section: Discussionmentioning

confidence: 99%

Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

Kim

Lee

Choi

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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“…It can achieve anastomosis of the endothelium edges of vessels, and reduce the contact between the thread and the blood in the lumen of the vessel. 33 Second, tension problems between donor and recipient vessels, sutures may tear the arterial wall if they are sewn together under tension, or the artery may kink and become occluded. Last, the equitable distribution of stitches is important.…”

Section: Discussionmentioning

confidence: 99%

Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

Zhao

Tong

2022

Journal of Craniofacial Surgery

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Background: For the complex posterior inferior cerebellar artery (PICA) aneurysms, standard microsurgical or endovascular technical options were not feasible. To determine the efficacy and outcomes of bypass surgery for complex PICA aneurysms, the authors herein review our recent surgical experience for complex PICA aneurysms. Methods: The authors retrospectively reviewed our experience of extracranial-intracranial bypass and intracranial-intracranial bypass surgery in treatment of proximal and distal complex PICA aneurysms at our institution from 2016 to 2020. Results: Twelve patients harboring 12 complex PICA aneurysms received bypass surgery at our institution. Seven (58.3%) patients with proximal PICA aneurysms underwent extracranial-intracranial bypass. Five (41.7%) patients with distal PICA aneurysms accepted intracranial-intracranial bypass. The postoperative symptom improvement: Of the 6 patients with preoperative hypoperfusion or ischemic of the cerebellar hemisphere, the symptom resolved in 5 patients, improved in 1 patient, of 5 patients with preoperative mass effect, the symptom resolved in 5 patients. During the follow-up period, ten patients had a modified Rankin scale (mRS) score of 0 to 1, and 1 patient had an mRS score of 2. One patient had an mRS score of 3. The long-term graft patency rate was 91.7%. All patients had no recurrence of intracranial aneurysm. Conclusions: Base on the complexity of anatomy structure and the vascular architecture, an individualized strategy was proposed for each patient. The use of different types of bypass procedures (occipital artery-PICA end-to-end bypass, PICA-PICA end-to-end anastomosis, and/or occipital artery graft) can safely and effectively manage these complex PICA aneurysms.

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“…23 Recently, the STA telescope bypass and its variants have been increasingly recognized for managing complex aneurysms of the distal anterior circulation (Table 2, Supplemental Material 2, Supplemental Figure 2, http://links.lww.com/ONS/B64). 12,15,24 A follow-up cadaveric study may be useful to explore whether the parietal branch interposition graft can reach deeper ACA branches with a reasonable distal diameter.…”

Section: Limitations and Caveatsmentioning

confidence: 99%

“…Bypass schematic diagrams of reported variants of the superficial temporal artery (STA) telescope bypass. A, The bypass reported by Ota et al 15…”

Section: Limitations and Caveatsmentioning

confidence: 99%

Anatomic Feasibility of a Superficial Temporal Artery to Distal Anterior Cerebral Artery Bypass With a Parietal Branch Interposition Graft: The Superficial Temporal Artery Telescope Bypass

Gandhi,

Benet,

Tabani

et al. 2024

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Revascularizing the postcommunicating segment of the anterior cerebral artery (ACA) using extracranial donor sites requires long interposition grafts. The superficial temporal artery (STA) is frequently used for extracranial-intracranial ACA revascularization. However, the length of either STA branch is not sufficient to reach the ACA with a proper caliber match, so an interposition graft is required. The aim of this study was to evaluate a bypass that uses the 2 main branches of the STA to reach the A3 (pericallosal) segment of the ACA. METHODS: The frontal and parietal branches of the STA were dissected from 10 cadaveric specimens. The middle internal frontal artery (MIFA) was exposed through an anterior interhemispheric approach. An interposition graft technique was applied using the parietal branch of the STA (pSTA) to connect the frontal branch of the STA (fSTA) with the MIFA. The bypass code is fSTA (E-Ec) pSTA + pSTA (E-Sc) MIFA. Measurements of length and caliber were taken at the anastomotic sites for the distal branches of the STA and the MIFA. RESULTS: The mean (SD) diameter of the MIFA measured 1.4 (0.2) mm, similar to the calibers of the frontal and parietal branches of the STA. The mean (SD) length of the end-to-side STA-MIFA bypass was 145.5 (7.4) mm, and the mean (SD) length of the donor-graft construct measured 204.2 (27.9) mm. This bypass design resulted in a surplus donor graft length of 38%. CONCLUSION: Using the pSTA as an interposition graft proved to be a successful technique for creating an STA-MIFA bypass, yielding excess donor graft length that facilitated an unstrained bypass construct. This approach offers several advantages, including a single skin incision, ample graft length, caliber compatibility, and a straightforward technical execution.

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Surgical Strategy for Complex Anterior Cerebral Artery Aneurysms: Retrospective Case Series and Literature Review

Cited by 33 publications

References 37 publications

Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

Bypass Surgery Management of Complex Proximal and Distal Posterior Inferior Cerebellar Artery Aneurysms

Anatomic Feasibility of a Superficial Temporal Artery to Distal Anterior Cerebral Artery Bypass With a Parietal Branch Interposition Graft: The Superficial Temporal Artery Telescope Bypass

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