Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

Moon, Hyung S.; Kim, Tae Sun; Joo, Sung‐Pil

doi:10.3340/jkns.2012.52.5.501

Cited by 16 publications

(2 citation statements)

References 7 publications

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“…In 2012, Moon et al reported a case of SA from the A2-A3 segment of the anterior cerebral artery. SA resection and ipsilateral-to-contralateral A3 revascularization were performed, and a favorable outcome was achieved at the 3-month follow-up 41 . In 2015, Pavesi et al reported a case of MCA SA in which preoperative coiling embolization was performed to reduce blood flow to the SA.…”

Section: Treatmentmentioning

confidence: 99%

Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

Guo

et al. 2016

Int. J. Med. Sci.

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An intracranial serpentine aneurysm (SA) is a clinically rare entity, and very few multi-case studies on SA have been published. The present study reviewed the relevant literature available on PubMed. The studied information included the formation mechanism and natural history of SA as well as its clinical manifestation, imaging characteristics, and current treatments. After reviewing the literature, we conclude that intracranial SA can be managed surgically and by endovascular embolization, but the degree of blood flow in normal brain tissue distal to the SA must be evaluated. A balloon occlusion test (BOT) or cross compression test is recommended for this evaluation. If the collateral circulation is sufficiently compensatory, direct excision or embolization can be performed. However, if the compensatory collateral circulation is poor, a bypass surgery is necessary. Satisfactory results can be achieved in the majority of SA patients after treatment. However, the size of the aneurysm may increase in some patients after endovascular treatment. Special attention should be paid to cases exhibiting a significant mass effect to avoid subsequent SA excision due to an intolerable mass effect. Satisfactory results can be achieved with careful treatment of SA.

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Section: Treatmentmentioning

confidence: 99%

Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

Guo

et al. 2016

Int. J. Med. Sci.

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“…The ACA joined to its contralateral ACA with a side-to-side anastomosis, whether at the rostrum, genu, or body, was the most widely used ACA bypass revascularizing the distal ACA territory with left-to-right flow. 3,6,8,20,22,25 Reanastomosis was the least common IC-IC reconstructive technique, 23,31 which may reflect the difficulty in bringing together ends of artery that have little redundancy and can be difficult to reapproximate after aneurysm excision. Reimplantation is a versatile technique, particularly when efferent arteries parallel uninvolved arteries on the contralateral side and might serve as donors (left-to-right bypass flow).…”

Section: The Gamut Of Aca Bypassesmentioning

confidence: 99%

Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options

Abla¹,

Lawton²

2014

JNS

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A neurysms that are too complex for conventional clipping or endovascular coiling often require bypass as part of a strategy that first revascularizes territories distal to the aneurysm and then occludes the aneurysm without risk of ischemic complications. This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms and has been applied with some success. Most aneurysms of the anterior cerebral artery (ACA) are amenable to conventional clipping or endovascular coiling, even when they are complex, and rarely require bypass surgery. In an experience with 82 patients with complex aneurysms, ACA bypasses were performed least of all. Department of Neurological Surgery, University of California, San Francisco, CaliforniaObject. The authors describe their experience with intracranial-to-intracranial (IC-IC) bypasses for complex anterior cerebral artery (ACA) aneurysms with giant size, dolichoectatic morphology, or intraluminal thrombus; they determine how others have addressed the limitations of ACA bypass; and they discuss clinical indications and microsurgical technique.Methods. A consecutive, single-surgeon experience with ACA aneurysms and bypasses over a 16-year period was retrospectively reviewed. Bypasses for ACA aneurysms reported in the literature were also reviewed.Results. Ten patients had aneurysms that were treated with ACA bypass as part of their surgical intervention. Four patients presented with subarachnoid hemorrhage and 3 patients with mass effect symptoms from giant aneurysms; 1 patient with bacterial endocarditis had a mycotic aneurysm, and 1 patient's meningioma resection was complicated by an iatrogenic pseudoaneurysm. One patient had his aneurysm discovered incidentally. There were 2 precommunicating aneurysms (A 1 segment of the ACA), 5 communicating aneurysms (ACoA), and 3 postcommunicating (A 2 -A 3 segments of the ACA). In situ bypasses were used in 4 patients (A 3 -A 3 bypass), interposition bypasses in 4 patients, reimplantation in 1 patient (pericallosal artery-to-callosomarginal artery), and reanastomosis in 1 patient (pericallosal artery). Complete aneurysm obliteration was demonstrated in 8 patients, and bypass patency was demonstrated in 8 patients. One bypass thrombosed, but 4 years later. There were no operative deaths, and permanent neurological morbidity was observed in 2 patients. At last follow-up, 8 patients (80%) were improved or unchanged. In a review of the 29 relevant reports, the A 3 -A 3 in situ bypass was used most commonly, extracranial (EC)-IC interpositional bypasses were the second most common, and reanastomosis and reimplantation were used the least.Conclusions. Anterior cerebral artery aneurysms requiring bypass are rare and can be revascularized in a variety of ways. Anterior cerebral artery aneurysms, more than any other aneurysms, require a thorough survey of patientspecific anatomy and microsurgical options before deciding on an individualized management strategy. The authors' experience demonstrates a preference for IC-IC reconstr...

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Rescue bypass for the treatment of pseudoaneurysm on the distal anterior cerebral artery: a case report of vertical side-to-side anastomosis of the distal callosomarginal artery-pericallosal artery

et al. 2017

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Pseudoaneurysm on the distal anterior cerebral artery (ACA) is rare but potentially fatal. It usually cannot be treated with typical treatment modalities. A 47-year-old female patient was diagnosed with a ruptured aneurysm on the pericallosal artery (PerA). During surgical exploration, it was found to be a pseudoaneurysm and could not be treated with clipping. We performed surgical trapping of the involved segment of the proximal PerA followed by side-to-side anastomosis between the ipsilateral PerA and the callosomarginal artery. The patient recovered without any neurologic deficit. This new method of anastomosis could be an alternative option.

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Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

Cited by 16 publications

References 7 publications

Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

Study and Therapeutic Progress on Intracranial Serpentine Aneurysms

Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options

Rescue bypass for the treatment of pseudoaneurysm on the distal anterior cerebral artery: a case report of vertical side-to-side anastomosis of the distal callosomarginal artery-pericallosal artery

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