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de Divitiis O, Di Somma A, Somma T, Cavallo LM, Marseglia M, Briganti F, Cappabianca P. Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature. J Med Case Rep 2015; 9:117. [PMID: 26001929 PMCID: PMC4490611 DOI: 10.1186/s13256-015-0604-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/28/2015] [Indexed: 12/19/2022] Open
Abstract
Introduction Dissecting aneurysms of the cerebral arteries are uncommon vascular malformations. Neurosurgical treatment remains critical in the management of patients with such vascular pathologies. Case presentation A 20-year-old Caucasian woman presented with a sudden onset of severe headache and loss of consciousness. Computed tomography revealed diffuse subarachnoid hemorrhage, while a computed tomography disclosed a dissecting aneurysm of the precommunicating segment of the right anterior cerebral artery. Cerebral carotid angiography confirmed the presence of the dissecting aneurysm. Due to the peculiar anatomic configuration, endovascular treatment was excluded and surgery was selected. As the left circulation perfused both postcommunicating segments of the anterior cerebral artery and the distal right precommunicating segment was hypoplastic, direct clipping of the right precommunicating segment, close to its origin from the internal carotid artery, was carried out. She recovered after surgery and a late angiography showed the correct positioning of the clip, with regular perfusion of both right and left postcommunicating segments. Conclusions The management of dissecting aneurysms of the cerebral arteries is still controversial. With this report we highlight a possible neurosurgical option among therapeutic strategies for these uncommon vascular lesions.
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Affiliation(s)
- Oreste de Divitiis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Alberto Di Somma
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Teresa Somma
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Luigi Maria Cavallo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, Unit of Interventional Neuroradiology, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, Unit of Interventional Neuroradiology, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | - Paolo Cappabianca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
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