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Toader C, Covache-Busuioc RA, Bratu BG, Corlatescu AD, Popa AA, Ciurea AV. Kissing Aneurysms of the Anterior Communicating Artery Treated With Surgical Clipping: A Case Report and Literature Review. Cureus 2024; 16:e60824. [PMID: 38910700 PMCID: PMC11190632 DOI: 10.7759/cureus.60824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Intracranial "kissing" aneurysms are rare vascular conditions described as two anatomically adjacent aneurysms originating from either the same or different arteries, with their walls pressed together. Two-dimensional angiography was formerly considered the gold standard for diagnosis, with the three-dimensional rotational type now offering more insightful details about vascular discrepancies. The treatment of anterior communicating artery (AcoA) "kissing" aneurysms poses significant challenges, with surgical clipping proving difficult due to their deep midline location or the bilateral anterograde arterial supply. However, advancements in endovascular coil embolization, such as dual-volume reconstruction, can assist in diagnosis. This study presents the case of a 50-year-old patient who was diagnosed with "kissing" aneurysms of the AcoA. The patient underwent surgical clipping and showed no pathological follow-up findings. The surgical intervention often provides a more direct and effective approach. This case contributes to the body of knowledge surrounding the management of this complex disease.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, Bucharest, ROU
| | | | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | | | - Andrei Adrian Popa
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Alexandru Vladimir Ciurea
- Department of Neurosurgery, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Neurosurgery, Sanador Clinical Hospital, Bucharest, ROU
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Endovascular Treatment of Intracranial Kissing Aneurysms: Technical Feasibility and Clinical Outcomes. World Neurosurg 2021; 155:e529-e537. [PMID: 34464777 DOI: 10.1016/j.wneu.2021.08.095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Kissing aneurysms are situated on the same artery but have separate points of origin. Open surgical strategies for access from opposing directions may be technically problematic. Recent advances in protective devices and coiling techniques have compelled the present study, aimed at technical aspects and procedural outcomes of coil embolization in this setting. METHODS Data prospectively accruing between May 2001 and May 2020 were systematically reviewed, assessing clinical and morphologic outcomes of coil embolization in 36 patients with 72 kissing aneurysms. RESULTS Lesions most often involved paraclinoid internal carotid artery (n = 22), followed by anterior communicating artery (n = 7). Single-stage coil embolization of both aneurysms took place in nearly all patients (n = 35). Microcatheter tips for selecting paired aneurysms were usually directed opposite to one another (32 of 36, 88.9%), applying protective devices (i.e., balloons or stents) to 1 or both aneurysms in 21 patients (58.3%). Balloons were placed in 9 patients, often when treating first aneurysms and largely for second aneurysms as well (7 of 9, 77.8%). Stents deployed in 14 patients involved first and second aneurysms equally. Two patients required balloon of stent combinations. No procedure-related morbidity or mortality resulted. In follow-up of 68 aneurysms (mean: 40.2 ± 28.1 months) after coiling, 86.8% (59 of 68) showed sustained complete saccular occlusion. CONCLUSIONS Strategies for endovascular treatment of kissing aneurysms rely heavily on characteristics that the paired aneurysms display. Properly conducted single-stage coil embolization is a safe and effective method of treating such lesions.
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Inci S, Karakaya D. Kissing Aneurysms: Radiological and Surgical Difficulties in 30 Operated Cases and a Proposed Classification. World Neurosurg 2021; 155:e83-e94. [PMID: 34384920 DOI: 10.1016/j.wneu.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The first aim of this study is to bring up the radiological and surgical difficulties of kissing aneurysms and to present solutions. The second aim is to develop a classification that can help to predict the difficulties encountered during surgery. METHODS The records of 817 patients who were operated on for aneurysm were reviewed retrospectively to identify kissing aneurysms. The radiological and clinical databases of these patients were evaluated in detail. RESULTS Kissing aneurysms were detected in 30 patients (3.6%). Radiologically correct diagnosis rate of kissing aneurysms was 80% throughout the series. The most common locations were the anterior communicating artery (12 cases, 40%) and the middle cerebral artery (12 cases, 40.0%). The ruptured aneurysm could not be detected preoperatively in 24% of the patients. Intraoperative rupture occurred in 4 patients (13.3%). Accompanying vascular anomaly/variation was seen in 16 patients (53.3%). As detailed in the text, kissing aneurysms were divided into 3 types according to their position with each other on the parent artery from the surgeon's point of view during surgery: type I (proximal/distal), type II (superior/inferior), and type III (right/left). CONCLUSIONS Despite advanced angiographic techniques, even today, kissing aneurysms can be misinterpreted as a single bilobular aneurysm. The ruptured aneurysm may not be detectable preoperatively. These complex aneurysms have a high intraoperative rupture risk. Accompanying vascular anomalies are more common than expected. Clip selection and sequencing are important. Proposed classification helps the surgeon to be aware of intraoperative difficulties that he/she may encounter in advance.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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Current Management of Mirror Distal Anterior Cerebral Artery Aneurysms in Association with Multiple Aneurysms: Case Report with Literature Review. World Neurosurg 2019; 130:324-334. [DOI: 10.1016/j.wneu.2019.07.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
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Fu CY, Chen JL, Liu ZH, Wang PC, Duan CZ, Zhao JN. Kissing aneurysms of the distal anterior cerebral artery: A case report and literature review. Exp Ther Med 2018; 15:3471-3476. [PMID: 29616086 DOI: 10.3892/etm.2018.5854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022] Open
Abstract
Intracranial 'kissing' aneurysms are rare types of multiple aneurysms referring to two adjacent aneurysms arising from identical or different arteries with separate origins and partially adherent walls. The present study reported a 54-year-old female patient, who was identified with a 'kissing' aneurysm in the A3 segment of the bilateral anterior cerebral arteries, as demonstrated by head computed tomography and emergency cerebral digital subtraction angiography analysis. In total, 12 days following the clipping of the aneurysms, the patient was discharged with a Modified Rankin Scale=0 and recovered well with no neurological deficits. Based on previous literature, it was indicated that the majority of patients with 'kissing' aneurysm have a good prognosis and the cure rate is as high as 96.8%. However, the recovery rate may not be that high as the sample size is not large enough to thoroughly demonstrate the complete prognosis of 'kissing' aneurysms.
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Affiliation(s)
- Chuan-Yi Fu
- Department of Neurosurgery, The National Key Clinic Specialty, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, Hainan 570311, P.R. China
| | - Jian-Long Chen
- Department of Neurosurgery, The National Key Clinic Specialty, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, Hainan 570311, P.R. China
| | - Zhao-Hui Liu
- Department of Neurosurgery, The National Key Clinic Specialty, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, Hainan 570311, P.R. China
| | - Peng-Cheng Wang
- Department of Neurosurgery, The National Key Clinic Specialty, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, Hainan 570311, P.R. China
| | - Chuan-Zhi Duan
- Department of Neurosurgery, The National Key Clinic Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Jian-Nong Zhao
- Department of Neurosurgery, The National Key Clinic Specialty, Hainan General Hospital, Hainan Clinical Medicine Research Institution, Haikou, Hainan 570311, P.R. China
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Czapiga B, Kozba-Gosztyla M, Bereza S, Jarmundowicz W. Unusual angiographic images of unruptured, large, kissing middle cerebral artery aneurysms. Acta Neurochir (Wien) 2013. [PMID: 23180168 PMCID: PMC3552363 DOI: 10.1007/s00701-012-1555-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Bogdan Czapiga
- Department of Neurosurgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Marta Kozba-Gosztyla
- Department of Neurosurgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Slawomir Bereza
- Department of Radiology, Wroclaw Medical University, Wroclaw, Poland
| | - Wlodzimierz Jarmundowicz
- Department of Neurosurgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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Mitsuhara T, Sakamoto S, Kiura Y, Kurisu K. Endovascular coil embolization for ruptured kissing aneurysms associated with A1 fenestration. Surg Neurol Int 2011; 2:85. [PMID: 21748037 PMCID: PMC3130439 DOI: 10.4103/2152-7806.82251] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 05/23/2011] [Indexed: 11/06/2022] Open
Abstract
Background: Fenestration of intracranial arteries is a rare anomaly, and is frequently associated with cerebral aneurysms. In this paper, we report rare kissing aneurysms associated with A1 fenestration. Case Description: A 71-year-old woman presented with subarachnoid hemorrhage. Diagnostic digital subtraction angiography revealed two saccular aneurysms at the proximal junction of a fenestration and posterior aspect of the fenestration that appeared to be ‘kissing’ each other. Emergent endovascular coil embolization was performed. Conclusion: Kissing aneurysms associated with fenestration of the horizontal segment in the anterior cerebral artery are rare, and have not been reported. During treatment of such specific types of aneurysms by endovascular treatment, three-dimensional rotational digital subtraction angiography was very useful for deciding the appropriate working angles.
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Affiliation(s)
- Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Choi CY, Han SR, Yee GT, Lee CH. Kissing aneurysms of the distal anterior cerebral artery. J Clin Neurosci 2011; 18:260-2. [DOI: 10.1016/j.jocn.2010.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 04/04/2010] [Indexed: 11/15/2022]
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TAKAHASHI C, KUBO M, OKAMOTO S, MATSUMURA N, HORIE Y, HAYASHI N, KUWAYAMA N, ENDO S. "Kissing" Aneurysms of the Internal Carotid Artery Treated by Coil Embolization -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:653-6. [DOI: 10.2176/nmc.51.653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Michiya KUBO
- Department of Neurosurgery, Saiseikai Toyama Hospital
| | | | | | - Yukio HORIE
- Department of Neurosurgery, Saiseikai Toyama Hospital
| | - Nakamasa HAYASHI
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Naoya KUWAYAMA
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
| | - Shunro ENDO
- Department of Neurosurgery, Faculty of Medicine, University of Toyama
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Objective evaluation of the treatment methods of intracranial aneurysm surgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2010. [PMID: 21125455 DOI: 10.1007/978-3-7091-0356-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
OBJECTIVE this study evaluated the clinical value of craniotomy and intravascular embotherapy in the treatment of intracranial aneurysms. METHODS The clinical data of 126 cases of intracranial aneurysms from July 2008 to July 2009 was analyzed retrospectively, 86 cases of all were clipped and other 40 cases were coiled. RESULTS in 86 cases with craniotomy (according to Hunt-Hess classification, 71 cases belong to grade I-III and 15 cases belong to grade IV-V), 1 case died, 3 cases recovered with serious nervous system symptoms, 9 cases recovered with Mild neurological symptoms, and the remaining 73 cases recovered with normal life and work. In 40 cases with intravascular embotherapy (according to Hunt-Hess classification, 33 cases belong to grade I-III and 7 cases belong to grade IV-V), 2 cases recovered with serious nervous system symptoms, 5 cases recovered with mild neurological symptoms, the remaining 33 cases recovered with normal life and work; no death case. CONCLUSIONS the situation is different in patients according to aneurysm size, shape, and location; if treatment for intracranial aneurysms is to achieve a satisfactory effect, two treatments must complement each other.
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Suh SJ, Kang DG, Ryu KY, Cho JH. Endovascular treatment of "kissing aneurysms" at the anterior communicating artery. J Korean Neurosurg Soc 2008; 44:163-5. [PMID: 19096669 DOI: 10.3340/jkns.2008.44.3.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 08/10/2008] [Indexed: 11/27/2022] Open
Abstract
Kissing aneurysms are the rare type of multiple aneurysms. They are adjacent aneurysms of different origin arteries in the same region, which require great care in diagnosis and treatment. We report a case of kissing aneurysms at the anterior communicating artery (AcomA) which were treated by endovascular coil embolization.
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Affiliation(s)
- Sang Jun Suh
- Department of Neurosurgery , Daegu Fatima Hospital, Daegu, Korea
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