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Conte M, Cagil E, Lanzino G, Keser Z. Fusiform aneurysms of anterior cerebral artery: center experience and systematic literature review. Neurosurg Rev 2023; 47:11. [PMID: 38087068 DOI: 10.1007/s10143-023-02247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
Fusiform aneurysms of the anterior cerebral artery (ACA) are uncommon, and the natural history of this entity is poorly characterized. Along with our center experience, we conducted a systematic literature review to help shed light on the clinical course of ACA fusiform aneurysms. We queried our institutional database to identify cases with fusiform aneurysms of ACA. In addition, following the PRISMA algorithm, we identified all reported cases published in the English literature from the inception of PubMed until December 2022. We categorized clinical presentations into three categories: (i) traumatic/iatrogenic, (ii) spontaneous symptomatic ruptured/unruptured, and (iii) spontaneous asymptomatic aneurysms. We utilized descriptive statistics. We identified seven cases from our center along with 235 patients from published literature. Blunt trauma was responsible for the development of 19 aneurysms. Sixty-three percent of these aneurysms tend to rupture within 2 weeks from the initial trauma, and despite treatment, only 74% of these patients had good clinical outcomes. Spontaneous symptomatic presentation occurred in 207 patients and was often associated with previous/concomitant ACA dissection. Subarachnoid hemorrhage from ruptured aneurysms was the most common presentation. Spontaneous symptomatic fusiform aneurysm is rapidly evolving lesions, and treatment is necessary. Three of our own cases were treated with an endovascular flow diverter (pipeline) stenting with good outcomes. Spontaneous asymptomatic aneurysms were reported in nine patients. These lesions are often associated with other vascular abnormalities. Treatment included surgical clipping with good clinical outcomes. Instead, four patients from our center database were managed conservatively with equally good outcomes. Our study demonstrates good clinical outcomes when fusiform aneurysms of ACA, especially when symptomatic, are treated promptly with either reconstructive or deconstructive therapies.
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Affiliation(s)
- Matteo Conte
- University of Padua, Padua, Italy
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Emin Cagil
- Department of Neurosurgery, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | | | - Zafer Keser
- Department of Neurology, Cerebrovascular Division, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Evolution of intracranial-intracranial bypass surgery: a bibliometric analysis. World Neurosurg 2022; 162:177-182.e9. [DOI: 10.1016/j.wneu.2022.02.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
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Tabibkhooei A, Abolmaali M, Ebrahimnia F. "Fountain Sign," a Basic Finding toward the Diagnosis of Partially Thrombosed Giant Aneurysm: Describing a Challenging Case and Literature Review. Asian J Neurosurg 2020; 15:1096-1101. [PMID: 33708697 PMCID: PMC7869258 DOI: 10.4103/ajns.ajns_352_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022] Open
Abstract
Although the occurrence of cerebral aneurysms in pediatric age group describes as rare, giant ones are more commonly be found than in adults. Insufficient epidemiological information, their association with other medical comorbidities, diagnostic pitfalls, complex surgical anatomy, and issues should be considered during surgery to make them difficult to diagnose and manage. We report a 6-year-old boy with presenting complaint of acute-onset headache without any other symptoms and a small area of intracerebral hemorrhage detected on initial computed tomography (CT) scan. Primary evaluations failed to result in a definite diagnosis, and delayed vascular studies suggested vascular malformation or an aneurysm as the causative factor of hemorrhage. Surgical exploration led to the diagnosis of a giant partially thrombosed aneurysm at the A2 segment of the left anterior cerebral artery and successful clipping. One of our findings on preoperative CT angiography, “fountain sign,” may be useful for the diagnosis of partially thrombosed aneurysms when active bleeding from the aneurysm has been ruled out. Fountain sign can be a useful finding in the diagnosis of partially thrombosed aneurysms. Vascular lesions should always be considered as the primary cause of intracranial hemorrhage in pediatrics despite negative initial studies. Therefore, close follow-up and using delayed and multimodality vascular evaluations are crucial for successful management.
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Affiliation(s)
- Alireza Tabibkhooei
- Department of Neurosurgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Abolmaali
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Khatam-Al-Anbia Hospital, Tehran, Iran.,Shefa Neuroscience Research Center, Khatam-Al-Anbia Hospital, Tehran, Iran
| | - Feiz Ebrahimnia
- Department of Neurosurgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Ravina K, Strickland BA, Rennert RC, Chien M, Mack WJ, Amar AP, Russin JJ. A3-A3 Anastomosis in the Management of Complex Anterior Cerebral Artery Aneurysms: Experience With in Situ Bypass and Lessons Learned From Pseudoaneurysm Cases. Oper Neurosurg (Hagerstown) 2020; 17:247-260. [PMID: 30462326 DOI: 10.1093/ons/opy334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A3-A3 side-to-side bypass is an intracranial-to-intracranial (IC-IC) revascularization option when aneurysm treatment involves occlusion of one anterior cerebral artery (ACA). OBJECTIVE To describe applications of A3-A3 side-to-side bypass in the management of ACA true and pseudoaneurysms along with a review of pertinent literature. METHODS Six consecutive patients undergoing an A3-A3 bypass as part of their aneurysm management, representing a single-surgeon experience in a 2-yr period, were included in this retrospective review of a prospectively collected database. RESULTS Three male and three female patients with a median (range) age of 41.5 (11-69) years representing four ruptured and two unruptured aneurysms were included. Two of the aneurysms were communicating while four were postcommunicating from which three were pseudoaneurysms. Complete aneurysm obliteration was achieved in 5/6 cases. Bypass patency was evaluated in all cases intra- and postoperatively. Good outcomes (modified Rankin Scale score ≤ 2) at follow-up were observed in 4/6 patients. An improvement in mRS scores at the most recent follow-up as compared to preoperative status was achieved in three while scores remained the same in two patients. Ischemic complications related to aneurysm treatment were observed in two patients, both of which achieved good functional recovery upon follow-up. One patient deceased postoperatively due to progression of vasospasm-related infarcts. CONCLUSION A3-A3 bypass in the management of true as well as pseudoaneurysms of the ACA can achieve good postoperative outcomes in selected patients. Prompt diagnosis and aggressive surgical treatment needs to be pursued if a vessel injury with pseudoaneurysm formation is suspected.
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Affiliation(s)
- Kristine Ravina
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert C Rennert
- Department of Neurosurgery, University of California at San Diego, San Diego, California
| | - Mark Chien
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arun P Amar
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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AlTinawi B, Vasilakis G, Marsh R. Surgical treatment of a giant intracranial serpentine complex aneurysm of the middle cerebral artery: Use of neuromonitoring and surgical decision tree analysis. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kosyrkova AV, Gavrilov AG, Eliava SS, Kravchuk AD. [Giant thrombosed aneurysm of the pericallosal artery: clinical observation, literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:74-81. [PMID: 31577272 DOI: 10.17116/neiro20198304174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Are characterized by Distal giant aneurysms of the anterior cerebral artery are an extremely rare pathology. There are less than 40 cases of this disease described in literature. OBJECTIVE The aim of the article is to present the clinical observation of a successfully treated giant aneurysm of the pericallosal artery in a 58-year-old man, and also analyze the publications on distal cerebral aneurysms. MATERIAL AND METHODS The data of a patient hospitalized with a suspected tumor of the left brain hemisphere spreading to the left lateral ventricle is presented. Repeated MRI suggests a giant subtotal thrombotic aneurysm of the left perical artery, which was confirmed by SCT angiography. The patient underwent aneurysm treping-cliping with dissection of the aneurysm sac. In the analysis of the literature it was shown that the frequency of perical artery aneurysms varies from 5.3-6.0%, and giant aneurysms of this localization are extremely rare and occur in 1-4.5% of all perical artery aneurysms. Unlike distal anterior cerebral artery aneurysms of small and medium size, giant aneurysms are characterized by pseudotumorrhagic symptoms, which causes diagnostic difficulties. CONCLUSION It is necessary to remember about the diagnostic difficulties caused by the pseudotumorrhosis of the giant aneurysms of the pericallosal artery and the frequent negative angiography data due to total thrombosis of the aneurysmal sac. The gold standard is microsurgical clipping with excision of the aneurysmal sac. The prognosis for this group of patients is favorable.
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Tao T, Dai W, Li W, Hang CH. Giant Serpentine Distal Anterior Cerebral Artery Aneurysm Treated with In Situ Side-to-Side A3-A3 Anastomosis and Aneurysm Resection. World Neurosurg 2019; 133:21-24. [PMID: 31526883 DOI: 10.1016/j.wneu.2019.09.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Giant serpentine aneurysms that occur in the distal anterior cerebral artery are extremely rare and challenging to manage because of their complex structure. In this case, we show an aneurysm resection performed after in situ side-to-side A3-A3 bypass to treat a giant serpentine distal anterior cerebral artery aneurysm. CASE DESCRIPTION Here, we present the case of a 55-year-old man with a giant distal anterior cerebral artery serpentine aneurysm who presented with severe headache and progressive unconsciousness. Computed tomography and cerebral angiography revealed a giant serpentine aneurysm in the right A2 segment. Both the right pericallosal and callosal marginal arteries branched from the outflow tract. To relieve the mass effect and preserve distal blood flow, an in situ side-to-side A3-A3 anastomosis and a partial aneurysm resection were performed sequentially. Postoperative cerebral angiography revealed no aneurysm blood filling and good perfusion in both anterior cerebral artery territories. CONCLUSIONS Anterior cerebral artery giant serpentine aneurysms are rare and usually present with headache and mass effect. Aneurysm resection and distal flow protection are issues that we must consider. The sequential procedure of anastomosis and aneurysm resection is a feasible and safe option.
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Affiliation(s)
- Tao Tao
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wei Dai
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wei Li
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Chun-Hua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Lee SH, Chung Y, Ryu JW, Choi SK, Kwun BD. Surgical Revascularization for the Treatment of Complex Anterior Cerebral Artery Aneurysms: Experience and Illustrative Review. World Neurosurg 2018; 111:e507-e518. [DOI: 10.1016/j.wneu.2017.12.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
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Lee SH, Chung Y, Ryu JW, Choi SK. 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. Acta Neurochir (Wien) 2017; 159:1687-1691. [PMID: 28744606 DOI: 10.1007/s00701-017-3276-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
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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Affiliation(s)
- Sung Ho Lee
- Department of Neurosurgery, School of Medicine, Kyung Hee University, 1 Hoeki-dong Dongdaemoon-gu, Seoul, Republic of Korea
| | - Yeongu Chung
- Department of Neurosurgery, School of Medicine, Kyung Hee University, 1 Hoeki-dong Dongdaemoon-gu, Seoul, Republic of Korea
| | - Ji Wook Ryu
- Department of Neurosurgery, School of Medicine, Kyung Hee University, 1 Hoeki-dong Dongdaemoon-gu, Seoul, Republic of Korea
| | - Seok Keun Choi
- Department of Neurosurgery, School of Medicine, Kyung Hee University, 1 Hoeki-dong Dongdaemoon-gu, Seoul, Republic of Korea.
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Ota N, Tanikawa R, Miyama M, Matsumoto T, Miyazaki T, Matsukawa H, Yanagisawa T, Suzuki G, Miyata S, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S. Surgical Strategy for Complex Anterior Cerebral Artery Aneurysms: Retrospective Case Series and Literature Review. World Neurosurg 2016; 87:328-45. [DOI: 10.1016/j.wneu.2015.10.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
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Xu K, Yu T, Guo Y, Yu J. Study and Therapeutic Progress on Intracranial Serpentine Aneurysms. Int J Med Sci 2016; 13:432-9. [PMID: 27279792 PMCID: PMC4893557 DOI: 10.7150/ijms.14934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/08/2016] [Indexed: 12/23/2022] Open
Abstract
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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Affiliation(s)
- Kan Xu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Tiecheng Yu
- 2. Department of Orthopedics, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Yunbao Guo
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Jinlu Yu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
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Pavesi G, Dimitriadis S, Baroni S, Vallone S, Valzania F, Costella GB, Feletti A. Intraoperative Functional and Perfusion Monitoring During Surgery for Giant Serpentine Middle Cerebral Artery Aneurysms. World Neurosurg 2015; 84:592.e15-21. [DOI: 10.1016/j.wneu.2015.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
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Abla AA, Lawton MT. Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. J Neurosurg 2014; 120:1364-77. [DOI: 10.3171/2014.3.jns132219] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
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 (A1 segment of the ACA), 5 communicating aneurysms (ACoA), and 3 postcommunicating (A2–A3 segments of the ACA). In situ bypasses were used in 4 patients (A3-A3 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 A3-A3 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 patient-specific anatomy and microsurgical options before deciding on an individualized management strategy. The authors' experience demonstrates a preference for IC-IC reconstruction, but EC-IC bypasses are reported frequently in the literature. The authors conclude that ACA bypass with indirect aneurysm occlusion is a good alternative to direct clip reconstruction for complex ACA aneurysms.
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