Neuronavigation-assisted microsurgical clipping of pericallosal aneurysms: A single-center retrospective study

Surgical clipping of pericallosal artery aneurysm is technically challenging since it is fragile and tends to rupture accidentally during the operation. This study was aimed to evaluate the efficacy and safety of MRI-neuronavigation-assisted microsurgery for pericallosal artery aneurysm clipping. Forty patients diagnosed with pericallosal artery aneurysms who underwent craniotomy clipping were enrolled. Among these patients, 18 cases accepted routine surgical approaches, while another 22 cases accepted MRI-neuronavigation-assisted microsurgery. Design of craniotomy, operation pathway, operation duration, intraoperative cerebral protection and superior drainage vein protection were analyzed retrospectively. All the 40 cases underwent aneurysm clipping by pre-coronal inter-hemispheric approach, and all aneurysms were clipped completely confirmed by postoperative CTA or DSA. During the operations, MRI-neuronavigation provided precise spatial configuration of pericallosal artery aneurysms, and allowed accurate and real-time identification for the adjacent arteries and brain structures, and no aneurysms ruptured accidentally during the operations. Functional cortex and draining veins were protected well. Compared with routine surgical approaches, the MRI-neuronavigation-assisted microsurgery showed less operation duration, few adverse events induced by accurate location for aneurysm and less invasion to draining veins. Therefore, MRI-neuronavigation-assisted microsurgery could precisely locate the pericallosal artery aneurysm, optimize surgical approaches, and help to cerebral protection. It is expected to reduce the surgical risk and improve the precision and security, can be regarded as an effective technology in the clipping of pericallosal artery aneurysms.

Contralateral transradial access for coil embolization of distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle

OBJECTIVE

Endovascular treatment of distal anterior cerebral artery aneurysms is commonly addressed via the ipsilateral A1 segment of the anterior cerebral artery. However, when the parent pericallosal artery has a sharp ipsilateral A1-A2 angle, catheterization through the ipsilateral A1 segment can potentially result in vessel injury, catheter kinking, and/or compromised/stagnant anterior cerebral artery flow. Here, we present a case of a distal anterior cerebral artery aneurysm associated with a steep ipsilateral A1-A2 angle treated with contralateral transradial coil embolization.

CASE PRESENTATION

A 91-year-old woman presented with a ruptured left distal anterior cerebral artery aneurysm at the A3 segment. The parent pericallosal artery had a steep ipsilateral A1-A2 angle. To safely achieve coil embolization of the aneurysm, a contralateral transradial system via the right A1 segment was employed. Although a secondary ipsilateral transradial system was required for contrast injection, aneurysm obliteration was successfully achieved without vessel injury or system instability.

CONCLUSION

The A1-A2 angle can be a key anatomical factor in the endovascular treatment of distal anterior cerebral artery aneurysms. The contralateral transradial system is a useful treatment option for distal anterior cerebral artery aneurysms associated with sharp ipsilateral A1-A2 angles. However, if the distal anterior cerebral artery aneurysm cannot be clearly visualized through the contralateral system, an ipsilateral system will be required for contrast injection.

Transradial quadraxial system for coil embolization of distal anterior cerebral artery aneurysms: A radial-first center case series and literature review

PURPOSE

Endovascular treatment is technically challenging as distal anterior cerebral artery (DACA) aneurysms have distal location, small-caliber parent artery, and small size/wide neck. This study evaluated the feasibility and safety of the transradial approach (TRA) with a radial-specific neurointerventional guiding sheath as the first-line technique for DACA aneurysms.

METHODS

We retrospectively analyzed an institutional database of consecutive patients with DACA aneurysm who underwent coil embolization using TRA. Ten consecutive patients were included in this study. After the radial-specific 6F Simmons guiding sheath (0.088″ inner diameter) was completely engaged into the target common carotid artery, a quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/single microcatheter) was used for embolization. Then, we assessed for procedural success, angiographic outcomes, and procedure-related or vascular access site complications.

RESULTS

Embolization procedures were conducted using simple coiling in eight and stent-assisted coiling with the trans-cell approach in two patients. The embolization procedure was successful in all patients (n = 10). Moreover, none presented with catheter kinking, parent artery flow stagnation, or system instability during the procedure. Immediate postprocedural angiography revealed complete obliteration in six and residual neck in four patients. Then, eight patients underwent follow-up angiography at a mean of 7.1 months, and none developed recanalization or required retreatment. The postprocedural course was uneventful, and there were no complications.

CONCLUSION

The transradial quadraxial system had the ability to achieve sufficient stability and kink resistance in DACA aneurysm embolization. Thus, this method was feasible and safe and had a high success rate.

A case report of pericallosal aneurysm successfully treated with flow diverter stents

Pericallosal artery aneurysm (PAA) is a relatively uncommon type of intracranial aneurysm that tends to rupture more frequently and cause higher mortality rates than other types of cerebral aneurysms. Surgery to address PAA is difficult due to its deep-seated location, the size of the aneurysmal sac, and the limited surgical field. In recent years, with the development of percutaneous interventions, endovascular treatment has become the preferred, minimally invasive intervention method for the treatment of pericallosal aneurysms. In this article, we present a case of PAA that was successfully treated with flow diversion therapy in a 51-year-old male.

Therapy results of pericallosal aneurysms: A retrospective unicenter study

This retrospective study aims to compare treatment results of ruptured and unruptured pericallosal artery aneurysms (PAAs) regarding patient outcome and aneurysm recurrence after endovascular treatment (EVT) and neurosurgical treatment (NT). A total of 67 patients with PAA were admitted to our hospital, 44 patients with subarachnoidal hemorrhage (SAH) due to a ruptured PAA and 23 patients with unruptured PAA. The radiographic features of PAA were collected from pre-treatment digital subtraction angiography. In addition, demographic, clinical and radiographic parameters of all patients were recorded. Outcome was measured based on the modified Rankin scale (mRS) at 6 months after admission (favorable mRS score, 0-2 vs unfavorable mRS score, 3-6). Overall 46 patients underwent EVT and 21 patients NT. Six months after discharge 24 patients with SAH had a favorable outcome (mRS 0-2) and 16 patients an unfavorable outcome (mRS 3-6). Mortality rate of patients with SAH was 9.1% (4/44). Overall aneurysm recurrence was treated in 13 % of patients in the EVT cohort (6/46), whereas patients treated with NT had no recurrence. All patients with unruptured PAA had a favorable outcome. EVT and NT of PAA show comparable good results, although aneurysm recurrence occurs more often after EVT.

Cerebrovascular disorders and Fahr's disease: Report of two cases and literature review

Fahr's disease is a rare idiopathic nosological entity, characterized by calcification of the basal ganglia and dentate nuclei of the cerebellum. Sometimes it may be associated to other diseases like cerebrovascular disorders. However, this link remains unclear and it needs to be further validated. We report two cases of patients with cerebrovascular disorders and Fahr's disease. In the first case, a 69-years-old woman with right internal capsule-basal ganglia haemorrhage. In the second case, a 72-years-old woman with ischemic stroke and pericallosal artery aneurysm. The physiopathology is discussed and concerning literature is reviewed.