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.
|
Authors | Adib A Abla, Michael T Lawton |
Journal | Journal of neurosurgery
(J Neurosurg)
Vol. 120
Issue 6
Pg. 1364-77
(Jun 2014)
ISSN: 1933-0693 [Electronic] United States |
PMID | 24745711
(Publication Type: Journal Article, Review)
|
Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Anterior Cerebral Artery
(diagnostic imaging, surgery)
- Cerebral Angiography
- Cerebral Revascularization
(methods)
- Endovascular Procedures
(methods)
- Female
- Humans
- Intracranial Aneurysm
(diagnostic imaging, surgery)
- Male
- Microsurgery
(methods)
- Middle Aged
- Neurosurgical Procedures
(methods)
- Retrospective Studies
- Treatment Outcome
- Young Adult
|