Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature.

Paolo Cappabianca,Oreste de Divitiis,Teresa Somma,Mariano Marseglia,Francesco Briganti,Alberto Di Somma,Luigi Maria Cavallo

doi:10.1186/s13256-015-0604-x

Paolo Cappabianca, Oreste de Divitiis + Show 5 more

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https://doi.org/10.1186/s13256-015-0604-x

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Abstract

IntroductionDissecting aneurysms of the cerebral arteries are uncommon vascular malformations. Neurosurgical treatment remains critical in the management of patients with such vascular pathologies.Case presentationA 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.ConclusionsThe 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.

Highlights

Dissecting aneurysms of the cerebral arteries are uncommon vascular malformations
The anterior cerebral artery (ACA) is usually involved in association with dissection in other locations, such as in an internal carotid artery (ICA) dissecting aneurysm, but a lesion confined to the ACA, especially in the precommunicating segment, is an extremely rare event (Table 1) [1,7,8,9,10,11,12,13,14,15,16,17,18]
Conservative treatment could be effective with a good outcome and a low rate of second rupture but, if there is a high risk of rebleeding, and/or severe clinical conditions arise, direct treatment of the dissecting aneurysm should be proposed

Summary

Conclusions

The management of cerebral dissecting aneurysms is still controversial. With this report we highlight a possible neurosurgical option among therapeutic strategies for these uncommon vascular lesions. OdD, ADS, TS and MM contributed to: the conception and design of the work; the acquisition, analysis, and interpretation of data; drafting the work, revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LMC, FB and PC were involved in: revising the article critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 5, 80131 Naples, Italy. 2Department of Advanced Biomedical Sciences, Unit of Interventional Neuroradiology, Università degli Studi di Napoli “Federico II”, Naples, Italy

Introduction

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