Distal Anterior Cerebral Artery Aneurysms Research Articles

Risk Factors for the Recurrence of Distal Anterior Cerebral Artery Aneurysms After Endovascular Treatment

We aimed to investigate risk factors for the recurrence of distal anterior cerebral artery (DACA) aneurysms after endovascular treatment (EVT). The clinical and radiological outcomes of DACA aneurysms treated with endovascular methods at a single tertiary hospital from September 2008 to December 2021 were retrospectively reviewed. We measured the angle between two distal branches of DACA aneurysms and categorized the angle as follows: 1) Wide-angle (≥ 180 degrees), and 2) Narrow-angle type configuration (< 180 degrees). Univariate and multivariate analyses were performed to demonstrate the relationships between characteristics of DACA aneurysm and recurrence risk. A total of 132 DACA aneurysms were treated in our institution. Among these, 47 DACA aneurysms after EVT were included in this study. Forty patients underwent coil embolization without stent, seven for stent-assisted coil embolization. At the last follow-up (mean 30.2 ± 24.2 months), overall recurrence rate was 23.4% (n=11). Recurrence rate of the wide-angle type (9 of 23, 39.1%) was significantly higher than narrow-angle type (2 of 24, 8.3%) (p=0.041, OR=8.174, 95% confidence interval [CI] 1.094-61.066). Irregular shape of the DACA aneurysm also showed significantly higher recurrence rate (p=0.011, OR=10.663, 95% CI 1.701-66.838) after endovascular treatment. The wide-angle between two distal branches of DACA aneurysm and irregular shape might be independent risk factors for the recurrence after endovascular treatment for DACA aneurysms.

Case Report of Ruptured Large Fusiform Distal Anterior Cerebral Artery Aneurysm Treated With A3-A3 In Situ Bypass, Reimplantation, and Trapping With Aneurysmectomy: 2-Dimensional Operative Video.

Large fusiform aneurysms in the distal anterior cerebral territory are infrequent and pose considerable treatment challenges, as they necessitate comprehensive aneurysm resolution without compromising physiological flow dynamics.1-3 We present the case of a 52-year-old man with a ruptured distal anterior cerebral artery fusiform aneurysm. The patient consented to the procedure; this complex condition was successfully managed through an A3-A3 in situ bypass, branch reconstruction, and trapping accompanied by aneurysmectomy. The multifaceted nature of fusiform lesions precludes the feasibility of endovascular interventions as a sole remedy. In addition, reconstructive and deconstructive approaches exhibit elevated mortality rates in patients experiencing high-grade subarachnoid hemorrhage.1,4 Given the intricacies intrinsic to this clinical context and the exigent nature of fusiform aneurysms, the surgical therapeutic arsenal embraces a diverse array of surgical methodologies, each offering a bespoke spectrum of techniques meticulously tailored to attain predefined objectives.3,5-7 These approaches are attuned to promptly abrogate imminent threats, while concurrently mitigating latent complications linked to subarachnoid hemorrhage ensuing from aneurysmal rupture, encompassing the specters of rebleeding, ischemic stroke, and edematous sequelae.8,9 Crucially, the selection of the most appropriate surgical approach hinges on a comprehensive understanding of available options, patient-specific anatomic considerations, and the preferences of the neurosurgeon. Such a nuanced decision-making process ensures an individualized treatment strategy tailored to optimize patient outcomes.3,6.

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study.

Flow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data. Data for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded. Forty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits. FDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.

Treatment and outcome analysis of patients with ruptured distal anterior cerebral artery aneurysms: a multicenter real-world study.

To reveal the safety and efficacy of clipping and coiling in patients with ruptured distal anterior cerebral artery aneurysms (DACAA) and to calculate the risk factors affecting the two-year survival rate in follow-up patients. A retrospective study was conducted on the data of 140 patients (21 were lost to follow-up) with DACAA rupture who were treated by neurosurgery at 12 medical centers over a 2-year period, from January 2017 to December 2020. Univariate analysis was used to examine factors contributing to poor patient prognosis and to compare the prognosis of coiling and clipping treatments. Survival analysis was employed to compare survival rates between coiling and clipping, and risk factors affecting patient survival were analyzed using multivariate Cox regression analysis. Out of 140 patients with ruptured DACAA, 80 (57.1%) were male, and 60 (42.9%) were female. A total of 111 (79.3%) patients were classified under Hunt-Hess scale grades I-III, while 95 (67.9%) were graded I-III according to the WFNs classification. Among them, 63 (45%) were treated with clipping, and 77 (55%) underwent coiling. Within 2 years of discharge from the hospital, 31 (59.6%) patients who underwent clipping and 54 (80.6%) who underwent coiling had a good prognosis. Multivariate Cox regression analysis revealed that only WFNs classification (I-III) was a protective factor influencing the 2-year survival of patients with ruptured DACAA. In the reality of medical practice, neurosurgeons are more likely to choose clipping as the treatment for cases with WFNs classification than or equal to III. There was no difference between clipping and coiling in the two-year prognosis at discharge. High priority should be given to DACAA cases with WFNs grading (I-III), as better outcomes can be achieved. The sample size will continue to be enlarged in the future to obtain more accurate findings. Abstracts for reviews, technical notes, and historical vignettes do not need to be separated into sections. They should begin with a clear statement of the paper's purpose followed by appropriate details that support the authors' conclusion(s).

Spectrum of Intracerebral Hemorrhage in a Tertiary Hospital

Introduction: Intracerebral hemorrhage is a devastating  type of stroke that leads to profound morbidity and carries high mortality. Survivors of  hemorrhagic stroke  suffer  not only from physical  and social decline but also results in loss of productivity and financial burden.&#x0D; Causes of hemorrhagic stroke are hypertension, coagulopathic condition, diabetes mellitus and cardiovascular diseases. lesional hemorrhagic stroke can be due to subarachnoid hemorrhage from intracranial aneurysm,  arteriovenous malformation, dural arteriovenous fistula etc.&#x0D; Methods: A retrospective cross sectional study carried out at KISTMCTH. Data from six years duration was analysed from hospital records, outpatient department records. Patients that presented with intracranial hemorrhage were included. Post operative patients and traumatic intracerebral hemorrhage cases were not included.&#x0D;  &#x0D; Results:  Total of 112 patients was included in the study. 73 (65.1%) of them were male and 39 (34.8%) were female. putamen and caudate region were most common 47 (41.9%) followed by subarachnoid region 27 (24.1%), thalamus 19 (16.9%), cerebellum 9 (8.04%) , lobar region 8 (7.1%) and brainstem 2 (1.7%). Intracranial hemorrhage was more common in age group of 41-60 years 59 (52.6%)  followed by age group 61- 100 years 42 (37.5%). 14 (51.8%) female had subarachnoid hemorrage in comparision to 13 male (48.1%). Anterior communicating artery aneurysm had highest occurrence 10 (37%) followed by middle cerebral artery aneurysm 6 (22.2%) , paraclinnoidal / anterior choroidal/posterior communicating artery aneurysm 5 (18.5%),  vertebral artery aneurysm 3 (11.1%), distal anterior cerebral artery aneurysm 1 (3.7%).&#x0D; Intracranial hemorrhage had highest occurrence on the month of January (15%)  and lowest on the month of November (3.57%). 29 (25.8%) of total intracranial hemorrhage patient had intraventricular extension of hemorrhage. Intraventricular extension was more common in thalamic hematoma 15 (13.39%) followed by caudate/putaminal hematoma 10 (8.9%), cerebellum 3 (2.6%).Modified Rankin Scale ( MRS) outcome score was found to be highest as MRS 6 for 34 (30.6%) patients . while good outcome in terms of MRS 1 , MRS 2 and MRS 3  were observed for  7 (6.2%), 26 (23.2%), 25 (22.3%) patients respectively.&#x0D; Conclusion: Hypertension remains one of the major risk factor that results in various location specific hemorrhage   and it  shows specific peak seasonal variation. Proper blood pressure control is recommended  for prevention of  intracranial hemorrhages.

DACA Aneurysm Presenting as Ischemic Stroke

AbstractAneurysms rarely present with features of ischemic stroke. The data on treatment of such strokes is limited. We present a case of multiple aneurysms and an ischemic stroke caused by distal anterior cerebral artery (DACA) aneurysm treated with flow diverter placement, the first case of endovascular treatment of DACA aneurysmal ischemic stroke reported to our knowledge.

Sexual Dysfunction after Clipping of Ruptured Intracranial Aneurysms.

Sexual dysfunction significantly affects interpersonal relationships and overall quality of life. It remains a matter of concern for risk assessment and counseling in patients with ruptured intracranial aneurysms. To assess the sexual dysfunctions in patients undergoing clipping for ruptured intracranial aneurysms and comparative evaluation among different anterior circulation aneurysms. We prospectively included 40 male patients of ruptured intracranial aneurysms of anterior circulation (age range: 20-60 years; sexually active preoperatively), managed with craniotomy and clipping. We evaluated the sexual outcome in patients with excellent Glasgow outcome score (GOS) five at a minimum one year of follow-up. Patients with GOS-5 status at follow-up were broadly classified into two groups: Anterior communicating artery aneurysm (Acom), and non-Acom) aneurysms. We valued sexual outcome with Subjective Sexual Arousal Scale for Men at follow-up, and compared in the two groups. Mean age of patients was 44.78 ± 9.51 years. Besides 20 Acom aneurysms, other groups included 11 middle cerebral artery aneurysms, five internal carotid artery aneurysms, three posterior communicating artery aneurysms, and one distal anterior cerebral artery aneurysm. The mean follow-up was 24.45 ± 13.58 months. Patients with non-Acom aneurysms had an overall better outcome in the sexual performance domain "P = 0.015," mental satisfaction domain "P = 0.009," and sexual assertiveness domain "P = 0.007." However, there was no statistical difference in partner communication domain "P = 0.593," and partner relationship domain "P = 0.378." Overall, the sexual outcome was inferior in patients treated for Acom aneurysms compared to other anterior circulation aneurysms. In cases of aneurysmal subarachnoid hemorrhage, sexual dysfunctions are common even after good clinical outcomes. The study revealed prominent differences in outcomes on the sexual quality of life in patients harboring Acom aneurysms as compared to anterior circulation aneurysms located off-midline.

Intra-aneurysmatic thrombectomy in a distal anterior cerebral artery aneurysm.

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm's wall obstructing the left DACA flow. We proceeded to open the aneurysm's dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA. Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient's postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

Coil embolization for ruptured distal anterior cerebral artery aneurysm at the supracallosal portion: Two case reports

Background: Distal anterior cerebral artery (ACA) aneurysms occur more frequently in the genu portion and much less frequently in the supracallosal portion (A4–A5). This report describes two cases of ruptured cerebral aneurysms occurring at the supracallosal portion successfully treated with coil embolization. Case Description: Case 1 involved a 61-year-old female with sudden-onset headache and vomiting attributed to subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) revealed a bihemispheric ACA and aneurysm in the supracallosal portion. Coil embolization was performed, and the patient was discharged without neurological deficit. Case 2 involved a 35-year-old man with severe headache and disturbance of consciousness caused by SAH. DSA showed an aneurysm in A4 of the accessory ACA, and coil embolization was performed. After rehabilitation, he was discharged with a modified Rankin scale score of 2. Conclusion: Coil embolization for a ruptured aneurysm at the supracallosal portion can yield good results if the patient is appropriately selected.

Rupture Risk Factors and Strategies for Unruptured Distal Anterior Cerebral Artery Aneurysms

Distal anterior cerebral artery (dACA) aneurysms are rare. Ruptured dACA aneurysms typically present with subarachnoid hemorrhage in conjunction with intracerebral hematoma and cause neurological deterioration. This study aimed to determine their risk of rupture and examine associated factors. We retrospectively analyzed patients with dACA aneurysms to compare patient and aneurysm characteristics between ruptured and unruptured aneurysms. Clinical outcome was used the modified Rankin scale. Univariate analyses were performed to identify rupture risk factors. One hundred three patients with dACA aneurysms were examined (51 ruptured and 52 unruptured). The median aspect ratio of ruptured and unruptured aneurysms was 1.69 and 1.22, respectively (P<0.01). The median maximum diameter of ruptured and unruptured aneurysms was 5.2 and 3.1mm, respectively (P<0.01). The median size ratio of ruptured and unruptured aneurysms was 3.32 and 2.17, respectively (P<0.01). Maximum diameter was <5mm in 45.2% of ruptured dACA aneurysms. dACA aneurysm, showing size ratio >2.4 and aspect ratio >1.4, had ruptured in 71.4% and 78.6%, respectively. We suggested that these are the threshold of size ratio and aspect ratio for rupture of dACA aneurysms. A total percentatge of 78.1% of aneurysms with aspect ratio >1.4 and size ratio >2.4 had ruptured. Distal anterior cerebral artery (dACA) aneurysms may rupture, even when small. We found a significant difference between ruptured and unruptured aneurysms with respect to maximum diameter, aspect ratio, and size ratio. Treatment for small aneurysms should be considered based on size ratio and aspect ratio, not just size.

Advantages of computed tomography-based navigation in clipping distal anterior cerebral artery aneurysms: a retrospective cohort study.

The occurrence rate of distal anterior cerebral artery (DACA) aneurysms is relatively low, primarily due to their deep-seated location, which makes surgical clamping challenging. The objective of this study was to investigate the efficacy and safety of computed tomography (CT) navigation-assisted clipping of DACA aneurysms compared to traditional clipping without navigation. A retrospective cohort study involving retrospective data collection was performed. The retrospective analysis was conducted on 139 patients with ruptured DACA aneurysms who underwent clipping. From January 2013 to November 2021, 164 patients were retrieved at the Department of Neurosurgery, Renmin Hospital of Wuhan University. The inclusion criteria were patients diagnosed with DACA aneurysms via CT angiography (CTA) or digital subtraction angiography (DSA), those with complete clinical data, and those who underwent craniotomy for aneurysm clipping. Meanwhile, the exclusion criteria were as follows: aneurysm recurrence, traumatic brain injury or surgery history, blood disorders or recent anticoagulant use, and severe organ dysfunction. Data on gender, age, Hunt-Hess grade, Fisher grade, modified Rankin Scale (mRS) score, aneurysm location, hospitalization time, aneurysm found time (the duration from incision to aneurysm discovery), and intraoperative bleeding volume were collected from medical records and neurosurgical databases. Patients were followed up in the clinic or by telephone in May 2022. All patients were divided into a navigation group or a traditional group for statistical analysis. No statistically significant differences were observed in age, sex, Fisher grade, Hunt-Hess grade, hospitalization time, or aneurysm site between the navigation group and traditional group (P>0.05). Intraoperative blood loss was lower in the navigation group than in the traditional group {370 [280-460] vs. 430 [310-610] mL, P=0.045}. Patients in the traditional group had a shorter aneurysm found time than did those in the navigation group {49 [42-53] vs. 79 [63-84] min, P<0.001}. There was no significant difference in the mRS score at hospital discharge (P=0.336) or follow-up (P=0.157) between the two groups. CT neuronavigation-assisted microsurgery for clipping DACA aneurysms may improve surgical accuracy, shorten the time to locate aneurysms, and reduce intraoperative blood loss. Although no significant difference in prognosis was observed, this technique shows promise as a safe and effective alternative to traditional clipping without navigation.

Revelation and Management of Distal Anterior Cerebral Artery Aneurysms

Pericallosal aneurysms can affect any segment of the anterior cerebral artery distal to the anterior communicating artery. They represent relatively 9% of all intracranial aneurysms and are mainly revealed by a hemorrhagic stroke in different forms. This retrospective study reviewed all patients that received clipping for DACA aneurysms among all cases of brain aneurysms. 10 patients were included in this group and several parameters were evaluated. 60% of patients were female and their ages ranged from 44 to 78 years. 80% of candidates complained of headaches and 50% presented seizures clipping. 60% of patients presented an IPH at their first presentation while SAH was found in half of them. A good WFNS score was noticed and almost of patients (80 %) were graded I. Most of aneurysms (80%) were located at the pericallosal – callosomarginal junction. We had two cases (20%) with additional aneurysms in other localizations. All of them received microsurgical clipping. most of them had good short and long -term follow-ups. We had one death after several systemic complications. DACA aneurysms are revealed at a small size with the onset of cingular hematoma or SAH, especially in the interhemispheric cistern. This could affect the cognitive functions and is considered a determining factor in the patient’s quality of life. The surgical clipping is an effective and durable option for their management

Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms.

Objective  The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods  Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results  Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking ( p -value 0.03) and use of temporary clip ( p -value 0.00) were significant predictors for unfavorable outcome. Conclusion  The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.

Disappearance of a moyamoya-related distal anterior cerebral artery aneurysm after target bypass revascularization: illustrative case.

Aneurysm formation is a complication of moyamoya disease (MMD). Distal anterior cerebral artery (ACA) aneurysms account for approximately 1% of MMD-related aneurysms. We report a case of target bypass for adult patients with MMD who presented with intracranial hemorrhage due to rupture of a distal ACA aneurysm, whose disappearance was confirmed postoperatively. A 45-year-old woman presented with sudden-onset headache and loss of consciousness. Head computed tomography showed hemorrhage in the genu of the corpus callosum with intraventricular extension. Digital subtraction angiography (DSA) revealed Suzuki stage III MMD and a left A3 segment aneurysm. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and STA-ACA target bypass were performed to reduce hemodynamic stress on the left ACA. DSA 6 months after surgery showed patency of both bypasses and disappearance of the aneurysm. At the 20-month follow-up, the patient was asymptomatic and neurologically intact. Bypass revascularization may be an effective treatment to reduce hemodynamic stress and eliminate MMD-related aneurysms.

A giant A4-A5 distal anterior cerebral artery aneurysm treated with microsurgical clip reconstruction

Background. Aneurysms of the distal anterior cerebral artery (DACA) are uncommon; they often form near the pericallosal-callosomarginal junction and are typically small. To our knowledge, giant DACA aneurysms developing from the more distant parts of the anterior cerebral artery (ACA), A4-5, have been described only once in the literature. Case description. A 66-year-old gentleman reported with a brief loss of consciousness followed by weakness in his right lower leg. The patient was admitted with a Glasgow Coma Score (GCS) of 15. A computed tomography (CT) scan of the head revealed a left hyperdense mass in the frontal parasagittal supracallosal region. Contrast MRI revealed a heterogeneously enhancing mass measuring 35x30x25 mm. CT angiography (CTA) revealed a small saccular aneurysm on the posteromedial aspect of the mass, perpendicular to the vertical plane of the coronal suture, corresponding to the A4-A5 junction of the left ACA. Through a left paramedian craniotomy, a modified anterior interhemispheric approach that was more posterior than the conventional projection was performed. A giant partially thrombosed was found. The aneurysm was resected, and the neck was reconstructed using four clips placed on top of them to enhance the clipping force over any remaining thrombus. The patient recovered as expected and was neurologically intact three months later. Conclusion. Giant distal anterior cerebral artery (DACA) aneurysms found in the A4-A5 segment represent a pathologically uncommon phenomenon. Due to the rarity of giant aneurysms at this location, their reporting is important to inform meticulous pre-operative planning.

Unique image findings around “kissing” distal anterior cerebral artery aneurysms in addition to perianeurysmal edema: A case report

Some aneurysms cause edema formation in the surrounding brain parenchyma and are thought to reflect various phenomena occurring in the aneurysm. Some authors highlighted perianeurysmal edema (PAE) as a finding that indicates higher risk of rupture of the aneurysm. On the other hand, there are no reports of image changes in the surrounding brain parenchyma of aneurysm other than edema formation.We describe a 63-year-old man with unique signal change in the surrounding brain parenchyma of "kissing" distal anterior cerebral artery aneurysms completely different from PAE. The large and partially thrombosed aneurysm presented well-defined signal change surrounding brain parenchyma in addition to PAE. Intraoperative findings revealed the signal change as a space of retaining serous fluid. Drain the fluid and clipping was made for the both anterior cerebral artery aneurysms. The postoperative course was uneventful and his headache was improved the day after the surgery. The perianeurysmal signal change was also disappeared immediately after the surgery except for the PAE.This case demonstrates a rare phenomenon of signal change around the aneurysm, and there is a possibility that the unique finding exists as an early manifestation of intracerebral hematoma associated with aneurysm rupture.

Management of Intraoperative Rupture of Intracranial Aneurysms: Agony and Ecstasy.

Intraoperative rupture (IOR) of an intracranial aneurysm is a serious complication, often with catastrophic consequences that are difficult to manage even by the best hands. Like most surgical complications, this one is better to avoid than to treat, but any vascular neurosurgeon should know how to deal with IOR of an aneurysm, because it is bound to occur. The aims of this study were to evaluate the incidence and factors associated with IOR during clipping of intracranial aneurysms, to analyze strategies for controlling hemorrhage in such cases, and to assess outcomes. Overall, 911 cases of intracranial aneurysms, which were treated surgically by the author during 26years of his professional career, were reviewed. IOR was never noted during clipping of an unruptured intracranial aneurysm (65 cases) but was encountered in 49 of 846 cases (5.8%) presenting with subarachnoid hemorrhage. This complication occurred most often in cases of internal carotid artery aneurysms (22 cases; 45%), followed by anterior communicating artery aneurysms (12 cases; 24%), distal anterior cerebral artery aneurysms (6 cases; 12%), middle cerebral artery aneurysms (6 cases; 12%), and posterior circulation aneurysms (3 cases; 6%). IOR was mostly encountered during early surgery (within 3days) after the ictus (26 cases; 53%) and most frequently occurred during dissection of the aneurysm (26 cases; 53%). Overall, 22 patients (45%) had good outcome, 18 (37%) had variable morbidity, and 9 (18%) died. Fatal consequences of IOR were noted only in cases of big or multilobulated internal carotid artery aneurysms. Detailed planning of the surgical procedure, application of meticulous microdissection techniques, and anticipation of possible intraoperative incidents during intervention aimed at clipping of an intracranial aneurysm can reduce the risk of IOR, as well as the associated morbidity and mortality.

Two cases of ruptured distal anterior cerebral artery aneurysms presenting as a pure acute subdural hematoma with a good outcome

Two cases of ruptured distal anterior cerebral artery aneurysms presenting as a pure acute subdural hematoma with a good outcome

Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience

ObjectiveIn recent years, endovascular treatment has become the treatment of choice for distal anterior cerebral artery (DACA) aneurysms. In this study, we report the outcomes of coil embolization for DACA aneurysms. MethodsEighteen DACA aneurysms in 16 patients treated with endovascular treatment between January 2010 and December 2020 were included in this study. We retrospectively analyzed patient characteristics, data on aneurysms, the reason for the selection of endovascular treatment, treatment technique, and treatment outcomes. ResultsThere were 18 procedures in 16 patients. The average age was 65.7 years and 56% of patients were male. The average diameter of the dome was 5.5 mm, and the location of aneurysm was A3 in 83% and A4 in 17%. We mainly selected endovascular treatment for patients with a past history of craniotomy and head trauma, or with systemic comorbidities. The technical success rate was 94%, and adequate obliteration immediately after treatment was achieved in 72%. There were no symptomatic periprocedural complications. The retreatment rate was 11.1%. ConclusionCoil embolization for DACA aneurysms yielded good treatment outcomes. Endovascular treatment for DACA aneurysms will become more common with advances in endovascular devices and the establishment of stable perioperative antiplatelet therapy.

Distal aneurysm of median artery of the corpus callosum: case report

Background. There are many variations of the developmental pathology of the anterior communicating artery with such forms as aplasia, hypoplasia, duplication, triplication and etc. The presence of the median artery of the corpus callosum is a rare pathology of the anterior part of the circle of Willis and, according to the literature the frequency is 4,5-14,2 %. About 81 % of cases, the occurrence of the median artery of the corpus callosum is combined with the presence of anterior communicating artery trifurcation. The incidence of distal anterior cerebral artery aneurysms has been estimated to be from 1.5 to 9.0 % of all intracranial aneurysms, while the median artery of the corpus callosum is rarely mentioned in the literature, the author of the article did not find cases of descriptions of distal anterior cerebral artery aneurysms in the PubMed. It should be borne in mind that when conducting radiation diagnostics, up to one third of all cases of the median artery of the corpus callosum remain undetected.Aim. To present a clinical case of successful surgical treatment of a distal aneurysm of the median artery of the corpus callosum in a patient K., 39 years old, performed using surgical neuronavigation.Materials and methods. A case report of the successful surgical management of 39-year-old patient with distal aneurysm of the median artery of the corpus callosum at the Sity Clinical Hospital No. 1 named after N.I. Pirogov of Moscow Healthcare Department. The patient had a saccular aneurysm of A2-3 segments of the median artery of the corpus callosum.Results. A microsurgical clipping of the distal aneurysm of the median artery of the corpus callosum using the right interhemispheric approach through the bifrontal craniotomy with a neuronavigational assistance was performed. The selective angiography of the intracranial arteries (10 mo after the clipping) no detected the signs of recanalization of the aneurysm.Conclusion. The deeper placement of the median artery of the corpus callosum (as compared with the anterior cerebral arteries) and the missing of anatomical landmarks complicates the surgical approach to the distal aneurysms of the median artery of the corpus callosum. The instrumentation of neuronavigation made it possible to perform minimal craniotomy and safe encephalotomy of the medial aspects of the frontal lobes (at site of the genu the corpus callosum) and reduce the operating time.