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Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt

BACKGROUND: Treatment options for a ruptured anterior communicating artery (ACoA) pseudoaneurysm are limited. In most cases trapping of the ACoA is the best treatment option. Occasionally, bypass surgery is warranted to ensure blood flow to the contralateral anterior cerebral artery (ACA) in cases w...

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Autores principales: Kim, Kyung Hyun, Ha, Eun Jin, Cho, Won-Sang, Kang, Hyun-Seung, Kim, Jeong Eun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350030/
https://www.ncbi.nlm.nih.gov/pubmed/30701148
http://dx.doi.org/10.2176/nmccrj.cr.2018-0142
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author Kim, Kyung Hyun
Ha, Eun Jin
Cho, Won-Sang
Kang, Hyun-Seung
Kim, Jeong Eun
author_facet Kim, Kyung Hyun
Ha, Eun Jin
Cho, Won-Sang
Kang, Hyun-Seung
Kim, Jeong Eun
author_sort Kim, Kyung Hyun
collection PubMed
description BACKGROUND: Treatment options for a ruptured anterior communicating artery (ACoA) pseudoaneurysm are limited. In most cases trapping of the ACoA is the best treatment option. Occasionally, bypass surgery is warranted to ensure blood flow to the contralateral anterior cerebral artery (ACA) in cases with one dominant A1. We report a case of an ACoA pseudoaneurysm presenting with delayed subarachnoid hemorrhage following surgical clipping of an unruptured ACoA aneurysm, with a review of the literature. CASE DESCRIPTION: A 74-year-old female had undergone surgical clipping of a 1.2-cm-sized unruptured ACoA aneurysm through the left supraorbital keyhole approach. During the operation, there had been a small tear between the aneurysm neck and the right proximal A2, and the tear point was controlled by clipping of the tear site. One month later, she was admitted again because of subarachnoid hemorrhage. Cerebral angiography showed a probable pseudoaneurysm from the previous tear site. The patient had a dominant left A1 with a right A1 aplasia. The pseudoaneurysm was treated with side-to-side bypass between the distal ACAs and subsequent trapping of the ACoA harboring a pseudoaneurysm. Both the distal ACAs were preserved; however, post-hemorrhagic neurological sequelae remained. CONCLUSIONS: Side-to-side bypass between distal ACAs and surgical trapping of the ACoA for the ruptured ACoA pseudoaneurysm was a good rescue option to prevent rebleeding and preserve blood supply to the contralateral ACA territory.
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spelling pubmed-63500302019-01-30 Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt Kim, Kyung Hyun Ha, Eun Jin Cho, Won-Sang Kang, Hyun-Seung Kim, Jeong Eun NMC Case Rep J Case Report BACKGROUND: Treatment options for a ruptured anterior communicating artery (ACoA) pseudoaneurysm are limited. In most cases trapping of the ACoA is the best treatment option. Occasionally, bypass surgery is warranted to ensure blood flow to the contralateral anterior cerebral artery (ACA) in cases with one dominant A1. We report a case of an ACoA pseudoaneurysm presenting with delayed subarachnoid hemorrhage following surgical clipping of an unruptured ACoA aneurysm, with a review of the literature. CASE DESCRIPTION: A 74-year-old female had undergone surgical clipping of a 1.2-cm-sized unruptured ACoA aneurysm through the left supraorbital keyhole approach. During the operation, there had been a small tear between the aneurysm neck and the right proximal A2, and the tear point was controlled by clipping of the tear site. One month later, she was admitted again because of subarachnoid hemorrhage. Cerebral angiography showed a probable pseudoaneurysm from the previous tear site. The patient had a dominant left A1 with a right A1 aplasia. The pseudoaneurysm was treated with side-to-side bypass between the distal ACAs and subsequent trapping of the ACoA harboring a pseudoaneurysm. Both the distal ACAs were preserved; however, post-hemorrhagic neurological sequelae remained. CONCLUSIONS: Side-to-side bypass between distal ACAs and surgical trapping of the ACoA for the ruptured ACoA pseudoaneurysm was a good rescue option to prevent rebleeding and preserve blood supply to the contralateral ACA territory. The Japan Neurosurgical Society 2018-12-18 /pmc/articles/PMC6350030/ /pubmed/30701148 http://dx.doi.org/10.2176/nmccrj.cr.2018-0142 Text en © 2019 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Case Report
Kim, Kyung Hyun
Ha, Eun Jin
Cho, Won-Sang
Kang, Hyun-Seung
Kim, Jeong Eun
Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title_full Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title_fullStr Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title_full_unstemmed Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title_short Side-to-Side Bypass between Bilateral Distal Anterior Cerebral Arteries and Surgical Trapping of a Pseudoaneurysm from the Anterior Communicating Artery: Lessons Learnt
title_sort side-to-side bypass between bilateral distal anterior cerebral arteries and surgical trapping of a pseudoaneurysm from the anterior communicating artery: lessons learnt
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350030/
https://www.ncbi.nlm.nih.gov/pubmed/30701148
http://dx.doi.org/10.2176/nmccrj.cr.2018-0142
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