Anterior interhemispheric approach for distal anterior cerebral artery aneurysm surgery: preoperative analysis of the venous anatomy can help to avoid venous infarction

Abstract

The present results suggest that the venous phase of a preoperative angiogram should be carefully evaluated before distal ACA aneurysm surgery. In particular, a DTISBV and DII over 50% and 30%, respectively, in patients with a normal SSV and over 40% and 25%, respectively, in patients with an aplastic SSV were found to be critical to the production of postoperative venous infarction.

Morphometric evaluation of parasagittal venous anatomy for intracranial approaches: a cadaveric study

“…Also, surgical procedures may cause venous infarction; neurosurgeons mostly use the anterior inter hemispheric approach for distal anterior cerebral artery aneurysms, but a frontal parasagittal bridging vein is occasionally sacrificed in this approach, creating a risk of postoperative venous infarction (10). Cerebral veins may be damaged during operations by three mechanisms: intentional coagulation and division to prevent their rupture, traction during an operation from their fixed drainage sites (into a dural sinus) causing their rupture, or damage during their dissection in the brain.…”

Endovascular treatment of frontopolar artery aneurysm

“…Intracerebral hemorrhage (ICH) has a negative implication on prognosis because of the limited subarachnoid space adjacent to the aneurysms. 7 Distal infarction is usually prevented by good and adequate leptomeningeal and pial collaterals in these cases. 8…”

Surgical Treatment of Distal Anterior Cerebral Artery Aneurysms with Horizontal Head Position

“…When necessary, the craniotomy should be extended along the superior sagittal sinus and an interval between veins that al− lows easy access should be chosen. If this detail is ignored, im− portant and troubling complications may be encountered [24,25].…”