Giant Serpentine Aneurysm of the Posterior Cerebral Artery

Fukamachi, Akira; Hirato, Masabumi; Wakao, Tetsuo; Kawafuchi, Jun‐ichi

doi:10.1227/00006123-198208000-00014

Cited by 39 publications

(7 citation statements)

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“…Originam-se na bifurcação dos ramos calcarinos e parieto-oecipitais da ACP, podendo ser abordados tanto por via subtemporal como por via inter-hemisférica. A abordagem subtemporal, devido a excessiva tração e elevação do lobo temporal e além de poder causar lacerações e lesões parenquimatosas mesmo com todo o cuidado de técnica, pode causar lesões das veias temporais que convergem para a região do seio transverso e petroso superior, levando a grande edema pós operatório 4,6,20 . A abordagem temporopolar proposta por Sano 16 (também chamada de pré-temporal) consiste em abordagem combinada pterional e subtemporal, abertura ampla da fissura de Silvius e mínima retração do lobo temporal, permitindo boa visualização das artérias da região, diminuindo substancialmente o risco de lesões das veias temporais, além de evitar lacerações e lesões do parênquima temporal.…”

Section: Discussionunclassified

[No Title Available]

Pereira¹,

Ramalho²,

Pereira³

et al. 1995

Arq. Neuro-Psiquiatr.

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RESUMO -Apresentamos caso de aneurisma gigante do segmento distal (P3) da artéria cerebral posterior. O aneurisma foi tratado microcirurgicamente pela via combinada proposta por Sano com clipagem do ramo terminal abordagem cirúrgica são feitas. A raridade desta patologia justifica o relato deste caso.PALAVRAS-CHAVE: aneurisma cerebral gigante, artéria cerebral posterior, abordagem microcirúrgica. subdividem topograficamente a ACP em três segmentos. O segmento PI é a porção compreendida entre a origem e o início da artéria comunicante posterior; o segmento P2 se situa entre a artéria comunicante posterior e a borda posterior do mesencéfalo; e o segmento P3 que vai do pulvinar do tálamo na face lateral da cisterna quadrigêmina até o limite anterior da fissura calcarina 19 -20 . Os aneurismas da circulação posterior perfazem cerca de 8% dos aneurismas cerebrais, conforme o último estudo cooperativo publicado por Kassel e col.8 . Os aneurismas da ACP são raros e, segundo alguns autores, têm incidência de 0,7 a 2,2% de todos os aneurismas intracranianos 491015 . São do tipo sacular em cerca de 80% dos casos, os gigantes correspondendo a aproximadamente 10% desse total 6 -9 .Os aneurismas que se localizam no segmento P3 representam apenas 13% dos aneurismas da ACP, o que representaria uma incidência aproximada de 0,09% de todos os aneurismas cerebrais. São aneurismas de difícil acesso cirúrgico. Relatamos caso de aneurisma gigante nesse segmento da ACP.

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Section: Discussionunclassified

[No Title Available]

Pereira¹,

Ramalho²,

Pereira³

et al. 1995

Arq. Neuro-Psiquiatr.

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“…39 Similar pathological findings have been published by other authors. 5,12,14,20,24,41,44 The origin of giant serpentine aneurysms is still uncertain. Because these aneurysms do not present at arterial branch points as do typical saccular aneurysms and because they have different clinical presentations, they may represent a different pathophysiology; thus, serpentine aneurysms are different from saccular aneurysms.…”

Section: Radiographic Characteristicsmentioning

confidence: 99%

Giant serpentine aneurysms

Christiano¹,

Gupta²,

Prestigiacomo³

et al. 2009

FOC

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Segal and McLaurin first described giant serpentine aneurysms, based on their distinct angiographic features, in 1977. These lesions are ≥ 25 mm, partially thrombosed aneurysms with a patent, serpiginous vascular channel that courses through the aneurysm. There is a separate inflow and outflow of the aneurysm, of which the outflow channel supplies brain parenchyma in the territory of the parent vessel. Given the large size, unique neck, and dependent distal vessels, these aneurysms pose a technical challenge in treatment. Initial management has included surgical obliteration, but as endovascular techniques have evolved, treatment options too have expanded. In this review the authors attempt to summarize the existing body of literature on this rare entity and describe some of their institutional management strategies.

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“…The aneurysms of surgical segment S 1 can be explored through a pterional-transsylvian, the aneurysms of $2 segment through a subtemporal, and the aneurysms of $3 segment through a posterior interhemispheric approach [5]. The authors propose for the exploration of aneurysms in $2 segment subtemporal-transventricular approach, which requires in their description "recsection of a small portion of brain tissue".…”

Section: Commentsmentioning

confidence: 99%

“…Thus, a detailed knowledge of the anatomical relationships of such aneurysms is essential to the surgical management and to the proper selection of the best surgical approach. As these aneurysms can be distributed anywhere [1,5,13,15,17,18,20] along the artery we have found it necessary to develop a classification that could give the rationale to approach each location.…”

Section: Introductionmentioning

confidence: 99%

Management strategies for posterior cerebral artery aneurysms: A proposed new surgical classification

et al. 1997

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In a period of 10 years fifteen patients bearing sixteen aneurysms arising at the posterior cerebral artery were operated at our institution. Based on the approaches selected for each location a division of the posterior cerebral artery into three surgical segments is proposed. The first segment (S1), or anterior extends from the basilar artery bifurcation to the point where the artery reaches the level of the most lateral edge of the cerebral peduncle, the second segment (S2), or middle extends from the posterior limit of S1 to a point located just before the most medial extent of the artery in the quadrigeminal cistern (collicular point), and the third segment (S3), or posterior corresponds to the collicular point and to the portions of the posterior cerebral artery distal to it. Utilizing the concept of surgical segments all aneurysms in our series were satisfactorily exposed. Those arising at the S1 segment (8 cases) were operated either through a pterional or a pretemporal approaches; those from the S2 segment (6 cases) were operated either via the subtemporal or the subtemporal transventricular routes; and that arising from the S3 segment (1 case) was managed through the occipital interhemispheric approach. Among the aneurysms eleven were small, one was large, and four were large or giant. Ten of these aneurysms were surgically clipped, two coagulated, three treated by trapping and in one case the aneurysm was resected and the posterior cerebral artery was reconstructed by a termino-terminal anastomosis. The surgical results were considered good in all cases but one, where the patient died due to clinical complications three months after surgery. It is our belief that the use of this classification can provide the means to best select the most appropriate surgical approach to treat aneurysms arising at the posterior cerebral artery.

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Giant Serpentine Aneurysm of the Posterior Cerebral Artery

Cited by 39 publications

References 0 publications

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Giant serpentine aneurysms

Management strategies for posterior cerebral artery aneurysms: A proposed new surgical classification

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