The Implication of Anterior Communicating Complex Rotation and 3-Dimensional Computerized Tomography Angiography Findings in Surgical Approach to Anterior Communicating Artery Aneurysms

Dehdashti, Amir R.; Chiluwal, Amrit; Regli, Luca

doi:10.1016/j.wneu.2016.03.051

Cited by 19 publications

(10 citation statements)

References 30 publications

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“…The difficulty of clipping AcomA aneurysm depends on the aneurysm size, dome projection, height from the anterior frontal base, and relationship with the parent artery. [ 3 7 8 9 12 ] The selection of the pterional or interhemispheric approach also depends on the aneurysm size, dome projection, and height from the anterior frontal base. [ 3 7 8 9 12 ] Our protocol is similar.…”

Section: Discussionmentioning

confidence: 99%

“…The difficulty of clipping AcomA aneurysm depends on the aneurysm size, direction, positional relationship with the parent artery, and height from the anterior frontal base. [ 3 7 8 9 12 ] The usefulness of three-dimensional computed tomography angiography (3D-CTA) in the evaluation of these structure and aneurysm is well established. [ 3 5 ] Our protocol is to use the pterional approach to clip aneurysms which are relatively small, with low height between the neck of the aneurysm and anterior frontal base and dome projection other than posterior.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 7 8 9 12 ] The usefulness of three-dimensional computed tomography angiography (3D-CTA) in the evaluation of these structure and aneurysm is well established. [ 3 5 ] Our protocol is to use the pterional approach to clip aneurysms which are relatively small, with low height between the neck of the aneurysm and anterior frontal base and dome projection other than posterior. Previous studies have investigated the selection of surgical approach based on the vertical distance between the aneurysm and anterior frontal base, but not the correlation between the horizontal distance from the anterior clinoid process and postoperative outcome.…”

Section: Introductionmentioning

confidence: 99%

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Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

et al. 2017

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Background:The difficulty of clipping aneurysm of the anterior communicating artery (AcomA) depends on the size, direction, positional relationship with the parent artery, and height from the anterior frontal base. Cases of clipping unruptured AcomA aneurysm through pterional approach were analyzed to investigate the importance of the horizontal distance from the base of the anterior clinoid process.Methods:Twenty-six consecutive unruptured AcomA aneurysms were treated by clipping through pterional approach in 10 males and 11 females aged 37–77 years (mean 61.8 years). Size and direction of the aneurysm, and vertical distance from the anterior frontal base and horizontal distance from the base of the anterior clinoid process were measured by preoperative three-dimensional computed tomography angiography (3D-CTA). Correlations with occurrence of clinical complications and computed tomography (CT) abnormalities after operation were investigated.Results:The aneurysms had a mean size of 4.7 mm (range 2.1–8.9 mm). Three patients suffered complications and all had anosmia. Three patients had CT abnormality and all were contusion. The mean horizontal distance from the base of the anterior clinoid process was −4.7 mm (range −12.3–3.5 mm). The patients were divided into the anterior and posterior groups with the boundary set at −5 mm. There were no significant complications between two groups (P = 0.26). There were statistically significant CT abnormalities in posterior group (P = 0.025).Conclusion:The horizontal distance from the base of the anterior clinoid process is important to predict CT abnormalities and complications in clipping of AcomA aneurysm through pterional approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

et al. 2017

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“…3 The surgeon must consider A1 dominance pattern, 4 projection of the dome of the aneurysm, ACoA angle, 5 and rotation of the A2 fork 6 when planning treatment strategy. 7 Aneurysms that project posteriorly with medial rotation of the dome of the aneurysm and of the A2 fork are a challenge because the neck of the aneurysm is hidden and perforators may be in the way of a potential clip.…”

Section: Introductionmentioning

confidence: 99%

A1–A2 Fenestration Tube Technique for Clipping a Ruptured Anterior Communicating Artery Aneurysm

et al. 2019

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A fenestration tube is a clipping reconstruction technique that allows the preservation of critical vessels in aneurysm surgery. A patient with a ruptured anterior communicating artery (ACoA) aneurysm with a posterior projection was admitted to our neurosurgery unit. A right dominant A1 with rotation of the A2 fork was observed on preoperative computed tomography angiography (CTA). During surgery, we observed that the recurrent artery of Heubner branched off the A2 just distal to the neck of the aneurysm. Successful clipping was achieved by building an “A1–A2 fenestration tube,” with preservation of the recurrent artery and of the ACoA perforators. Surgical nuances and the advantages of fenestration tubes are discussed.

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“…This case is a presentation of one possible approach for repair of an unruptured rotated anterior communicating artery aneurysm . The patient presented with headaches and was found to have a 6 mm anterior communicating artery aneurysm.…”

mentioning

confidence: 98%

Microsurgical clipping of an unruptured superiorly projecting ACoM aneurysm in a rotated ACoM complex

Glauser

Choudhri

2019

Clinical Case Reports

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Key Clinical Message This case illustrates surgical technique for wide neck aneurysm clipping in a rotated complex and how to manage intraoperative aneurysm rupture while maintaining hemostasis (Cai et al., Anterior communicating artery aneurysm morphology and the risk of rupture. World Neurosurg. 2018;109:119 and Dehdashti et al., The implication of anterior communicating complex rotation and 3‐dimensional computerized tomography angiography findings in surgical approach to anterior communicating artery aneurysms. World Neurosurg. 2016;91:34).

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The Implication of Anterior Communicating Complex Rotation and 3-Dimensional Computerized Tomography Angiography Findings in Surgical Approach to Anterior Communicating Artery Aneurysms

Cited by 19 publications

References 30 publications

Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

Horizontal distance of anterior communicating artery aneurysm neck from anterior clinoid process is critically important to predict postoperative complication in clipping via pterional approach

A1–A2 Fenestration Tube Technique for Clipping a Ruptured Anterior Communicating Artery Aneurysm

Microsurgical clipping of an unruptured superiorly projecting ACoM aneurysm in a rotated ACoM complex

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