Surgical revascularization for the treatment of complex anterior cerebral artery aneurysms: Experience and illustrative review.

Surgical revascularization for the treatment of complex anterior cerebral artery aneurysms: Experience and illustrative review.

World Neurosurg. 2017 Dec 27;:

Authors: Lee SH, Jung Y, Ryu JW, Choi SK, Kwun BD

Abstract
BACKGROUND: A variety of methods for tackling complex anterior cerebral artery (ACA) aneurysms are available; however, there is substantial variation among methods because of various aneurysm locations, the relationship of the aneurysm to arterial branches, aneurysm size and other morphological characteristics, and/or the diameters of the parent or branching arteries.
METHODS: We review complex ACA aneurysm cases based on both our own experience as well as the available literature. Each unique case is analyzed in terms of the characteristics of the aneurysm, along with an analysis and classification of the revascularization method used. Computer tablet-drawn illustrations of every unique technique are provided for easy comprehension and application in various possible situations.
RESULTS: Over the prior six years, we have treated a total of five cases of complex ACA aneurysms (one precommunicating, one communicating, one postcommunicating, and two precallosal-supracallosal segment) with revascularization. Side-to-side anastomosis was performed between A3-A3 in three cases, between A4-A4 in another case, and between the ipsilateral callosomarginal artery-pericallosal in the remaining case. Final modified Rankin scale was 0 in four of the five cases, and three in one case. Six treatment strategies were used for the precommunicating case, eight for the communicating case, seven for the postcommunicating case, and nine for the two precallosal-supracallosal segment aneurysms.
CONCLUSION: Treatment of complex ACA aneurysms should be tailored according to the location and nature of the aneurysm, as well as collateral circulation. Viable and feasible treatment strategies must be established by the neurovascular surgeon.

PMID: 29288845 [PubMed - as supplied by publisher]

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