J Korean Neurosurg Soc.  2012 Nov;52(5):501-504. 10.3340/jkns.2012.52.5.501.

Surgical Treatment of Giant Serpentine Aneurysm of A2-A3 Segment Distal Anterior Cerebral Artery : Technical Case Report

• Moon HS
• Kim TS
• Joo SP

• KMID: 2018262
• DOI: http://doi.org/10.3340/jkns.2012.52.5.501

Abstract

OBJECTIVE
To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping.
METHODS
A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant (30x18 mm sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow.
CONCLUSION
Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.

Keyword

Aneurysm; Trapping; Distal anterior cerebral artery; Bypass

MeSH Terms

Aneurysm
Angiography
Anterior Cerebral Artery
Brain
Cerebral Angiography
Female
Headache
Humans
Intracranial Aneurysm
Unconsciousness

Figure

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  Fig. 1 Non-contrast computed tomography demonstrating a 3×1.8 cm sized, rim calcified, and bilobulated mass lesion in the above corpus callosum. B : Brain T2-weighted magnetic resonance image revealed partially thrombosed, signal voided aneurysm. C : Cerebral angiography showing a 4.5×1.8 cm sized, irregular serpentine aneurysm. D : 3-D angiography image of the aneurysm involving the entire A2 segment of the distal anterior cerebral artery. E : Entire scheme of distal anterior cerebral artery serpentine giant fusiform aneurysm.

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  Fig. 2 Intraoperative findings. A : 4×4 cm sized bone flap is made and dural flap is reflected after cutting the superior sagittal sinus. B : Atherosclerotic distal end of aneurysm is seen at the top. C : Both olfactory nerves are intact and dissected well. D : End to side bypass. E : Atherosclerotic, calcified aneurysm with small opening for blood aspiration.

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  Fig. 3 A : Postoperative computed tomography scan showing a placed clip and no hemorrhagic contusion. B : Follow-up angiography demonstrating good patency of bypass (arrow). C : Follow-up T2-weighted magnetic resonance image showing reduced aneurysm size. D : Follow-up T2-weighted magnetic resonance image showing reduced aneurysm size.

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