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Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options.
J Neurosurg 2014; 120(6):1364-77JN

Abstract

OBJECT

The authors describe their experience with intracranial-to-intracranial (IC-IC) bypasses for complex anterior cerebral artery (ACA) aneurysms with giant size, dolichoectatic morphology, or intraluminal thrombus; they determine how others have addressed the limitations of ACA bypass; and they discuss clinical indications and microsurgical technique.

METHODS

A consecutive, single-surgeon experience with ACA aneurysms and bypasses over a 16-year period was retrospectively reviewed. Bypasses for ACA aneurysms reported in the literature were also reviewed.

RESULTS

Ten patients had aneurysms that were treated with ACA bypass as part of their surgical intervention. Four patients presented with subarachnoid hemorrhage and 3 patients with mass effect symptoms from giant aneurysms; 1 patient with bacterial endocarditis had a mycotic aneurysm, and 1 patient's meningioma resection was complicated by an iatrogenic pseudoaneurysm. One patient had his aneurysm discovered incidentally. There were 2 precommunicating aneurysms (A1 segment of the ACA), 5 communicating aneurysms (ACoA), and 3 postcommunicating (A2-A3 segments of the ACA). In situ bypasses were used in 4 patients (A3-A3 bypass), interposition bypasses in 4 patients, reimplantation in 1 patient (pericallosal artery-to-callosomarginal artery), and reanastomosis in 1 patient (pericallosal artery). Complete aneurysm obliteration was demonstrated in 8 patients, and bypass patency was demonstrated in 8 patients. One bypass thrombosed, but 4 years later. There were no operative deaths, and permanent neurological morbidity was observed in 2 patients. At last follow-up, 8 patients (80%) were improved or unchanged. In a review of the 29 relevant reports, the A3-A3 in situ bypass was used most commonly, extracranial (EC)-IC interpositional bypasses were the second most common, and reanastomosis and reimplantation were used the least.

CONCLUSIONS

Anterior cerebral artery aneurysms requiring bypass are rare and can be revascularized in a variety of ways. Anterior cerebral artery aneurysms, more than any other aneurysms, require a thorough survey of patient-specific anatomy and microsurgical options before deciding on an individualized management strategy. The authors' experience demonstrates a preference for IC-IC reconstruction, but EC-IC bypasses are reported frequently in the literature. The authors conclude that ACA bypass with indirect aneurysm occlusion is a good alternative to direct clip reconstruction for complex ACA aneurysms.

Authors+Show Affiliations

Department of Neurological Surgery, University of California, San Francisco, California.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

24745711

Citation

Abla, Adib A., and Michael T. Lawton. "Anterior Cerebral Artery Bypass for Complex Aneurysms: an Experience With Intracranial-intracranial Reconstruction and Review of Bypass Options." Journal of Neurosurgery, vol. 120, no. 6, 2014, pp. 1364-77.
Abla AA, Lawton MT. Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. J Neurosurg. 2014;120(6):1364-77.
Abla, A. A., & Lawton, M. T. (2014). Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. Journal of Neurosurgery, 120(6), pp. 1364-77. doi:10.3171/2014.3.JNS132219.
Abla AA, Lawton MT. Anterior Cerebral Artery Bypass for Complex Aneurysms: an Experience With Intracranial-intracranial Reconstruction and Review of Bypass Options. J Neurosurg. 2014;120(6):1364-77. PubMed PMID: 24745711.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior cerebral artery bypass for complex aneurysms: an experience with intracranial-intracranial reconstruction and review of bypass options. AU - Abla,Adib A, AU - Lawton,Michael T, Y1 - 2014/04/18/ PY - 2014/4/22/entrez PY - 2014/4/22/pubmed PY - 2014/9/30/medline KW - ACA = anterior cerebral artery KW - ACoA = anterior communicating artery KW - EC = extracranial KW - ELANA = excimer laser-assisted nonocclusive anastomosis KW - IC = intracranial KW - MCA = middle cerebral artery KW - PCA = posterior cerebral artery KW - RAG = radial artery graft KW - STA = superficial temporal artery KW - SVG = saphenous vein graft KW - aneurysm KW - anterior cerebral artery KW - bypass KW - mRS = modified Rankin Scale KW - vascular disorders SP - 1364 EP - 77 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 120 IS - 6 N2 - OBJECT: The authors describe their experience with intracranial-to-intracranial (IC-IC) bypasses for complex anterior cerebral artery (ACA) aneurysms with giant size, dolichoectatic morphology, or intraluminal thrombus; they determine how others have addressed the limitations of ACA bypass; and they discuss clinical indications and microsurgical technique. METHODS: A consecutive, single-surgeon experience with ACA aneurysms and bypasses over a 16-year period was retrospectively reviewed. Bypasses for ACA aneurysms reported in the literature were also reviewed. RESULTS: Ten patients had aneurysms that were treated with ACA bypass as part of their surgical intervention. Four patients presented with subarachnoid hemorrhage and 3 patients with mass effect symptoms from giant aneurysms; 1 patient with bacterial endocarditis had a mycotic aneurysm, and 1 patient's meningioma resection was complicated by an iatrogenic pseudoaneurysm. One patient had his aneurysm discovered incidentally. There were 2 precommunicating aneurysms (A1 segment of the ACA), 5 communicating aneurysms (ACoA), and 3 postcommunicating (A2-A3 segments of the ACA). In situ bypasses were used in 4 patients (A3-A3 bypass), interposition bypasses in 4 patients, reimplantation in 1 patient (pericallosal artery-to-callosomarginal artery), and reanastomosis in 1 patient (pericallosal artery). Complete aneurysm obliteration was demonstrated in 8 patients, and bypass patency was demonstrated in 8 patients. One bypass thrombosed, but 4 years later. There were no operative deaths, and permanent neurological morbidity was observed in 2 patients. At last follow-up, 8 patients (80%) were improved or unchanged. In a review of the 29 relevant reports, the A3-A3 in situ bypass was used most commonly, extracranial (EC)-IC interpositional bypasses were the second most common, and reanastomosis and reimplantation were used the least. CONCLUSIONS: Anterior cerebral artery aneurysms requiring bypass are rare and can be revascularized in a variety of ways. Anterior cerebral artery aneurysms, more than any other aneurysms, require a thorough survey of patient-specific anatomy and microsurgical options before deciding on an individualized management strategy. The authors' experience demonstrates a preference for IC-IC reconstruction, but EC-IC bypasses are reported frequently in the literature. The authors conclude that ACA bypass with indirect aneurysm occlusion is a good alternative to direct clip reconstruction for complex ACA aneurysms. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/24745711/Anterior_cerebral_artery_bypass_for_complex_aneurysms:_an_experience_with_intracranial_intracranial_reconstruction_and_review_of_bypass_options_ L2 - https://thejns.org/doi/10.3171/2014.3.JNS132219 DB - PRIME DP - Unbound Medicine ER -