Microsurgical Clip Ligation of an Unruptured Azygos Bifurcation Aneurysm Indented by the Falx Cerebri: 3-Dimensional Operative Video.
Oper Neurosurg (Hagerstown)
; 19(3): E294, 2020 Sep 01.
Article
en En
| MEDLINE
| ID: mdl-31930321
ABSTRACT
Dissecting pericallosal aneurysms from the falx cerebri is technically challenging, as one must release the adherent dome but minimize shearing injury, which could result in intraoperative rupture. We discuss a 51-yr-old woman with a history of hypertension and smoking who presented with severe headaches and was found to have a 6-mm unruptured, multilobulated pericallosal aneurysm abutting the falx, with anterior and superior projecting domes on either side. She also had an azygos anterior cerebral artery (ACA), a rare anatomic variant associated with pericallosal aneurysms, where both A1 segments form a single A2. After considering endovascular and open surgical techniques, we proceeded with clip ligation given her younger age, smoking history, daughter aneurysms seen on angiography, and azygos ACA. We positioned her supine with her head turned lateral, left side down to maximize gravitational retraction, mapped a bicoronal incision, and performed a small craniotomy, followed by an interhemispheric approach. Rather than cutting the falx around the dome, a described technique that risks blind vessel injury, we temporarily clipped inflow vessels to reduce the dome's turgor and sharply and bluntly dissected apart its attachments, which freed the aneurysm from beneath the falx and allowed visualization of associated vessels. Using suction to manipulate the dome, we then placed stacked, angled clips, and used a micro-Doppler to confirm brisk inflow and outflow. Postoperatively, she was neurologically intact, and her angiogram showed no residual aneurysm. Our 3-dimensional video demonstrates a safer, alternative approach to treating this rare aneurysm with its associated anatomical variant. Patient consented to her clinical presentation and microscope media being used for academic purposes.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Aneurisma Intracraneal
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Disección Aórtica
Tipo de estudio:
Clinical_trials
Límite:
Female
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Humans
Idioma:
En
Revista:
Oper Neurosurg (Hagerstown)
Año:
2020
Tipo del documento:
Article
Pais de publicación:
EEUU
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ESTADOS UNIDOS
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ESTADOS UNIDOS DA AMERICA
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EUA
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UNITED STATES
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UNITED STATES OF AMERICA
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US
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USA