- citati u SCIndeksu: 0
- citati u CrossRef-u:0
- citati u Google Scholaru:[
]
- posete u poslednjih 30 dana:7
- preuzimanja u poslednjih 30 dana:1
|
|
2020, vol. 77, br. 7, str. 746-750
|
Nerupturisane distalne identične bilateralne aneurizme prednjih moždanih arterija udružene sa rupturisanom aneurizmom srednje moždane arterije
Unruptured distal anterior cerebral artery mirror aneurysms associated with ruptured middle cerebral artery aneurysm: A case report
aUniverzitet u Beogradu, Medicinski fakultet, Srbija + Klinički centar Srbije, Klinika za neurohirurgiju, Beograd, Srbija bUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Srbija + Klinički centar Kragujevac, Centar za neurohirurgiju, Srbija cKlinički centar Srbije, Klinika za neurohirurgiju, Beograd, Srbija dKlinički centar Srbije, Centar za radiologiju i magnetnu rezonancu, Beograd, Srbija
e-adresa: lukas.rasulic@gmail.com
Sažetak
Uvod. Aneurizme distalnog segmenta prednje moždane arterije [distal anterior cerebral artery (DACA)], takođe poznate kao perikalozna arterija, retke su, dok su bilateralne aneurizme u identičnoj poziciji ekstremno retke. Te aneurizme imaju veliku tendenciju ka rupturi (PHASES skor je uvek > 4). U više od polovine bolesnika sa rupturom DACA aneurizme formira se intracerebralni hematom, koji je prediktor lošeg ishoda lečenja. Prikaz bolesnika. Bolesnica, stara 49 godina je, zbog rupture aneurizme na srednje-moždanoj arteriji [middle cerebral artery (MCA)], prethodno lečena endovaskularnom procedurom u drugoj ustanovi, kada su dijagnostikovane i dve male simetrične aneurizme na DACA obostrano. Dimenzija leve aneurizme bila je 4,5 mm, a desne 6 mm, dok su širine vrata bile 3 mm, odnosno 4 mm. Tada je interventni radiolog doneo odluku da leči samo krvareću aneurizmu na MCA. Bolesnica je upućena u našu ustanovu 6 meseci kasnije i doneta je odluka da se sprovede mikrohirurško lečenje aneurizmi na DACA. Uz pomoć unilateralnog interhemisferičnog pristupa i mikrohirurške tehnike obe simetrične aneurizme na kalozo-kalozomarginalnom spoju isključene su iz cirkulacije. Zaključak. Lečenje DACA aneurizmi je hirurški izazov, čak i za iskusne neurohirurge. I dalje postoji kontroverza u vezi izbora modaliteta lečenja - mikrohirurgija ili endovaskularna procedura, pogotovu u slučajevima kada se coiling u istom aktu sa udruženim aneurizmama čini kao odličan izbor. Zbog tendencije ka ranoj rupturi tih aneurizmi, mikrohirurško lečenje ne treba odlagati. Obavezna je provera postojanja udruženih aneurizmi.
Abstract
Introduction. Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal aneurysms are rare, while aneurysms in mirror position are extremely rare. These aneurysms have high tendency for rupture (PHASES score is always > 4). In more than a half of the patients with the DACA aneurysm rupture, imaging reveals intracerebral hematoma which is a predictor of poor outcome. Case report. A 49-year-old female patient was treated endovascularly in other institution, due to middle cerebral artery aneurysm (MCA) rupture, when the two small bilateral aneurysms at the distal segments of anterior cerebral artery (ACA) were revealed, left one measuring 4.5 mm and the right one measuring 6 mm in size, with the aneurysmal neck width of 3 mm and 4 mm, respectively. The decision was made by the interventional neuroradiologist only to treat the bleeding MCA aneurysm immediately. The patient was referred to our department six months later, and it was decided to perform microsurgical occlusion of the remaining DACA aneurysms. Unilateral interhemispheric approach was chosen to reach the distal ACAs and aneurysms at pericallosal-callosomarginal junction were clipped and completely excluded from the circulation. Conclusion. Management of DACA aneurysms is a surgical challenge, even for experienced neurosurgeons. It is controversial whether these should be surgically clipped or coiled endovascularly, especially in cases like this one when a same-stage, endovascular coiling might look like a perfect approach. Surgical treatment should be prompt due to their tendency to early rupture. Careful evaluation for multiplicity is mandatory.
|
|
|
Reference
|
|
Andrade-Barazarte, H., Kivelev, J., Goehre, F., Jahromi, B.R., Noda, K., Ibrahim, T.F., et al. (2015) Contralateral approach to bilateral middle cerebral artery aneurysms: Comparative study, angiographic analysis, and surgical results. Neurosurgery, 77(6): 916-26; discussion 926
|
|
Dashti, R., Hernesniemi, J., Lehto, H., Niemelä, M., Lehecka, M., Rinne, J., et al. (2007) Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol, 68(4): 366-77
|
|
de Sousa, A.A., Rolemberg, D.F.L., de Carvalho, G.T.C., Costa, B.S. (1999) Distal anterior cerebral artery aneurysms. Surgical Neurology, 52(2): 128-136; discussion 135-6
|
|
Gherasim, D.N., Gyorki, G., Balasa, A. (2017) Single center experience and technical nuances in the treatment of distal anterior cerebral artery aneurysms. Romanian Neurosurgery, 31(1): 17-24
|
|
Greving, J.P., Wermer, M.J.H., Brown, R.D. J., Morita, A., Juvela, S., Yonekura, M., Ishibashi, T., Torner, J.C., Nakayama, T., Rinkel, G.J.E., Algra, A. (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: A pooled analysis of six prospective cohort studies. Lancet Neurology, 13(1): 59-66
|
|
Inci, S., Akbay, A., Ozgen, T. (2012) Bilateral middle cerebral artery aneurysms: A comparative study of unilateral and bilateral approaches. Neurosurgical Review, 35(4): 505-518; discussion 517-8
|
|
Kwon, T.H., Chung, H.S., Lim, D.J., Park, J.Y., Park, Y.K., Lee, H.K., Suh, J.K. (2001) Distal anterior cerebral artery aneurysms: Clinical features and surgical outcome. Journal of Korean Medical Science, 16(2): 204-208
|
|
Laitinen, L., Snellman, A. (1960) Aneurysms of the pericallosal artery: A study of 14 cases verified angiographically and treated mainly by direct surgical attack. J Neurosurg, 17: 447-58
|
|
Lee, J.W., Lee, K.C., Kim, Y.B., Huh, S.K. (2008) Surgery for distal anterior cerebral artery aneurysms. Surgical Neurology, 70(2): 153-159; discussion 159
|
|
Lehecka, M., Lehto, H., Niemelä, M., Juvela, S., Dashti, R., Koivisto, T., et al. (2008) Distal anterior cerebral artery aneurysms: Treatment and outcome analysis of 501 patients. Neurosurgery, 62(3): 590-601; discussion 590-601
|
|
Lehecka, M., Porras, M., Dashti, R., Niemelä, M., Hernesniemi, J.A. (2008) Anatomic features of distal anterior cerebral artery aneurysms: A detailed angiographic analysis of 101 patients. Neurosurgery, 63(2): 219-28; discussion 228-9
|
|
Lehecka, M., Dashti, R., Lehto, H., Kivisaari, R., Niemelä, M., Hernesniemi, J. (2010) Distal anterior cerebral artery aneurysms. u: Acta neurochir suppl: Surgical management of cerebrovascular disease, 107: 15-26
|
|
Monroy-Sosa, A., Nathal, E., Rhoton, A.L. J. (2017) Operative management of distal anterior cerebral artery aneurysms through a mini anterior interhemispheric approach. World Neurosurgery, 108: 519-528
|
|
Mori, T., Fujimoto, M., Shimada, K., Shin, H., Sakakibara, T., Yamaki, T. (1995) Kissing aneurysms of distal anterior cerebral arteries demonstrated by magnetic resonance angiography. Surgical Neurology, 43(5): 497-499
|
|
Nguyen, T.N., Raymond, J., Roy, D., Chagnon, M., Weill, A., Iancu-Gontard, D., Guilbert, F. (2007) Endovascular treatment of pericallosal aneurysms. Journal of Neurosurgery, 107(5): 973-976
|
|
Niijima, K.H., Yonekawa, Y., Kawano, T. (1989) Bilateral pericallosal artery aneurysms in a mirror position. No Shinkei Geka, 17(8): 779-81. (Japanese)
|
|
Ohno, K., Monma, S., Suzuki, R., Masaoka, H., Matsushima, Y., Hirakawa, K. (1990) Saccular aneurysms of the distal anterior cerebral artery. Neurosurgery, 27(6): 907-12; discussion 912-3
|
|
Orz, Y. (2011) Surgical strategies and outcomes for distal anterior cerebral arteries aneurysms. Asian Journal of Neurosurgery, 6(1): 13-17
|
|
Petr, O., Coufalová, L., Bradáč, O., Rehwald, R., Glodny, B., Beneš, V. (2017) Safety and efficacy of surgical and endovascular treatment for distal anterior cerebral artery aneurysms: A systematic review and meta-analysis. World Neurosurgery, 100: 557-566
|
|
Şekerci, Z., Şanlı, M., Ergün, R., Oral, N. (2011) Aneurysms of the distal anterior cerebral artery: A clinical series. Neurologia i Neurochirurgia Polska, 45(2): 115-120
|
|
Seo, J.S., Choi, J.H., Huh, J.T. (2011) Clinical features of distal anterior cerebral artery aneurysm and treatment outcomes. Kor J Cerebrovasc Surg, 13(2): 93-101
|
|
Sindou, M., Pelissou-Guyotat, I., Mertens, P., Keravel, Y., Athayde, A.A. (1988) Pericallosal aneurysms. Surgical Neurology, 30(6): 434-440
|
|
Snyckers, F.D., Drake, C.G. (1973) Aneurysms of the distal anterior cerebral artery: A report on 24 verified cases. S Afr Med J, 47(39): 1787-91
|
|
Sousa, J., Iyer, V., Roberts, G. (2002) 'Mirror image' distal anterior cerebral artery aneurysms: A case report of two patients with review of literature. Acta Neurochirurgica, Wien, 144(9): 933-935; discussion 935
|
|
Sturiale, C.L., Brinjikji, W., Murad, M.H., Cloft, H.J., Kallmes, D.F., Lanzino, G. (2013) Endovascular treatment of distal anterior cerebral artery aneurysms: Single-center experience and a systematic review. American Journal of Neuroradiology (AJNR), 34(12): 2317-2320
|
|
Sugar, O., Tinsley, M. (1948) Aneurysm of terminal portion of anterior cerebral artery. Archives of Neurology And Psychiatry, 60(1): 81-85
|
|
Wisoff, J.H., Flamm, E.S. (1987) Aneurysms of the distal anterior cerebral artery and associated vascular anomalies. Neurosurgery, 20(5): 735-41
|
|
Yasargil, M. (1984) Surgery of the intracranial aneurysms and results. u: Yasargil M.G. [ur.] Microsurgery: Vol II: Clinical considerations, Stuttgart: George Thieme Verlag, p. 224-31
|
|
|
|