Türk Nöroşirürji Dergisi
2018 , Vol 28 , Num 1
Surgical Treatment of Proximal Anterior Cerebral Artery and Anterior Communicating Artery Aneurysms
1Sağlık Bilimleri Üniversitesi, Ankara Numune Eğitim ve Araştırma Hastanesi, Beyin ve Sinir Cerrahisi Kliniği, Ankara, Türkiye
Proximal anterior cerebral artery (A1) aneurysms are dangerous aneurysms in terms of clinical progression, although they are rare and
of small size. The size is usually less than 2-2.5 mm, so patients who present with subarachnoid hemorrhage (SAH) or intracerebral
hematoma require repeat digital subtraction angiography (DSA) even if the original DSA does not detect any aneurysm. Because
of the high risk of rupture of incidental A1 aneurysms, it is necessary to treat them regardless of their size. The A1 aneurysms often
arise from the proximal vicinity of the perforating branches. In a preoperative A1 aneurysm, the relationships between the parent
A1, Heubner" recurrent artery and other perforating branches, optic chiasm and inferior frontal lobe should be examined in detail.
Anterior communicating artery (AComA) aneurysms are complex, large and giant aneurysms. In the AComA aneurysm surgery,
as in A1 aneurysms, a detailed examination of the patient"s vasculature and AComA complex variations before surgery is crucial
for orientation at the time of dissection. The projection of AComA aneurysms may be to the anterior, posterior, inferior or superior
side. Therefore, it is necessary to reveal the 12 major arteries during AComA aneurysm dissection. Flow control with micro-doppler
should be routinely performed after clipping in both A1 and AComA aneurysms.
Anahtar Kelimeler :
Aneurysm, Proximal anterior cerebral artery, Anterior communicating artery aneurysm, Recurrent artery of Heubner