Türk Nöroşirürji Dergisi 2018 , Vol 28 , Num 1
Surgical Treatment of Proximal Anterior Cerebral Artery and Anterior Communicating Artery Aneurysms
Özhan Merzuk UÇKUN1,Deniz DİVANLIOĞLU1,Ahmet Deniz BELEN1
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