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In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video

In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment... Abstract Here we present a 46-yr-old man with recurrent syncopal episodes thought to be of cardiac origin. He was eventually found to harbor a giant, partially thrombosed, saccular aneurysm arising from the A1/A2 segment of the right anterior cerebral artery with foramen of Monro obstruction and a trapped left-sided ventricular system. An azygous left A2 artery segment supplied both callosomarginal arteries. We performed an in situ side-to-side anastomosis between the distal left azygous anterior cerebral artery and the right pericallosal artery, which was previously supplied by the right A1. The right A1 was clip ligated, and the aneurysm evacuated with an ultrasonic aspirator. Postoperatively, the patient did well with no recurrence of the aneurysm and resolution of his preoperative obstructive hydrocephalus. He continues to be independent >7 yr post surgery. His 6-mo follow-up angiogram revealed a patent bypass. Side-to-side bypass, Giant aneurysm, Technique video, Ultrasonic aspiration, ACA side-to-side bypass Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy110 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy110 In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video Close COMMENTS We commend the authors on their well-organized and technically proficient surgical video, presenting the surgical management of a giant, partially thrombosed aneurysm found at the A1/A2 segment of the anterior cerebral artery. With the present shift towards finding endovascular solutions for these complex aneurysms, employing a surgical solution by performing a well demonstrated side-to-side bypass between the left azygous anterior cerebral artery to right pericallosal artery has vital contribution for cerebrovascular neurosurgeons nowadays, enabling them to learn and consolidate skills as confronting these type of complex aneurysms is exceedingly rare and challenging. We will see more and more that practitioners and teams will gravitate towards an endovascular solution. Still it has to be remembered that long-term durability of the solution achieved by surgical or interventional means does not always go along with the ease of the solution or perceived or real measure of invasiveness at the time of the intervention. Competent and effective surgical solutions such as presented in this video remain a critical part of the surgical toolset of the cerebrovascular surgeon or multi-disciplinary team managing these challenging patients. Clemens M. Schirmer Oded Goren Danville, Pennsylvania This is an excellent educational operative video showing an elegant solution to rare and complex pathology. This case highlights why microdissection and microanastomosis bypass skills remain important training components for any neurosurgical residency program and remain imperative for those training in cerebrovascular fellowships. Nicolas K. Khattar Robert F. James Louisville, Kentucky Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
DOI
10.1093/ons/opy110
Publisher site
See Article on Publisher Site

Abstract

Abstract Here we present a 46-yr-old man with recurrent syncopal episodes thought to be of cardiac origin. He was eventually found to harbor a giant, partially thrombosed, saccular aneurysm arising from the A1/A2 segment of the right anterior cerebral artery with foramen of Monro obstruction and a trapped left-sided ventricular system. An azygous left A2 artery segment supplied both callosomarginal arteries. We performed an in situ side-to-side anastomosis between the distal left azygous anterior cerebral artery and the right pericallosal artery, which was previously supplied by the right A1. The right A1 was clip ligated, and the aneurysm evacuated with an ultrasonic aspirator. Postoperatively, the patient did well with no recurrence of the aneurysm and resolution of his preoperative obstructive hydrocephalus. He continues to be independent >7 yr post surgery. His 6-mo follow-up angiogram revealed a patent bypass. Side-to-side bypass, Giant aneurysm, Technique video, Ultrasonic aspiration, ACA side-to-side bypass Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy110 View largeDownload slide Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy110 In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video In Situ Left Azygous Anterior Cerebral Artery to Right Pericallosal Artery Bypass for Treatment of a Giant Right A1/2 Aneurysm: 2-Dimensional Operative Video Close COMMENTS We commend the authors on their well-organized and technically proficient surgical video, presenting the surgical management of a giant, partially thrombosed aneurysm found at the A1/A2 segment of the anterior cerebral artery. With the present shift towards finding endovascular solutions for these complex aneurysms, employing a surgical solution by performing a well demonstrated side-to-side bypass between the left azygous anterior cerebral artery to right pericallosal artery has vital contribution for cerebrovascular neurosurgeons nowadays, enabling them to learn and consolidate skills as confronting these type of complex aneurysms is exceedingly rare and challenging. We will see more and more that practitioners and teams will gravitate towards an endovascular solution. Still it has to be remembered that long-term durability of the solution achieved by surgical or interventional means does not always go along with the ease of the solution or perceived or real measure of invasiveness at the time of the intervention. Competent and effective surgical solutions such as presented in this video remain a critical part of the surgical toolset of the cerebrovascular surgeon or multi-disciplinary team managing these challenging patients. Clemens M. Schirmer Oded Goren Danville, Pennsylvania This is an excellent educational operative video showing an elegant solution to rare and complex pathology. This case highlights why microdissection and microanastomosis bypass skills remain important training components for any neurosurgical residency program and remain imperative for those training in cerebrovascular fellowships. Nicolas K. Khattar Robert F. James Louisville, Kentucky Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Operative NeurosurgeryOxford University Press

Published: May 12, 2018

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