SURGICAL VIDEO Interhemispheric Approach for Excision of Callosal Marginal Dissecting Aneurysm With End-to-End Anastomosis: 3-Dimensional Operative Video Jayson A. Neil, MD, Khaled M. Krisht, MD, William T. Couldwell, MD, PhD Department of Neurosurgery, University of Utah, Salt Lake City, Utah Watch now at http://links.lww.com/NEU/A897 Aneurysms of the distal anterior cerebral artery (ACA) are The 3-D video can be viewed at http://links.lww.com/NEU/A897. difficult to treat because their small caliber and distal location Disclosure provide limited endovascular options. Standard options for treatment of distal ACA dissecting aneurysms include wrapping The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. of the aneurysm or trapping or excision of the aneurysm with either sacrifice of the parent vessel or anastomosis. Anastomotic Acknowledgments options include side-to-side anastomosis to the contralateral We thank Vance Mortimer for helping with the video production and Kristin ACA, interpositional graft, or end-to-end anastomosis after Kraus, MSc, for editorial assistance. aneurysm resection. The case described in this video involved COMMENT a 44-year-old woman who presented to an outside hospital 2 years earlier with a subarachnoid hemorrhage and left lower- espite improvements in microsurgical and endovascular techniques, extremity paresis and numbness. At that time, it was noted that D a subset of aneurysms remains unamenable to direct clipping or the right callosal marginal artery was not filling, so no treatment endovascular therapies. In this subset of cases, revascularization techni- was performed. Over time, her paresis improved but her ques remain an important tool in the arsenal of the cerebrovascular sur- numbness did not. On follow-up imaging, the right callosal geon. The authors present a case of a distal anterior cerebral artery artery was filling and an associated dissecting aneurysm was aneurysm treated with aneurysm excision and end-to-end anastomosis of the anterior cerebral artery. Alternatively, aneurysms in this location can noted, which prompted consultation at our clinic. Excision of be treated with vessel occlusion and A3-A3 or A4-A4 bypass to revascu- the aneurysm with end-to-end anastomosis of the parent vessel larize the distal territories. This case highlights the importance of main- was completed successfully. We chose this option rather than taining microsurgical techniques, especially in the setting of training interpositional bypass because the senior author prefers to limit programs, to prepare future surgeons for these rare but challenging cases. the number of anastomotic sites, which increase the chances for M. Yashar S. Kalani occlusion. There were no complications, and postoperatively, the patient noted that her left lower-extremity numbness had Robert F. Spetzler resolved. Phoenix, Arizona 394 | VOLUME 12 | NUMBER 4 | DECEMBER 2016 www.operativeneurosurgery-online.com Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
Operative Neurosurgery – Oxford University Press
Published: Dec 1, 2016
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