SURGICAL VIDEO Microsurgical Treatment of Distal Anterior Cerebral Artery Aneurysms: 3-Dimensional Operative Video Vijay Agarwal, MD, Daniel L. Barrow, MD Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy136 Correspondence: Vijay Agarwal, MD, Department of Neurosurgery, Emory University Hospital, 1365 Clifton Rd NE, Suite B6200, Atlanta, GA 30322. E-mail: firstname.lastname@example.org second patient had a 3-mm DACA aneurysm and a Selecting appropriate patient position for surgery must right frontal proliferative angiopathy and developmental take into consideration a variety of factors. For an inter- venous anomaly with evidence of prior hemorrhage. hemispheric approach to distal anterior cerebral artery (DACA) aneurysms, the patient may be positioned with Due to the vascular anomaly, we positioned the head the head either horizontal or vertical with respect to the in a vertical position for surgery to clip the aneurysm, floor. We preferentially place the patient in the supine which was thought to be the source of hemorrhage. The position with the shoulder elevated and the head turned videos illustrate the approach to DACA aneurysms, which parallel to the floor with the side of the approach down typically exposes the aneurysm before complete exposure and the vertex tilted 45 up. In this way, gravity is utilized of the proximal parent artery is obtained. In one case, the to allow the right frontal lobe to fall away from the falx, use of both frameless guidance and intraoperative angiog- eliminating the need for retraction. To demonstrate the raphy was useful in identifying a small previously ruptured importance of individualizing the choice of position to aneurysm. each patient, we present here 2 illustrative cases of DACA All appropriate patient consents were obtained for this aneurysms in which different positioning was selected. submission. One patient presented with a 7-mm bilobed perical- Video and Figures (0:57-1:16 and 6:30-6:37), 2017 losal artery aneurysm; the aneurysm was approached Department of Neurosurgery, Emory University. Used with permission. with the head horizontal with respect to the floor. The KEY WORDS: Distal anterior cerebral artery aneurysm, Interhemispheric, Cerebrovascular Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy136 Received, January 26, 2018. Accepted, April 26, 2018. Disclosure presented and the surgical treatment is well described and performed. The authors have no personal, financial, or institutional interest in any of the This video is highly education for young neurosurgeons interested in drugs, materials, or devices described in this article. neuromuscular pathology. Roberto Assietti Milano, Italy COMMENT his video is a very useful summary of the surgical treatment options T of the distal ACA aneurysms. Two cases with different anatomy are OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy136/4999297 by Ed 'DeepDyve' Gillespie user on 12 July 2018
Operative Neurosurgery – Oxford University Press
Published: May 18, 2018
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