Management of a Previously Coiled Anterior Cerebral Artery Aneurysm in a Child: 3-Dimensional Operative Video

Management of a Previously Coiled Anterior Cerebral Artery Aneurysm in a Child: 3-Dimensional... SURGICAL VIDEO Management of a Previously Coiled Anterior Cerebral Artery Aneurysm in a Child: 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/opy041 Correspondence: Vijay Agarwal, MD, Department of Neurosurgery, Emory University Hospital, 1365 Clifton Rd. NE, Suite B6200, Atlanta, GA 30322. E-mail: vijay.agarwal@emory.edu gyrus rectus was removed to expose the A2 segments We present the case of an 11-yr-old male who origi- and the remainder of the large, partially thrombosed nally presented to an outside hospital with subarachnoid and coiled sac of the aneurysm. Thrombus and the hemorrhage. He was discovered at that time to have previously placed coils were removed in a piecemeal a ruptured right A1-A2 junction anterior cerebral artery aneurysm just proximal to the anterior communicating fashion. Two fenestrated clips were used to reconstruct artery. He underwent endovascular coiling at the outside the right A1, with the blades used to bring together center. While recovering at a rehabilitation center, he normal tissue on the ventral surface to create a new had a rehemorrhage and acute neurological decline. He lumen. A Doppler ultrasound was used to insunate both was transferred to our service, where he underwent A1s and A2s to confirm patency. Intraoperative cerebral surgical exploration and clip reconstruction of what angiogram showed complete obliteration of the aneurysm appeared to be a pseudoaneurysm. After a frontotem- and excellent reconstruction of the anterior cerebral poral exposure, the right A1 segment was identified at the complex. carotid bifurcation and followed medially. The aneurysm The patient did very well and was neurologically intact was significantly larger than on the original angiogram on discharge. and the wall of the aneurysm was extraordinarily thin, All appropriate patient consents were obtained for this consistent with a pseudoaneurysm. A small portion of the submission. KEY WORDS: Anterior cerebral artery, Intracerebral aneurysm, Clip reconstruction Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy041 Received, October 17, 2017. Accepted, February 13, 2018. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy041/4957027 by Ed 'DeepDyve' Gillespie user on 12 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Management of a Previously Coiled Anterior Cerebral Artery Aneurysm in a Child: 3-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
D.O.I.
10.1093/ons/opy041
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Abstract

SURGICAL VIDEO Management of a Previously Coiled Anterior Cerebral Artery Aneurysm in a Child: 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/opy041 Correspondence: Vijay Agarwal, MD, Department of Neurosurgery, Emory University Hospital, 1365 Clifton Rd. NE, Suite B6200, Atlanta, GA 30322. E-mail: vijay.agarwal@emory.edu gyrus rectus was removed to expose the A2 segments We present the case of an 11-yr-old male who origi- and the remainder of the large, partially thrombosed nally presented to an outside hospital with subarachnoid and coiled sac of the aneurysm. Thrombus and the hemorrhage. He was discovered at that time to have previously placed coils were removed in a piecemeal a ruptured right A1-A2 junction anterior cerebral artery aneurysm just proximal to the anterior communicating fashion. Two fenestrated clips were used to reconstruct artery. He underwent endovascular coiling at the outside the right A1, with the blades used to bring together center. While recovering at a rehabilitation center, he normal tissue on the ventral surface to create a new had a rehemorrhage and acute neurological decline. He lumen. A Doppler ultrasound was used to insunate both was transferred to our service, where he underwent A1s and A2s to confirm patency. Intraoperative cerebral surgical exploration and clip reconstruction of what angiogram showed complete obliteration of the aneurysm appeared to be a pseudoaneurysm. After a frontotem- and excellent reconstruction of the anterior cerebral poral exposure, the right A1 segment was identified at the complex. carotid bifurcation and followed medially. The aneurysm The patient did very well and was neurologically intact was significantly larger than on the original angiogram on discharge. and the wall of the aneurysm was extraordinarily thin, All appropriate patient consents were obtained for this consistent with a pseudoaneurysm. A small portion of the submission. KEY WORDS: Anterior cerebral artery, Intracerebral aneurysm, Clip reconstruction Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy041 Received, October 17, 2017. Accepted, February 13, 2018. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy041/4957027 by Ed 'DeepDyve' Gillespie user on 12 July 2018

Journal

Operative NeurosurgeryOxford University Press

Published: Mar 30, 2018

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