Department of Neurosurgery Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Neurosurgery Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
World Neurosurg. 2024 Oct;190:130. doi: 10.1016/j.wneu.2024.07.049. Epub 2024 Jul 27.
Intracranial kissing aneurysms, arising either from the same artery or from 2 adjacent arteries at similar locations, are rare. The internal carotid artery is most frequently involved; kissing aneurysms rarely affect the distal anterior cerebral artery (DACA). By dint of the close proximity of the aneurysm fundus, these aneurysms can pose unique operative challenges. A highly fragile aneurysm dome with a high intraoperative rupture rate is a unique management challenge in DACA aneurysms. The stakes are higher when there is an aneurysm rupture in the setting of kissing DACA aneurysms requiring an anterior interhemispheric approach. The negotiation of a tight interhemispheric fissure in between the bridging veins and prevention of a premature aneurysm rupture at a narrow space become vital in these situations. Video 1 highlights the surgical steps of clipping bilateral kissing DACA aneurysms in a 60-year-old woman. This surgical video highlights the microneurosurgical nuances of opening a tense interhemispheric fissure and maneuvers for prevention of a premature aneurysm rupture. These nuances are quintessential in the successful surgical clipping of kissing DACA aneurysms. The patient in Video 1 presented with an acute subarachnoid hemorrhage with severe headache of sudden onset and nuchal rigidity (World Federation of Neurological Surgeons grade II). Both aneurysms were located at the A3-A4 junction and successfully clipped through a right-sided anterior interhemispheric approach. She made a satisfactory postoperative recovery (modified Rankin Scale score of 1 at 6-week follow-up and 0 at 6-month follow-up) with an excellent angiographic outcome.
颅内“亲吻”动脉瘤,要么由同一动脉或两个毗邻的动脉在相似部位产生,要么由同一动脉或两个毗邻的动脉在相似部位产生,均较为罕见。颈内动脉最常受累;“亲吻”动脉瘤很少影响远端大脑前动脉(DACA)。由于动脉瘤底部非常接近,这些动脉瘤可能会带来独特的手术挑战。动脉瘤瘤顶极脆弱,术中破裂率高,是 DACA 动脉瘤的独特处理挑战。在前交通动脉入路治疗吻部 DACA 动脉瘤时,如果发生动脉瘤破裂,情况就会变得更加复杂。在这种情况下,在桥静脉之间狭窄空间中谨慎处理紧密的大脑间裂,防止动脉瘤过早破裂,就变得至关重要。视频 1 重点介绍了一名 60 岁女性双侧 DACA“亲吻”动脉瘤夹闭的手术步骤。本手术视频突出了在紧张的大脑间裂中打开并防止动脉瘤过早破裂的显微神经外科技术要点。这些技术要点是成功夹闭 DACA“亲吻”动脉瘤的关键。视频 1 中的患者突发剧烈头痛、颈项强直(世界神经外科学会分级 II 级),伴有急性蛛网膜下腔出血。两个动脉瘤均位于 A3-A4 交界处,通过右侧大脑前动脉入路成功夹闭。她术后恢复良好(6 周随访时改良 Rankin 量表评分为 1,6 个月随访时评分为 0),血管造影结果极佳。
J Korean Neurosurg Soc. 2007-10
J Cerebrovasc Endovasc Neurosurg. 2023-9
Clin Neurol Neurosurg. 2023-3