Surgical treatment of frontopolar artery aneurysm: a case report
https://doi.org/10.17650/1683-3295-2019-21-1-60-65
Abstract
The study objective is to describe the results of surgical treatment of a patient with frontopolar artery aneurysm rupture. Materials and methods. A 22-year-old female patient in grave condition (Hunt and Hess grade 3, Glasgow coma score 14) was admitted to the Department of Neurosurgery on day 5 after hemorrhage. The patient presented with headache, nausea, weakness, and stiff neck. However, no hemodynamic, respiratory, motor, or sensitive disorders were observed. Computed tomography of the brain revealed a 35 cm3 intracerebral hemorrhage in the projection of the interhemispheric fissure and frontal lobes without transverse or axial dislocation. Computed tomography angiography demonstrated a distal aneurysm of the right frontopolar artery. Results. The patient underwent emergency osteoplastic craniotomy in the right pterional region followed by aneurysm excision and removal of intracerebral hemorrhage. The postoperative period was uneventful (Glasgow outcome score 5). The patient was discharged on day 14 postoperatively with no signs of focal neurological deficit. Conclusion. Thorough preoperative examination of patients with lobar hemorrhages prevents severe complications during surgery, such as uncontrolled intraoperative bleeding.
About the Authors
V. A. LukyanchikovRussian Federation
I. V. Senko
Russian Federation
M. M. Idalov
Russian Federation
R. M. Umarov
Russian Federation
M. M. Yusupova
Russian Federation
Z. M. Idalov
Russian Federation
V. V. Krylov
Russian Federation
References
1. Surgery of intracranial aneurysms. Ed. by V.V. Krylov. In 3 vol. Vol. 2. Moscow: T.A. Alekseev Publishing House, 2012. 516 p. (In Russ.)
2. Hernesniemi J., Tapaninaho A., Vapalahti M. et al. Saccular aneurysms of the distal anterior cerebral artery and its branches. Neurosurgery 1992;31(6):994–8. PMID: 1470334.
3. Nussbaum E.S., Madison M.T., Goddard J.K. et al. Peripheral intracranial aneurysms: management challenges
4. in 60 consecutive cases. J Neurosurg 2009;110(1):7–13. DOI: 10.3171/2008.6.JNS0814. PMID: 18928355.
5. Rodríguez-Hernández A., Zador Z., Rodríguez-Mena R., Lawton M.T. Distal aneurysms of intracranial arteries: application of numerical nomenclature, predilection for cerebellar arteries, and results of surgical management. World Neurosurg 2013;80(1–2):103–12. DOI: 10.1016/j.wneu.2012.09.010. PMID: 23017587.
6. Wu C., Sun Z., Wang F. et al. [Surgical managements of peripheral intracranial aneurysms (In Chinese)]. Zhonghua Yi Xue Za Zhi 2014;94(9):698– 700. PMID: 24842213.
7. Takinami K., Hasegawa T., Miyamori T., Matumoto T. [A ruptured aneurysm in the bifurcation of the proximal anterior cerebral artery and the frontopolar artery: case report(In Japanese)]. No Shinkei Geka 2002;30(11):1191–4. PMID: 12428352.
8. Kutlay M., Colak A., Demircan N., Akin O. Distal-end aneurysm of the frontopolar artery with an atypical postoperative complication: case report. Mil Med 2006;171(2):103–6. PMID: 16578976.
9. Afshar F. Direct surgical obliteration of frontopolar artery aneurysm. Surg Neurol 1981;15(2):135–6. PMID: 7245004.
10. Aiba T., Takahashi S., Fukuda M. [Ruptured frontopolar artery aneurysm: two cases(In Japanese)]. No Shinkei Geka 2003;31(9):1009–12. PMID: 14513785.
11. Karanam L., Alurkar A., Chakka S. Endovascular treatment of frontopolar artery aneurysm. Neuroradiol J 2016;29(4):280–2. DOI: 10.1177/1971400916643338. PMID: 27048313.
12. Castaño-Leon A.M., Cicuendez M., Paredes I. et al. Coil embolization of ruptured frontopolar artery aneurysm: case report. Neurocirurgia(Astur) 2014;25(2):73–6. DOI: 10.1016/j.
13. neucir.2013.04.002. PMID: 23731558.
14. Lebedeva E.R., Kolotvinov V.S., Sakovich V.P., Medvedeva S.Ju. Systematic dysplasia of connective tissue and clinical manifestation of intracranial aneurysms. Neyrokhirurgiya = Russian Journal of Neurosurgery 2013;(2):42–8. (In Russ.)
15. Tkachev V.V., Lepshokov M.Kh., Kran O.I., Muzlaev G.G. Combination of multiple distal posterior fossa aneurysms with cerebellar AVM. Zhurnal “Voprosy neirokhirurgii im. N.N. Burdenko” = Problems of Neurosurgery n. a. N.N. Burdenko 2012;76(5):48–52. (In Russ.)
16. Biondi A., Jean B., Vivas E. et al. Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am J Neuroradiol 2006;27(8):1685–892. PMID: 16971615.
17. Sakamoto S., Ikawa F., Kawamoto H. et al. Acute surgery for ruptured dissecting aneurysm of the M3 portion of the middle cerebral artery. Neurol Med Chir (Tokyo) 2003;43(4):188–91. PMID: 12760497.
18. Wisoff J.H., Flamm E.S. Aneurysms of the distal anterior cerebral artery and associated vascular anomalies. Neurosurgery 1987;20(5):735–41. PMID: 3601020.
19. Krylov V.V., Calankina I.Ye., Dashyan V.C. et al. A successful two-stage surgical treatment of a giant aneurysm in the distal portion of the medial cerebral artery. Neyrokhirurgiya = Russian Journal of Neurosurgery 2003;(2):46–9. (In Russ.)
20. Krylov V.V., Nakhabin O.Ju., Vinokurov A.G. et al. The successful treatment of right calloso-marginal aneurysm by its trapping followed by intraintracranial bypass. Neyrokhirurgiya = Russian Journal of Neurosurgery 2013;(4):58–63. (In Russ.)
21. Sazonov I.A. Aneurysms of the distal segments of the anterior cerebral artery(aneurysm of the pericallous). Clinic, diagnosis and features of surgical treatment: abstract of dis. … of cand. of med. sciences. Moscow, 1998. 27 p. (In Russ.)
22. Dinc C., Iplikcioglu A.C., Bikmaz K. Distal anterior cerebral artery aneurysms: report of 26 cases. Neurol Med Chir (Tokyo) 2006;46(12):575–80. PMID: 17185882.
23. Lehecka M. Distal anterior cerebral artery aneurysms. Academic Dissertation. Helsinki: Helsinki University Press, 2009. 367 p.
24. Mann K.S., Yue C.P., Wong G. Aneurysms of the pericallosal-callosomarginal junction. Surg Neurol 1984;21(3):261–6. PMID: 6695321.
25. Shukla D., Bhat D.I., Srinivas D. et al. Microsurgical treatment of distal anterior cerebral artery aneurysm: a 25 year institutional experience. Neurol India 2016;64(6):1204–9. DOI: 10.4103/0028-3886.193827. PMID: 27841188.
26. Sindou M., Pelissou-Guyotat I., Mertens P. et al. Pericallosal aneurysms. Surg Neurol 1988;30(6):434–40. PMID: 3222721.
27. Perlmutter D., Rhoton A.L. Jr. Microsurgical anatomy of the distal anterior cerebral artery. J Neurosurg 1978;49(2):204–28. DOI: 10.3171/jns.1978.49.2.0204. PMID: 671075.
28. Sydorak A.D., Tsimeiko O.A. Topography-anatomical characteristics and the choice of surgical access to aneurysms of distal segments of the anterior cerebral artery. 2014;(3):100–5. Nevrologiya i neyrokhirurgiya = Neurology and Neurosurgery. Eastern Europe 2014;(3):100–5. (In Russ.)
29. Steven D.A., Lownie S.P., Ferguson G.G. Aneurysms of the distal anterior cerebral artery:results in 59 consucutively managed patients. Neurosurgery 2007;60(2):227–33. DOI: 10.1227/01.NEU.0000249267. 33945.E7. PMID: 17290172.
30. De Sousa A.A., Dantas F.L., de Cardoso G.T., Costa B.S. Distal anterior cerebral artery aneurysms. Surg Neurol 1999;52(2):128–35. PMID: 10447278.
31. Lee J.W., Lee K.C., Kim Y.B., Huh S.K. Surgery for distal anterior cerebral artery aneurysms. Surg Neurol 2008;70(2):153–9. DOI: 10.1016/j.surneu.2008.03.012. PMID: 18482760.
32. Petr O., Coufalová L2, Bradáč O. et al. Safety and efficacy of surgical and endovascular treatment for distal anterior cerebral artery aneurysms: a systematic review and meta-analysis. World Neurosurg 2017;100:557–66. DOI: 10.1016/j.wneu.2016.11.134. PMID: 27923755.
33. Proust F., Toussaint P., Hannequin D. et al. Outcome in 43 patients with distal anterior cerebral artery aneurysms. Stroke 1997;28(12):2405–9. PMID: 9412622.
34. Kwon T.H., Chung H.S., Lim D.J. et al. Distal anterior cerebral artery aneurysms: clinical features and surgical outcome. J Korean Med Sci 2001;16(2):204–8. DOI: 10.3346/jkms.2001.16.2.204. PMID: 11306748.
35. Miyazawa N., Nukui H., Yagi S. et al. Statistical analysis of factors affecting the outcome of patients with ruptured distal anterior cerebral artery aneurysms. Acta Neurochir (Wien) 2000;142(11):1241–6. PMID: 11201638.
36. Orz Y. Surgical strategies and outcome for distal anterior cerebral arteries aneurysms. Asian J Neurosurg 2011;6(1):13–7. DOI: 10.4103/1793-5482.85628. PMID: 22059099.
37. Pandey A., Rosenwasser R., Veznedaroglu E. Management of distal anterior cerebral artery aneurysms: a single institution retrospective analysis (1997–2005). Neurosurgery 2007;67(5): 909–17. DOI: 10.1227/01.neu. 0000303186. 26684.81. PMID: 18091267.
38. Suzuki S., Kurata A., Yamada M. et al. Outcome analysis of ruptured distal anterior cerebral aneurysms treated by endosaccular embolization and surgical clipping. Interv Neuroradiol 2011;17(1):49–57. DOI: 10.1177/159101991101700108. PMID: 21561558.
Review
For citations:
Lukyanchikov V.A., Senko I.V., Idalov M.M., Umarov R.M., Yusupova M.M., Idalov Z.M., Krylov V.V. Surgical treatment of frontopolar artery aneurysm: a case report. Russian journal of neurosurgery. 2019;21(1):60-65. (In Russ.) https://doi.org/10.17650/1683-3295-2019-21-1-60-65