Current Management of Mirror Distal Anterior Cerebral Artery Aneurysms in Association with Multiple Aneurysms: Case Report with Literature Review
| Autor: | Yasuhiro Yamada, Haso Sefo, Ibrahim Omerhodžić, Adi Ahmetspahić, Eldin Burazerović, Kenan I. Arnautović, Yoko Kato, Muhammed Abdullah Gülmez |
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| Rok vydání: | 2019 |
| Předmět: |
Middle Cerebral Artery
medicine.medical_specialty Anterior Cerebral Artery medicine.medical_treatment Hemodynamics Aneurysm Ruptured 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery medicine Anterior cerebral artery Humans cardiovascular diseases Multiple aneurysms Craniotomy business.industry Intracranial Aneurysm Middle Aged medicine.disease Cerebral Angiography Intracerebral hematoma Anterior communicating artery Current management 030220 oncology & carcinogenesis cardiovascular system Female Surgery Stress Mechanical Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 130:324-334 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2019.07.084 |
| Popis: | Background Mirror aneurysms represent 2 adjacent arterial protrusions. Although the size is considered a major risk factor in terms of rupture, sometimes it is the smaller aneurysm that ruptures. Here, we present the contemporary management of mirror distal anterior cerebral artery (DACA) aneurysms associated with multiple aneurysms. Computational fluid dynamic (CFD) analysis was performed when assessing multiple aneurysms using Hemoscope, version 2015. Case Description Among multiple aneurysms, a mirror A2/A3 DACA aneurysm was found in a single patient. Surgical treatment was provided for all aneurysms through a single-stage procedure. The left ruptured A2/A3 aneurysm was smaller compared with the right (7.5 × 3.5 mm/10.8 × 3.2 mm). CFD showed greater wall pressure (WP) in the left ruptured A2/A3 aneurysm (left A2/A3 WP 84,000–84,402 Inst. mm Hg/right A2/3 WP 84,224–84,315). WP in the left middle cerebral artery and anterior communicating artery aneurysms showed lesser values compared with the ruptured aneurysm (WP upper values 84,361 and 84,367, respectively). Wall shear stress showed low values for all aneurysms with the lowest flow rate values in the left A2/A3 aneurysm. Conclusions In cases of ruptured mirror aneurysms followed by the presence of intracerebral hematoma, surgery is considered the primary option with the best results. A one-stage dual craniotomy procedure was found safe in the associated treatment of other multiple aneurysms. At present, the size of the aneurysm, the hemodynamic influence, and the local configuration are all considerations during the preoperative assessment of multiple aneurysm cases. According to our knowledge, this article presents the first CFD analysis of mirror DACA aneurysms associated with aneurysm multiplicity. |
| Databáze: | OpenAIRE |
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