• Journal of Korean Neurosurgical Society
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• 제29권6호
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• pp.832-835
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• 2000

A case of unruptured cerebral aneurysm at the junction of accessory middle cerebral artery and the distal portion of the $A_1$ segment of the anterior cerebral artery is reported. To the authors' knowledge, this is the first reported case of cerebral aneurysm developed at the junction of accessory middle cerebral artery, demonstrated on magnetic resonance angiography(MRA). The accessory middle cerebral artery is a rare vascular variant of middle cerebral artery. Furthermore, it is extremely rare for an aneurysm to be developed at the origin of the accessory middle cerebral artery. The development of the accessory middle cerebral artery is very important in surgery of cerebral aneurysm and collateral circulation of cerebral infarction. Review of the literature regarding the genesis and anatomical variation of the accessory middle cerebral artery is also presented.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.963-967
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• 2000

The aneurysm arising from the posterior cerebral artery is relatively uncommon, and has been reported in 0.7- 2.2% of whole cerebral aneurysm. Moreover, only a few cases of the giant aneurysm over 2.5cm in diameter arising from the distal portion of the posterior cerebral artery have been reported. Neurologic complications may occur after surgical treatment of this aneurysm due to difficult surgical approach and neurovascular complexity around the brain stem. Authors experienced a case of the thrombosed giant aneurysm with approximately 2.7cm in diameter arising from the P2 segment of the left posterior cerebral artery. Complete removal of the thrombus in the aneurysmal sac and direct neck clipping was performed via left subtemporal approach.

• Journal of Korean Neurosurgical Society
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• 제42권6호
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• pp.478-480
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• 2007

Unruptured non-traumatic dissecting aneurysm in the M4 segment of the middle cerebral artery (MCA) accompanied by complete occlusion of the ipsilateral internal cerebral artery (ICA) has never been reported. A 41-year-old man presented with an infarction manifesting as left-sided weakness and dysarthria. Magnetic resonance angiography revealed a subacute stage infarction in the right MCA territory and complete occlusion of the right ICA. Angiography demonstrated aneurysmal dilatation of the M4 segment of the right MCA. Surgery was performed to prevent hemorrhage from the aneurysm. The aneurysm was proximally clipped guided by Navigation-CT angiography and flow to the distal MCA was restored by superficial temporal artery-middle cerebral artery (STA-MCA) anastornosis. We report this rare case with literature review.

• Journal of Chest Surgery
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• 제3권1호
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• pp.39-46
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• 1970

Aneurysm of the common carotid artery is uncommon. In surgery for carotid aneurysm there is the risk of endangering cerebral circulation during the period of arterial occlusion necessary for the resection. Therefore a method which will allow adequate cerebral circulation during carotid artery anastomisis is obviously to be desired. A case of aneurysm of the common carotid artery is presented in which the aneurysm was partially resected and the artery was reconstructed by end to end anastomosis. while cerebral circulation was maintained by an internal polyethylene shunt. The occurrence of this aneurysm was associated with a chronic stasis ulcer of the left fore leg. On this basis the aneurysm was thought to be of mycotic origin though this has not been proved histologically or by laboratory methods. The literature on aneurysm of the carotid artery is briefly reviewed.

• Journal of Korean Neurosurgical Society
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• 제51권5호
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• pp.292-295
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• 2012

Many reports have been published on complications related to middle cerebral artery (MCA) aneurysm surgical clipping procedures. We report an emergency intracranial in situ bypass surgery case which was performed as a rescue procedure after aneurysmal neck laceration during clipping of an MCA large aneurysm. In this case, we performed in situ M3-superficial temporal artery (STA) interposition graft-M3 bypass procedure. If a STA-MCA anastomosis is not available under MCA flow obstruction, we can consider an emergency in situ MCA-MCA bypass procedure with or without an STA interposition graft.

• Journal of Korean Neurosurgical Society
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• 제46권6호
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• pp.568-571
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• 2009

Accessory middle cerebral artery (MCA) is an infrequent vascular anomaly of the brain. Cerebral aneurysms associated with this anomalous artery are also very rare. To our knowledge, there have only been ten previous reports of an aneurysm associated with accessory MCA. The authors present two patients with accessory MCA-related aneurysms. A 38-year-old male and a 59-year-old female both presented with sudden-onset severe headache. In both patients, computed tomography (CT) scan revealed subarachnoid hemorrhage. A subsequent angiogram demonstrated an accessory MCA arising from the anterior cerebral artery (ACA) and a saccular aneurysm at the anterior communicating artery (ACoA) complex associated with an accessory MCA. Surgical clipping allowed for complete exclusion of the aneurysm from the arterial circulation. Based on our review of the ten cases of aneurysms associated with accessory MCA documented in the literature, we suggest that accessory MCA-related aneurysms can be classified according to whether the accessory MCA originates from the proximal A1 segment or from the ACoA complex. We also emphasize the importance of precise interpretation of preoperative angiograms and intraoperative precaution in determining the presence of this anomalous artery prior to temporary clip placement.

• Journal of Korean Neurosurgical Society
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• 제38권6호
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• pp.465-467
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• 2005

Anterior cerebral artery[ACA] dissecting aneurysms are extremely rare and optimal treatment remains unclear. The majority of cases manifest as cerebral infarction or as intracranial bleeding. The authors report two cases of ACA dissecting aneurysm, one with a large partially thrombosed gradually growing aneurysm and one with a cerebral infarction in the ACA territory. The patient with a large aneurysm was treated by trapping the aneurysm, and the patient with infarction by conservative management. We report on two cases of dissecting aneurysm of the ACA and include a review of pertinent literature.

• Journal of Korean Neurosurgical Society
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• 제53권5호
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• pp.293-296
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• 2013

The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.131-134
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• 2006

The cerebral vasospasm after clipping surgery of unruptured aneurysm is uncommon. A 44-year-old man with unruptured left middle cerebral artery[MCA] aneurysm had clipping surgery. From the third postoperative day, he presented with drowsy mentality, dysphasia and right hemiparesis. Computed tomographic scans showed low density area in frontotemporal lobe and midline shift. Transfemoral cerebral angiography revealed severe vasospasm in supraclinoid internal carotid artery, anterior cerebral artery, and MCA on the operative side. We performed left frontotemporoparietal craniectomy and hypertensive-hypervolemic therapy. He recovered without neurological deficits but for dysphasia. Neurosurgeon should be alert to the possibility of vasospasm after clipping surgery even in case of unruptured cerebral aneurysm.

• Journal of Korean Neurosurgical Society
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• 제52권5호
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• pp.501-504
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• 2012

Objective : To report our surgical experience using in situ end-to-side bypass for giant serpentine distal anterior cerebral artery aneurysm, unsuitable for microsurgical clipping. Methods : A 49-year-old woman presented with headache and intermittent loss of consciousness. The brain computed tomography scan revealed a partially calcified mass in the interhemispheric fissure. On cerebral angiography, that was giant ($30{\times}18mm$ sized), serpentine aneurysm originating from the A2 to A3 segment of the distal anterior cerebral artery (DACA). The aneurysm was trapped with clips, and the right A3 segment to left A3 segment of DACA, end-to-side in situ bypass was performed. Surgical result was favorable, with no newly developed ischemic event in the acute recovery period. Postoperative angiography showed total occlusion of the aneurysm and good patency, with preserved distal flow. Conclusion : Giant fusiform aneurysms of the DACA are extremely rare and can be particularly challenging to treat. End-to-side A3 : A3 bypass with aneurysm trapping could be a treatment modality for these locations.