• Nakao Ota, Rokuya Tanikawa, Masataka Miyama, Takashi Matsumoto, Takanori Miyazaki, Hidetoshi Matsukawa, Takeshi Yanagisawa, Go Suzuki, Shiro Miyata, Kosumo Noda, Toshiyuki Tsuboi, Rihei Takeda, Hiroyasu Kamiyama, and Sadahisa Tokuda.
• Stroke Center, Department of Neurosurgery, Teishinkai Hospital, Hokkaido, Japan. Electronic address: nakao1980@gmail.com.
• World Neurosurg. 2016 Mar 1; 87: 328-45.

ObjectiveGiant, or complex, aneurysms of the anterior cerebral artery (ACA) are rare, but their surgical treatment is important. The authors describe their experiences with bypasses for complex ACA aneurysms and discuss the new classification of ACA bypasses, the concept of using bypasses for insurance during the approach to the aneurysm, and simplifying the surgical algorithms for these complex ACA aneurysms.MethodsOver a 19-year period, 7 cases of complex ACA aneurysm were treated with bypasses and reviewed retrospectively. The bypasses were classified into 4 groups according to donor blood flow: internal carotid artery-ACA, external carotid artery-ACA, communicating bypass, and reconstruction bypass of the ipsilateral postcommunicating ACA.ResultsThe cases included 1 precommunicating aneurysm, 3 communicating aneurysms, 2 postcommunicating aneurysms, and 1 double aneurysm (communicating and postcommunicating). The types of bypass included 1 internal carotid artery-ACA, 6 communicating bypasses, 3 external carotid artery-ACAs, and 2 reconstruction bypass of the postcommunicating ACA. Postoperative modified Rankin Scale scores were 0 (6 cases) and 3 (1 case of a communicating aneurysm with complicated memory disturbance because of infarction). One case revealed asymptomatic infarction.ConclusionsSurgical treatment of complex ACA aneurysms requires knowledge of a variety of bypass techniques. Although the type of bypass should be selected according to patient-specific anatomy and the neurosurgeon's preference, the new classification of bypass-specified ACA aneurysms may alter the way surgeons think about ACA bypasses, and in combination with the concept of the protective bypass, can be used to establish a comprehensive algorithm for each type of complex ACA aneurysm.Copyright © 2016 Elsevier Inc. All rights reserved.

39 keywords...

hide…