Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2015

Open Access 01-12-2015 | Case report

Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature

Authors: Oreste de Divitiis, Alberto Di Somma, Teresa Somma, Luigi Maria Cavallo, Mariano Marseglia, Francesco Briganti, Paolo Cappabianca

Published in: Journal of Medical Case Reports | Issue 1/2015

Login to get access

Abstract

Introduction

Dissecting aneurysms of the cerebral arteries are uncommon vascular malformations. Neurosurgical treatment remains critical in the management of patients with such vascular pathologies.

Case presentation

A 20-year-old Caucasian woman presented with a sudden onset of severe headache and loss of consciousness. Computed tomography revealed diffuse subarachnoid hemorrhage, while a computed tomography disclosed a dissecting aneurysm of the precommunicating segment of the right anterior cerebral artery. Cerebral carotid angiography confirmed the presence of the dissecting aneurysm. Due to the peculiar anatomic configuration, endovascular treatment was excluded and surgery was selected. As the left circulation perfused both postcommunicating segments of the anterior cerebral artery and the distal right precommunicating segment was hypoplastic, direct clipping of the right precommunicating segment, close to its origin from the internal carotid artery, was carried out. She recovered after surgery and a late angiography showed the correct positioning of the clip, with regular perfusion of both right and left postcommunicating segments.

Conclusions

The management of dissecting aneurysms of the cerebral arteries is still controversial. With this report we highlight a possible neurosurgical option among therapeutic strategies for these uncommon vascular lesions.
Literature
1.
go back to reference Yamashita M, Tanaka K, Matsuo T, Yokoyama K, Fujii T, Sakamoto H. Cerebral dissecting aneurysms in patients with moyamoya disease. Report of two cases. J Neurosurg. 1983;58(1):120–5. doi:10.3171/jns.1983.58.1.0120.PubMed Yamashita M, Tanaka K, Matsuo T, Yokoyama K, Fujii T, Sakamoto H. Cerebral dissecting aneurysms in patients with moyamoya disease. Report of two cases. J Neurosurg. 1983;58(1):120–5. doi:10.3171/jns.1983.58.1.0120.PubMed
2.
go back to reference Mizutani T, Kojima H, Asamoto S, Miki Y. Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms. J Neurosurg. 2001;94(5):712–7. doi:10.3171/jns.2001.94.5.0712.PubMed Mizutani T, Kojima H, Asamoto S, Miki Y. Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms. J Neurosurg. 2001;94(5):712–7. doi:10.3171/jns.2001.94.5.0712.PubMed
3.
go back to reference Prasad V, Gandhi D, Jindal G. Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. BMJ Case Rep. 2013;2013. doi:10.1136/bcr-2013-010899. Prasad V, Gandhi D, Jindal G. Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. BMJ Case Rep. 2013;2013. doi:10.1136/bcr-2013-010899.
4.
go back to reference Yadav RR, Kumar A, Somani R, Phadke RV. Spontaneous resolution in dissecting aneurysms of the distal middle cerebral artery. Neuroradiol J. 2011;24(6):899–906.PubMed Yadav RR, Kumar A, Somani R, Phadke RV. Spontaneous resolution in dissecting aneurysms of the distal middle cerebral artery. Neuroradiol J. 2011;24(6):899–906.PubMed
5.
go back to reference Badve MS, Henderson RD, O’Sullivan JD, Wong AA, Mitchell K, Coulthard A et al. Vertebrobasilar dissections: Case series comparing patients with and without dissecting aneurysms. J Clin Neurosci. 2014. doi:10.1016/j.jocn.2014.02.015. Badve MS, Henderson RD, O’Sullivan JD, Wong AA, Mitchell K, Coulthard A et al. Vertebrobasilar dissections: Case series comparing patients with and without dissecting aneurysms. J Clin Neurosci. 2014. doi:10.1016/j.jocn.2014.02.015.
6.
go back to reference Lanzino G. Vertebrobasilar dissections. J Neurosurg Pediatr. 2010;6(3):231. discussion 231–2. doi:10.3171/2010.4.PEDS09476.PubMed Lanzino G. Vertebrobasilar dissections. J Neurosurg Pediatr. 2010;6(3):231. discussion 231–2. doi:10.3171/2010.4.PEDS09476.PubMed
7.
go back to reference Gherardi GJ, Lee HY. Localized dissecting hemorrhage and arteritis. Renal and cerebral manifestations. JAMA. 1967;199(3):219–20.PubMed Gherardi GJ, Lee HY. Localized dissecting hemorrhage and arteritis. Renal and cerebral manifestations. JAMA. 1967;199(3):219–20.PubMed
8.
go back to reference Hasegawa S, Manabe H, Takemura A, Nagahata M. [Surgical treatment for dissecting aneurysm of the anterior cerebral artery presenting only with headache: a case report]. Brain Nerve. 2004;56(9):789–93.PubMed Hasegawa S, Manabe H, Takemura A, Nagahata M. [Surgical treatment for dissecting aneurysm of the anterior cerebral artery presenting only with headache: a case report]. Brain Nerve. 2004;56(9):789–93.PubMed
9.
go back to reference Wakabayashi Y, Nakano T, Isono M, Shimomura T, Hori S. Dissecting aneurysm of the anterior cerebral artery requiring surgical treatment – case report. Neurol Med Chir (Tokyo). 2000;40(12):624–7. Wakabayashi Y, Nakano T, Isono M, Shimomura T, Hori S. Dissecting aneurysm of the anterior cerebral artery requiring surgical treatment – case report. Neurol Med Chir (Tokyo). 2000;40(12):624–7.
10.
go back to reference Nelson JW. Dissecting subintimal hematomas of the intracranial arteries: report of a case. J Am Osteopath Assoc. 1968;67(5):512–27.PubMed Nelson JW. Dissecting subintimal hematomas of the intracranial arteries: report of a case. J Am Osteopath Assoc. 1968;67(5):512–27.PubMed
11.
go back to reference Islam MS, Manabe H, Hasegawa S, Takemura A, Nagahata M. Successful staged treatment for ruptured blister-like dissecting aneurysm of the intracranial internal carotid artery: acute GDC embolization for the blister-like aneurysm followed by proximal occlusion with extracranial-intracranial bypass in the chronic stage. Minim Invasive Neurosurg. 2004;47(3):165–8. doi:10.1055/s-2004-818490.PubMed Islam MS, Manabe H, Hasegawa S, Takemura A, Nagahata M. Successful staged treatment for ruptured blister-like dissecting aneurysm of the intracranial internal carotid artery: acute GDC embolization for the blister-like aneurysm followed by proximal occlusion with extracranial-intracranial bypass in the chronic stage. Minim Invasive Neurosurg. 2004;47(3):165–8. doi:10.1055/s-2004-818490.PubMed
12.
go back to reference Iwashita T, Kitazawa K, Koyama J, Nagashima H, Koyama T, Tanaka Y, et al. A saccular-like dissecting aneurysm of the anterior cerebral artery that developed 2 years after an ischemic event. Surg Neurol. 2005;64(6):538–41. discussion 41. doi:10.1016/j.surneu.2005.01.023.PubMed Iwashita T, Kitazawa K, Koyama J, Nagashima H, Koyama T, Tanaka Y, et al. A saccular-like dissecting aneurysm of the anterior cerebral artery that developed 2 years after an ischemic event. Surg Neurol. 2005;64(6):538–41. discussion 41. doi:10.1016/j.surneu.2005.01.023.PubMed
13.
go back to reference Leach JC, Mitchell PJ, Siu K. Subarachnoid haemorrhage due to a dissecting aneurysm of the anterior cerebral artery: a case report. J Clin Neurosci. 2004;11(3):334–7. doi:10.1016/S0967-5868(03)00165-6.PubMed Leach JC, Mitchell PJ, Siu K. Subarachnoid haemorrhage due to a dissecting aneurysm of the anterior cerebral artery: a case report. J Clin Neurosci. 2004;11(3):334–7. doi:10.1016/S0967-5868(03)00165-6.PubMed
14.
go back to reference Lv X, Li Y, Jiang C, Jiang P, Wu Z. Dissecting aneurysm at the proximal anterior cerebral artery treated by parent artery occlusion. Interv Neuroradiol. 2009;15(1):123–6.PubMedPubMedCentral Lv X, Li Y, Jiang C, Jiang P, Wu Z. Dissecting aneurysm at the proximal anterior cerebral artery treated by parent artery occlusion. Interv Neuroradiol. 2009;15(1):123–6.PubMedPubMedCentral
15.
go back to reference Wu SW, Chiu TL. Dissecting aneurysm at the A1 segment of the anterior cerebral artery presenting as visual loss and visual field defect. Br J Neurosurg. 2013;27(6):822–3. doi:10.3109/02688697.2013.791663.PubMed Wu SW, Chiu TL. Dissecting aneurysm at the A1 segment of the anterior cerebral artery presenting as visual loss and visual field defect. Br J Neurosurg. 2013;27(6):822–3. doi:10.3109/02688697.2013.791663.PubMed
16.
go back to reference Pilz P. [Dissecting aneurysm of the anterior cerebral artery and Guillain-Barré-syndrome during pregnancy (author’s transl)]. J Neurol. 1977;214(4):295–9.PubMed Pilz P. [Dissecting aneurysm of the anterior cerebral artery and Guillain-Barré-syndrome during pregnancy (author’s transl)]. J Neurol. 1977;214(4):295–9.PubMed
17.
go back to reference Hirao J, Okamoto H, Watanabe T, Asano S, Teraoka A. Dissecting aneurysms at the A1 segment of the anterior cerebral artery – two case reports. Neurol Med Chir (Tokyo). 2001;41(5):271–8. Hirao J, Okamoto H, Watanabe T, Asano S, Teraoka A. Dissecting aneurysms at the A1 segment of the anterior cerebral artery – two case reports. Neurol Med Chir (Tokyo). 2001;41(5):271–8.
18.
go back to reference Honda N, Yuge T, Miyagi J, Shigemori M. A surgical case of dissecting aneurysm of the anterior cerebral artery. No Shinkei Geka J. 1997;6:634–8. Honda N, Yuge T, Miyagi J, Shigemori M. A surgical case of dissecting aneurysm of the anterior cerebral artery. No Shinkei Geka J. 1997;6:634–8.
19.
go back to reference Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9.PubMed Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9.PubMed
20.
go back to reference Dashti R, Hernesniemi J, Lehto H, Niemela M, Lehecka M, Rinne J, et al. Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol. 2007;68(4):366–77. doi:10.1016/j.surneu.2007.07.084.PubMed Dashti R, Hernesniemi J, Lehto H, Niemela M, Lehecka M, Rinne J, et al. Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol. 2007;68(4):366–77. doi:10.1016/j.surneu.2007.07.084.PubMed
Metadata
Title
Surgical clipping of a dissecting aneurysm of the precommunicating segment of the anterior cerebral artery: a case report and review of the literature
Authors
Oreste de Divitiis
Alberto Di Somma
Teresa Somma
Luigi Maria Cavallo
Mariano Marseglia
Francesco Briganti
Paolo Cappabianca
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2015
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-015-0604-x

Other articles of this Issue 1/2015

Journal of Medical Case Reports 1/2015 Go to the issue