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01-10-2018 | Original Article

Radiographic and microsurgical characteristics of proximal (A1) segment aneurysms of the anterior cerebral artery

Authors: Chang Ki Jang, E-Wook Jang, Kwang-Chun Cho, Sang Hyun Suh, Joonho Chung, Yong Bae Kim, Chang-Ki Hong, Jin-Yang Joo

Published in: Neurological Sciences | Issue 10/2018

Abstract

Background

Proximal A1 segment aneurysms of the anterior cerebral artery (ACA) radiologically resemble internal carotid artery bifurcation (ICBIF) aneurysms because of their anatomical proximity. However, proximal A1 aneurysms exhibit distinguishing features, relative to ICBIF aneurysms. We report our experience of managing proximal A1 aneurysms, then compare them to ICBIF aneurysms.

Methods

Among 2191 aneurysms treated between 2000 and 2016 in a single institution, we retrospectively reviewed 100 cases categorized as ICBIF or A1 aneurysms. We included aneurysms originating from the ICBIF and ACA, proximal to the anterior communicating artery (A1 segment) and divided them into two groups: proximal A1 (n = 32) and ICBIF (n = 50). If any portion of the aneurysm involved the ICBIF, it was classified as ICBIF. Aneurysms wholly located in the A1 segment were classified as proximal A1. Patient factors and angiographic factors were evaluated and compared.

Results

The proximal A1 group exhibited differences in aneurysm size (p = 0.013), posterior aneurysm direction (p = 0.001), and A1 perforators as incorporating vessels (p = 0.001). The proximal A1 group tended to rupture more frequently when the aneurysm was smaller (p = 0.046). One case of morbidity occurred in the proximal A1 group.

Conclusion

Compared to ICBIF aneurysms, proximal A1 aneurysms were smaller and directed posteriorly, with incorporating perforators. Because of these characteristics, it may be difficult to perform clipping with 360° view in microsurgical field. Therefore, when planning to treat proximal A1 aneurysms, different treatment strategies may be necessary, relative to those used for ICBIF aneurysms.

Bhaisora KS, Behari S, Prasadh G, Srivastava AK, Mehrotra A, Sahu RN, Jaiswal AK (2014) A I-segment aneurysms: management protocol based on a new classification. Neurol India 62(4):410–416CrossRefPubMed

Handa J, Nakasu Y, Matsuda M, Kyoshima K (1984) Aneurysms of the proximal anterior cerebral artery. Surg Neurol 22(5):486–490CrossRefPubMed

Suzuki M, Onuma T, Sakurai Y, Mizoi K, Ogawa A, Yoshimoto T (1992) Aneurysms arising from the proximal (A1) segment of the anterior cerebral artery. A study of 38 cases. J Neurosurg 76(3):455–458CrossRefPubMed

Wakabayashi T, Tamaki N, Yamashita H, Saya H, Suyama T, Matsumoto S (1985) Angiographic classification of aneurysms of the horizontal segment of the anterior cerebral artery. Surg Neurol 24(1):31–34CrossRefPubMed

Sakamoto S, Ohba S, Shibukawa M, Kiura Y, Okazaki T, Arita K, Kurisu K (2006) Characteristics of aneurysms of the internal carotid artery bifurcation. Acta Neurochir 148(2):139–143 discussion 143CrossRefPubMed

van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607CrossRefPubMed

Hino A, Fujimoto M, Iwamoto Y, Oka H, Echigo T (2002) Surgery of proximal anterior cerebral artery aneurysms. Acta Neurochir 144(12):1291–1296 discussion 1296CrossRefPubMed

Wanibuchi M, Kurokawa Y, Ishiguro M, Fujishige M, Inaba KI (2001) Characteristics of aneurysms arising from the horizontal portion of the anterior cerebral artery. Surg Neurol 55(3):148–154 discussion 154-145CrossRefPubMed

Park HS, Choi JH, Kang M, Huh JT (2013) Management of aneurysms of the proximal (A1) segment of the anterior cerebral artery. J Cerebrovasc Endovasc Neurosurg 15(1):13–19CrossRefPubMedPubMedCentral

10.

Lee JM, Joo SP, Kim TS, Go EJ, Choi HY, Seo BR (2010) Surgical management of anterior cerebral artery aneurysms of the proximal (A1) segment. World Neurosurg 74(4–5):478–482CrossRefPubMed

11.

Juvela S, Porras M, Poussa K (2008) Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg 108(5):1052–1060CrossRefPubMed

12.

Wiebers DO, Whisnant JP, Huston J 3rd et al (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362(9378):103–110CrossRefPubMed

13.

Morita A, Kirino T, Hashi K et al (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366(26):2474–2482CrossRefPubMed

14.

Dashti R, Hernesniemi J, Lehto H, Niemelä M, Lehecka M, Rinne J, Porras M, Ronkainen A, Phornsuwannapha S, Koivisto T, Jääskeläinen JE (2007) Microneurosurgical management of proximal anterior cerebral artery aneurysms. Surg Neurol 68(4):366–377CrossRefPubMed

15.

Cho YD, Ahn JH, Jung SC, Kim CH, Kang HS, Kim JE, Son YJ, Han MH (2014) Coil embolization in precommunicating (A1) segment aneurysms of anterior cerebral artery. Neuroradiology 56(3):219–225CrossRefPubMed

16.

Kataoka K, Taneda M, Asai T, Kinoshita A, Ito M, Kuroda R (1999) Structural fragility and inflammatory response of ruptured cerebral aneurysms. A comparative study between ruptured and unruptured cerebral aneurysms. Stroke 30(7):1396–1401CrossRefPubMed

17.

Wilkinson IM (1972) The vertebral artery. Extracranial and intracranial structure. Arch Neurol 27(5):392–396CrossRefPubMed

18.

Leblanc R, Melanson D, Tampieri D et al (1995) Familial cerebral aneurysms: a study of 13 families. Neurosurgery 37(4):633–638 discussion 638-639CrossRefPubMed

19.

Schievink WI, Schaid DJ, Michels VV, Piepgras DG (1995) Familial aneurysmal subarachnoid hemorrhage: a community-based study. J Neurosurg 83(3):426–429CrossRefPubMed

20.

Ronkainen A, Hernesniemi J, Tromp G (1995) Special features of familial intracranial aneurysms: report of 215 familial aneurysms. Neurosurgery 37(1):43–46 discussion 46-47CrossRefPubMed

21.

Brown RD Jr, Broderick JP (2014) Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 13(4):393–404CrossRefPubMed

22.

Bor AS, Rinkel GJ, van Norden J et al (2014) Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study. Lancet Neurol 13(4):385–392CrossRefPubMed

23.

Broderick JP, Brown RD Jr, Sauerbeck L et al (2009) Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke 40(6):1952–1957CrossRefPubMedPubMedCentral

24.

Lazzaro MA, Ouyang B, Chen M (2012) The role of circle of Willis anomalies in cerebral aneurysm rupture. J Neurointerv Surg 4(1):22–26CrossRefPubMed

25.

Maurer J, Maurer E, Perneczky A (1991) Surgically verified variations in the A1 segment of the anterior cerebral artery. Report of two cases. J Neurosurg 75(6):950–953CrossRefPubMed

26.

Friedlander RM, Oglivy CS (1996) Aneurysmal subarachnoid hemorrhage in a patient with bilateral A1 fenestrations associated with an azygos anterior cerebral artery. Case report and literature review. J Neurosurg 84(4):681–684CrossRefPubMed

27.

Taylor R, Connolly ES Jr, Duong H (2000) Radiographic evidence and surgical confirmation of a saccular aneurysm on a hypoplastic duplicated A1 segment of the anterior cerebral artery: case report. Neurosurgery 46(2):482–484CrossRefPubMed

28.

Kwon WK, Park KJ, Park DH, Kang SH (2013) Ruptured saccular aneurysm arising from fenestrated proximal anterior cerebral artery: case report and literature review. J Korean Neurosurg Soc 53(5):293–296CrossRefPubMedPubMedCentral

29.

Czepko R, Libionka W, Lopatka P (2005) Characteristics and surgery of aneurysms of the proximal (A1) segment of the anterior cerebral artery. J Neurosurg Sci 49(3):85–95PubMed

30.

Kedia S, Daisy S, Mukherjee KK, Salunke P, Srinivasa R, Narain MS (2013) Microsurgical anatomy of the anterior cerebral artery in Indian cadavers. Neurol India 61(2):117–121CrossRefPubMed

31.

Chaddad-Neto F, Doria-Netto HL, Campos-Filho JM et al (2014) Head positioning for anterior circulation aneurysms microsurgery. Arq Neuropsiquiatr 72(11):832–840CrossRefPubMed

32.

Perlmutter D, Rhoton AL Jr (1976) Microsurgical anatomy of the anterior cerebral-anterior communicating-recurrent artery complex. J Neurosurg 45(3):259–272CrossRefPubMed

Title: Radiographic and microsurgical characteristics of proximal (A1) segment aneurysms of the anterior cerebral artery
Authors: Chang Ki Jang
E-Wook Jang
Kwang-Chun Cho
Sang Hyun Suh
Joonho Chung
Yong Bae Kim
Chang-Ki Hong
Jin-Yang Joo
Publication date: 01-10-2018
Publisher: Springer Milan
Published in: Neurological Sciences / Issue 10/2018
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-018-3492-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radiographic and microsurgical characteristics of proximal (A1) segment aneurysms of the anterior cerebral artery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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