End-to-end anastomosis of the anterior cerebral artery after excision of a giant aneurysm

Case report

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✓ A case of a giant anterior cerebral artery fusiform aneurysm is presented. The lesion was treated by primary excision of the involved segment with an end-to-end anastomosis of the proximal-distal segments of the anterior cerebral artery. It is believed that this technique has not been reported previously for lesions involving major intracranial arteries.

Article Information

Address reprint requests to: Robert R. Smith, M.D., Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216.

© AANS, except where prohibited by US copyright law.

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Figures

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    Computerized tomography scan on admission showing an enhancing lesion in the right parasagittal frontal lobe.

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    Angiogram, lateral (left) and oblique (right) views, demonstrating a fusiform enlargement of the anterior cerebral artery proximal to the callosomarginal branch. Irregularity of the distal vessel is also seen.

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    A and B: After dividing the falx cerebri, the aneurysm was approached in the interhemispheric fissure. C: Clips were placed on either side of the fusiform enlargement and the lesion excised. D and E: Approximation of the blades of the clip brought the proximal and distal ends of the vessel together. Anastomosis was completed first on one side, then the other.

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    Left: Postoperative computerized tomography scan demonstrating some increased density in the parasagittal area remaining after excision of the aneurysm. No distal ischemic lesions were identified. Right: Postoperative angiogram illustrating patency of the anastomosis.

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