ArticleNeurosurgery practice2025
Surgical Treatment of Two Simultaneous De Novo Para-Anastomotic Aneurysms Following Side-to-Side Bypass of Anterior Cerebral Artery: A Technical Case Instruction.
Article in Neurosurgery practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and importanceAnterior cerebral artery aneurysms requiring bypass are rare; thus, the literature regarding the subsequent pathology related to the procedure is severely lacking. Hence, there is no consensus regarding the management strategy. The progressive enlargement of de novo para-anastomotic aneurysm carries a higher rupture risk of this abnormal vessel. The peculiar location, related vascular territory, and small corridor of interhemispheric fissure pose challenges to its management. CLINICAL PRESENTATION: We present a 70-year-old woman with two simultaneous de novo para-anastomotic aneurysms after an A3-A3 bypass. Previously, she had an A3-A3 bypass and aneurysm trapping of left A2 dissecting aneurysm 7 years ago. On routine follow-up imaging, she had progressive enlargement of two aneurysm-liked lesions on top of anastomosis vessels. She underwent a modified trapping and superficial temporal artery-anterior cerebral artery bypass with excellent clinical outcome and no recurrence.
conclusionManaging de novo aneurysm formation after in situ A3-A3 bypass is challenging. Complex procedures are required to secure the aneurysm from circulation and ensure its vascularization at the distal site. Long-term follow-up is necessary for all bypass procedures.
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