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Impact of dome projection on operative steps during clipping of a ruptured pure posteriorly directed posterior communicating artery aneurysms

Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.

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Publication Date
Thu Dec 15 2022
Journal Name
Romanian Neurosurgery
Mobilization of the temporal pole as integrated step in microsurgical clipping of pure posteriorly directed posterior communicating artery aneurysm

A pure posteriorly posterior communicating artery (PCoA) aneurysm represents a surgical challenge. This is mainly when there is a need for good exposure of the aneurysmal neck, sac, PCoA, and anterior choroidal arteries. Ruptured pure posteriorly directed PCoA aneurysm imposes significantly extra challenge as the surgeon undergoes dissection through a tight brain. Even with measures commonly used to attain brain relaxation like the lumbar drain and cisternal fenestration. Here, we describe a technique for posterior temporal pole mobilization (TPM) as an integrated part of microsurgical clipping of ruptured pure posteriorly directed PCoA aneurysms. This technique is implicated in twenty-three successive cases of ruptured PCoA aneurys

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Publication Date
Sat Aug 01 2020
Journal Name
Surgical Neurology International
Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm
Background:

Absence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associa

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Publication Date
Sun Jan 03 2010
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Surgical Management of a Hydatid Cyst of the Hepatic Dome Ruptured into the Biliary Tree

Background: Hydatid disease remains an important & challenging medical problem.
Case report: A62 year old male patient was admitted complaining of upper abdominal discomfort. Six days earlier he suffered from acute pain in the right upper quadrant, mild systemic allergic manifestation, a fever of 38.5oC and chills. He was managed by a new surgical approach of myoplasty of the right hemidiaphragm combined with preoperative decompression of the bile duct by an endoscopic sphincterotomy. A case search identified study describing rupture of a hydatid cyst of the hepatic dome into biliary tract. The incidence of intrabiliary rupture of hepatic hydatid cysts is 25% in patients treated with external surgical

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Publication Date
Mon Mar 08 2021
Journal Name
Surgical Neurology International
Ruptured giant aneurysm of a cortical middle cerebral artery: A case report
Background:

Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity.

Case Description:

A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracer

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Publication Date
Tue Sep 15 2020
Journal Name
Romanian Neurosurgery
Enlarged anterior communicating artery masquerading as intracranial aneurysm

Background. The anterior communicating artery (ACoA) complex consists of the ACoA, the pre-and post-communicating segments of the anterior cerebral artery, and the recurrent artery of Heubner. It is the most common site for anatomical variations in the circle of Willis. Such variations can mimic intracranial aneurysms. Case description. A 30-year-old female presented with recurrent episodes of extreme headache and bilateral tinnitus. A brain computed tomography (CT) scan showed no significant lesions, while her CT-angiography (CTA) showed an enlarged vascular lesion at the ACoA, raising the suspicion for an ACoA aneurysm. A repeated CTA revealed a rare anatomical variation with a pattern of cross dominance in the ACoA complex;

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Publication Date
Wed Aug 30 2023
Journal Name
Al-kindy College Medical Journal
‘Peacock tail’ Clipping Technique for a Giant Middle Cerebral Artery Aneurysm: A Technical Note

Background: Giant middle cerebral artery (MCA) aneurysms are surgically challenging lesions. Because of the complexity and variability of these aneurysms, a customized surgical technique is often needed for each case. In this article, we present a modified clip reconstruction technique of a ruptured complex giant partially thrombosed middle cerebral artery aneurysm.

Case description: The aneurysm was exposed using the pterional approach. Following proximal control, the aneurysm sac was decompressed. Then, we applied permanent clips to reconstruct the aneurysm neck. The configuration of the aneurysm mandated a tailored clipping pattern to account for resi

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Publication Date
Tue Jun 16 2020
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Rupture of renal artery aneurysm during cesarean section: a case report: Ruture of renal artery aneurysm r cesarean seection

 

Introduction:

Renal artery aneurysm (RAA) occurs to focal dilatation of artery secondary to weakness of the arterial intima and media. RAA is a rare clinical entity with an incidence of 0.01 – 1%.1

Rupture RAA during pregnancy is extremely rare event. The obstetric and urologic literatures are deficient in this regard. Diagnosis of ru

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Publication Date
Thu Sep 15 2022
Journal Name
Romanian Neurosurgery
Cervical carotid artery vasospasm during cerebral angiography

Background: Vasospasm occurs commonly in the intracranial arteries as a complication of subarachnoid haemorrhage. On the other hand, extracranial Internal carotid artery (ICA) vasospasm is scarce, and it may occur due to mechanical manipulation during cerebral angiography. We report a case of cervical carotid artery vasospasm during diagnostic cerebral angiography, which caused anterior cerebral artery territory hypoperfusion, to discuss potential risk factors. Case description: For a 22-year-old female with a ten-year history of epilepsy on multiple drugs, brain magnetic resonance imaging (MRI) showed frontal periventricular developmental venous anomaly. Diagnostic catheter cerebral angiography was used to better identify the vas

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Publication Date
Fri Jan 20 2023
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
On the Stability and Acceleration of Projection Algorithms

The focus of this paper is the presentation of a new type of mapping called projection Jungck zn- Suzuki generalized and also defining new algorithms of various types (one-step and two-step algorithms) (projection Jungck-normal N algorithm, projection Jungck-Picard algorithm, projection Jungck-Krasnoselskii algorithm, and projection Jungck-Thianwan algorithm). The convergence of these algorithms has been studied, and it was discovered that they all converge to a fixed point. Furthermore, using the previous three conditions for the lemma, we demonstrated that the difference between any two sequences is zero. These algorithms' stability was demonstrated using projection Jungck Suzuki generalized mapping. In contrast, the rate of convergenc

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Publication Date
Fri May 01 2015
Journal Name
Journal Of The Faculty Of Medicine
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