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Computed tomography angiography in detection and characterization of ruptured anterior cerebral artery aneurysms at uncommon location for emergent surgical clipping

  • Chia-yuen Chen
    Affiliations
    Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC
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  • Shu-Chiang Hsieh
    Affiliations
    Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC
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  • Wai-Man Choi
    Affiliations
    Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC
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  • Pei-yeh Chiang
    Affiliations
    Department of Neurosurgery, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC
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  • Jerry Chin-Wei Chien
    Affiliations
    Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC
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  • Wing P. Chan
    Correspondence
    Corresponding author. Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111, Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC. Tel.: +886 2 2930 7930x1300; fax: +886 2 2931 6809.
    Affiliations
    Department of Radiology, Taipei Medical University–Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan, ROC

    Department of Radiology, School of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC
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Published:November 30, 2005DOI:https://doi.org/10.1016/j.clinimag.2005.09.022

      Abstract

      Introduction

      Cerebral subarachnoid hemorrhage may result from rupture of saccular aneurysms at uncommon location [excluding the anterior communicating artery (ACOM)] of the anterior cerebral artery (ACA). The purpose of this study was to evaluate the usefulness of helical computed tomography angiography (CTA) in detection and characterization of intracranial aneurysms at such uncommon locations before emergent surgical clipping.

      Materials and methods

      Between 1998 and 2003, records for 50 consecutive patients who underwent emergent surgical clipping for intracranial aneurysms were reviewed. Eighteen of these patients had aneurysms in the ACA. After those patients with unequivocal ACOM aneurysms were excluded, eight patients with eight aneurysms in an uncommon location of the ACA were recruited to this study. Plain computed tomography (CT) and CTA were performed in eight patients, and digital subtraction angiographies were done in three patients. Each aneurysm was evaluated for the detection, quantification, and characterization of the aneurysms with 2D multiplanar reformatted and 3D volume-rendering techniques.

      Results

      There were two small aneurysms arising from the A1 segment, one from the A2 segment, two at the junction of triplicated ACAs, two at the junction of A2 and A3 segments, and one at the junction of A2 and A3 segments of the azygos ACA. The average diameter of the aneurysmal sac was 4.44 mm (range, 2.7–7.0 mm), and the aneurysmal neck averaged 2.59 mm (range, 1.2–3.5 mm) in size. The smallest aneurysm measured 2.2×1.8×2.7 mm (neck, 1.2 mm) in the A1 segment of the left ACA. Three patients had intracerebral hematoma, seven had intraventricular hemorrhage, and three had acute hydrocephalus.

      Conclusion

      Aneurysms in uncommon locations of ACAs exhibited characteristic features. Rupture of these aneurysms can cause intracerebral hematoma, intraventricular hemorrhage, and/or acute hydrocephalus. Noninvasive CTA can reliably detect and characterize intracranial aneurysms at such uncommon location for planning of emergent surgical intervention.

      Keywords

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      References

        • Howng SL
        • Hung TP
        • Kwan AL
        • et al.
        Intracranial aneurysm in Taiwan.
        J Formos Med Assoc. 1995; 94: S73-S80
        • Tatter SB
        • Crowell RM
        • Ogilvy CS
        Aneurysmal and microaneurysmal “angio-negative” subarachnoid hemorrhage.
        Neurosurgery. 1995; 37: 48-55
        • Fernadez ZA
        • Guglielmi G
        • Vinuela F
        • et al.
        Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results.
        AJNR Am J Neuroradiol. 1994; 15: 815-820
        • Villablanca JP
        • Jahan R
        • Hooshi P
        • et al.
        Detection and characterization of very small cerebral aneurysms by using 2D and 3D helical CT angiography.
        AJNR Am J Neuroradiol. 2002; 23: 1187-1198
        • Suzuki M
        • Onuma T
        • Sakurai Y
        • et al.
        Aneurysm arising from the proximal (A1) segment of the anterior cerebral artery.
        J Neurosurg. 1992; 76: 455-458
        • De Sousa AA
        • Dantas FL
        • de Cardoso GT
        • et al.
        Distal anterior cerebral artery aneurysms.
        Surg Neurol. 1999; 52: 128-136
        • Villablanca JP
        • Martin N
        • Jahan R
        • et al.
        Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms.
        J Neurosurg. 2000; 93: 254-264
        • Zouaoui A
        • Sahel M
        • Marro B
        • et al.
        Three-dimensional computed tomographic angiography in detection of cerebral aneurysms in acute subarachnoid hemorrhage.
        Neurosurgery. 1997; 41: 125-130
        • Lenhart M
        • Bretschneider T
        • Gmeinwieser J
        • et al.
        Cerebral CT angiography in the diagnosis of acute subarachnoid hemorrhage.
        Acta Radiol. 1997; 38: 791-796
        • Ogawa T
        • Okudera T
        • Noguchi K
        • et al.
        Cerebral aneurysms: evaluation with three-dimensional CT angiography.
        AJNR Am J Neuroradiol. 1996; 17: 447-454
        • Imakita S
        • Onishi Y
        • Hashimoto T
        • et al.
        Subtraction CT angiography with controlled-orbit helical scanning for detection of intracranial aneurysms.
        AJNR Am J Neuroradiol. 1998; 19: 291-295
        • Anderson GB
        • Findlay JM
        • Steinke DE
        • et al.
        Experience with computed tomographic angiography for the detection of intracranial aneurysms in the setting of acute subarachnoid hemorrhage.
        Neurosurgery. 1997; 41: 522-528
        • Kogori Y
        • Takahashi M
        • Katada K
        • et al.
        Intracranial aneurysms: detection with three-dimensional CT angiography with volume rendering—comparison with conventional angiographic and surgical findings.
        Radiology. 1999; 211: 497-506
        • Velthuis BK
        • Rinkel GJE
        • Ramos LMP
        • et al.
        Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography.
        Radiology. 1998; 208: 423-430
        • Schwartz RB
        • Tice HM
        • Hooten SM
        • et al.
        Evaluation of cerebral aneurysms with helical CT: correlation with conventional angiography and MR angiography.
        Radiology. 1994; 192: 717-722
        • Harrison MJ
        • Johnson BA
        • Gardner GM
        • Welling BG
        Preliminary results on the management of unruptured intracranial aneurysms with magnetic resonance angiography and computed tomographic angiography.
        Neurosurgery. 1997; 40: 947-957
        • Broderick JP
        • Brott TG
        • Duldner JE
        • et al.
        Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage.
        Stroke. 1994; 25: 1342-1347
        • Velthuis BK
        • Leeuwen MSV
        • Witkamp TD
        • et al.
        Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography.
        J Neurosurg. 1999; 91: 761-767
        • Van der Jagt M
        • Hasan D
        • Bijvoet HW
        • et al.
        Validity of prediction of the site of ruptured intracranial aneurysms with CT.
        Neurology. 1999; 52: 34-39
        • Inci S
        • Erbengi A
        • Ozgen T
        Aneurysms of the distal anterior cerebral artery.
        Surg Neurol. 1998; 50: 130-140
        • Miyazawa N
        • Nukui H
        • Yagi S
        • et al.
        Statistical analysis of factors affecting the outcome of patients with ruptured distal anterior cerebral artery aneurysms.
        Acta Neurochir. 2000; 142: 1241-1246
        • Hino A
        • Fujimoto M
        • Iwamoto Y
        • et al.
        Surgery of proximal anterior cerebral artery aneurysms.
        Acta Neurochir. 2002; 144: 1291-1296
        • Wakabayashi T
        • Tamaki N
        • Yamashita H
        • et al.
        Angiographic classification of aneurysms of the horizontal segment of the anterior cerebral artery.
        Surg Neurol. 1985; 24: 31-34
        • Baptista AG
        Studies of the arteries of the brain II. The anterior cerebral artery: some anatomic features and their clinical implications.
        Neurology. 1963; 13: 825-835
        • Shimosegawa Y
        • Takahashi A
        • Onuma T
        Ruptured cerebral aneurysm of the median artery of the corpus callosum (accessory anterior cerebral artery): case report.
        No Shinkei Geka. 1985; 13: 579-583
        • Kaido T
        • Nakase H
        • Goda K
        • et al.
        Value of 3D CTA in association with accessory anterior cerebral artery with ruptured anterior communicating artery aneurysm.
        Acta Neurochir. 2003; 145: 157-158
        • Mount LA
        • Brisman R
        Treatment of multiple aneurysms—symptomatic and asymptomatic.
        Clin Neurosurg. 1974; 21: 166-170