Clipping and superficial temporal artery-M2 bypass for unruptured anterior communicating artery aneurysm associated with atherosclerotic internal carotid artery occlusion: report of 2 cases.
BACKGROUND
The management of the unruptured AcomA aneurysm associated with atherosclerotic occlusion of the unilateral internal carotid artery (ICA) raises several strategic dilemmas.


METHODS
Two such patients with unruptured aneurysm on the AcomA, which supply cross-flow toward the hemisphere with ICA occlusion, are presented.


RESULTS
Both patients were treated with STA-M2 bypass followed by clipping of the unruptured AcomA aneurysm in 1 stage through the transsylvian route. Both patients were doing well without neurological deficit nor cognitive impairment at 1 year follow-up.


CONCLUSIONS
In the surgical treatment of unruptured AcomA aneurysm with atherosclerotic ICA occlusion, preceding bypass would be ideal in case of intraoperative rupture as well as to reduce perioperative ischemia if the bypass procedure itself could be performed with minimal risk. Enough and atraumatic exposure of the sylvian fissure contributed to reduce brain retraction during the clipping of AcomA aneurysm and, in addition, to ease the STA-M2 bypass.
Department of Neurosurgery, Showa general hospital, 2-450 Tenjinn-cho Kodaira-shi, Tokyo, 187-8510, Japan.
Tomohiro
T
Inoue
Kazuo
K
Tsutsumi
Shinobu
S
Adachi
Shota
S
Tanaka
Kuniaki
K
Saito
Naoto
N
Kunii
D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000601:surgery*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged