Revascularization of the anterior cerebral artery by Y-shaped superficial temporal artery interposition graft for the treatment of a de novo aneurysm arising at the site of A3-A3 bypass: technical case report

• Published in: Journal of neurosurgery Vol. 129; no. 5; p. 1120
• Main Authors: Endo, Hidenori, Sugiyama, Shin-Ichiro, Endo, Toshiki, Fujimura, Miki, Shimizu, Hiroaki, Tominaga, Teiji
• Format: Journal Article
• Language: English
• Published: United States 01.11.2018
• Subjects: Anterior Cerebral Artery - diagnostic imaging; Anterior Cerebral Artery - surgery; Cerebral Angiography; Cerebral Revascularization - methods; Female; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Middle Aged; Neurosurgical Procedures - methods; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - surgery; Temporal Arteries - transplantation; Treatment Outcome; ACA = anterior cerebral artery; STA = superficial temporal artery; de novo aneurysm; DSA = digital subtraction angiography; MCA = middle cerebral artery; interposition graft; CFD = computational fluid dynamics; bypass surgery; anterior cerebral artery; vascular disorders
• ISSN: 1933-0693
• DOI: 10.3171/2017.6.JNS17931

The most frequently used option to reconstruct the anterior cerebral artery (ACA) is an ACA-ACA side-to-side anastomosis. The long-term outcome and complications of this technique are unclear. The authors report a case of a de novo aneurysm arising at the site of A3-A3 anastomosis. A 53-year-old woman underwent A3-A3 side-to-side anastomosis for the treatment of a ruptured right A2 dissecting aneurysm. At 44 months after surgery, a de novo aneurysm developed at the site of anastomosis. The aneurysm developed in the front wall of the anastomosis site, and projected to the anterosuperior direction. A computational fluid dynamics (CFD) study showed the localized region with high wall shear stress coincident with the pulsation in the front wall of the anastomosis site, where the aneurysm developed. A Y-shaped superficial temporal artery (STA) interposition graft was used successfully to reconstruct both ACAs, and then the aneurysm was trapped. To the authors' knowledge, this is the first case of a de novo aneurysm that developed at the site of an ACA-ACA side-to-side anastomosis. A CFD study showed that hemodynamic stress might be an underlying cause of the aneurysm formation. A Y-shaped STA interposition graft is a useful option to treat this aneurysm. Long-term follow-up is necessary to detect this rare complication after ACA-ACA anastomosis.