The authors described different type of aneurysms in the distal anterior cerebral artery(DACA), which is difficult to approach surgically. there are anomalies of distal anterior cerebral artery in about one fourth and narrow space, which made more careful surgical dissection. We experienced 7 cases of DACA aneurysm, 6 cases of which were treated surgically through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the non-dominant side. Surgical results were anatomical complexities, modern microsurgical technique aided by microscope make the approach more exactly and safely.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Intracranial Aneurysm*

Seven cases of A2 anomaly including azygous A2 and accessory A2 were observed during aneurysm surgery. We present case histories, angiograms and operative descriptions, and discuss with the clinical significance of the anomaly. The recognition of the anatomic variations prior to clip placement for anterior cerebral artery aneurysm is emphasized.
Aneurysm ; Anterior Cerebral Artery* ; Intracranial Aneurysm*

Some aneurysms with peculiar shapes, large sized or in unusual location cannot be obliterated by ordinary methods. We present four cases using two kinds of fenestrated clips. There were 4 aneurysms in the 4 patients:3 saccular and 1 fusiform aneurysm. Two aneurysms were located in anterior communicating artery, one left carotico-opthalmic artery, and one distal middle cerebral artery. All of the aneurysms were successfully obliterated. Our results suggest that the various shape of fenestrated clips may be benefit for clipping difficult aneurysms, which would not be clipped with ordinary one.
Aneurysm ; Arteries ; Intracranial Aneurysm* ; Middle Cerebral Artery

Aneurysmal ruptures associated with middle cerebral artery(MCA) anomalies, such as a duplicated MCA and an accessory MCA, are quite rare. The authors reviewed the clinical relevance and possible etiology of these anomalies.
Aneurysm ; Aneurysm, Ruptured ; Intracranial Aneurysm* ; Middle Cerebral Artery* ; Rupture*

We report a unique case of bilateral mirror image M1 aneurysms, one of which was an unruptured aneurysm arising from the proximal end of right middle cerebral artery fenestration with long loop and the other ruptured aneurysm from the contralateral side. We clipped ruptured aneurysm first and unruptured one in three months after the first operation. The difficulties of identifying this unusual vascular anomaly and possible problems during the surgery of an aneurysm at the site of fenestration are discussed with a review of the literature.
Aneurysm ; Aneurysm, Ruptured ; Intracranial Aneurysm ; Middle Cerebral Artery

The azygous anterior cerebral artery (ACA) is a rare type of ACA anomaly. In the conventional angiography, cognition of its realm is difficult without considerable reading. Clinically, misreading its nature causes confusion during the surgical approach to its associated cerebral aneurysm. We report this rare clinical experience with an angiographic and surgical review.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Cerebral Angiography ; Cognition ; Intracranial Aneurysm

PURPOSE: The purpose of this study was to assess the relative diagnostic capability of magnetic resonance angiography(MRA) and CT angiography(CTA) in the evaluation of intracranial aneurysm. MATERIALS AND METHODS: MRA and CTA were performed in 14 intracranial aneurysms (Including four which were ruptured) confirmed in the II patients involved by conventional angiography(CA). The size(in largest dimension) of the aneurysms ranged between 3 mm and 20 mm and the mean was 10.5 mm. For MRA, the 3D TOF method, with magnetization transfer suppression, wasused at 1.5T. For CTA, twenty seconds after beginning the injection of contrast media(100mL with use of a power injector at the rate of 3 mL/sec), CT scanning(30-second exposure and 60-mm length) was performed with a table speed of 2 mm/sec and a section thickness of 2mm. The resulting data were reformatted by MIP. MRA and CTA were compared with regard to the detection of aneurysms and their neck, size, shape, direction, intensity and relationship to adjacent bony structures or vessels. RESULTS: All aneurysms were clearly visualized with CTA. Inone case with a 3-mm aneurysm, however, this was not defined on MRA. Of the 13 aneurysms demonstrated by both MRA and CTA, eight were seen equally well with both modalities. CTA was considered to be superior to MRA in fivecases, either because calcification in the aneurysm wall was seen only on CTA(n = 3) or because the relationship with adjacent bony structures were seen better with CTA(n = 2). With CTA, the intensities of the aneurysm were homogeneous in all cases ; with MRA, however, the intensities of three large aneurysms were different. CONCLUSION: MRA and CTA may be useful in the evaluation of intracranial aneurysm, CTA has specific advantages over MRA inthe evaluation of large aneurysms, calcification of aneurysm wall and relationship with adjacent bony structure.
Aneurysm ; Angiography* ; Cerebral Angiography ; Intracranial Aneurysm* ; Magnetic Resonance Angiography* ; Neck

Rerupture of intracranial aneurysms during cerebral angiography is a rare complication and it usually occurs with in 24 hours after initial bleeding. We experienced three cases of aneurysmal rerupture during cerebral angiography, and in each case, angiography was performed after 24 hours from the initial attack. We have noticed extravasation of contrast medium to subarachnoid space or intraventricular space during angiography. In result, two patients died and one patient was disabled moderately.
Aneurysm ; Angiography* ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Subarachnoid Space

Three cases of cerebral rete mirabile associated with aneurysms are presented. In two cases the aneurysms were located at the anterior communicating arteries, and in one at the peripheral portion of the middle cerebral artery. For the anterior communicating artery aneurysms, operations were performed. Based on these experiences, the difficulties and necessities of operations for the aneurysms associated with cerebral rete mirabilies are briefly discussed.
Aneurysm* ; Arteries ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mirabilis ; Moyamoya Disease*

The author describes the basic and standard operative method of interhemispheric(IH) approach for intracranial aneurysms especially aneurysm in anterior cerebral artery territory.Though most neurosurgeons prefer to pterional approach for anterior communicating artery aneurysm, some neurosurgeons select IH approach routinely for this aneurysm because of least brain retraction and excellent anatomical orientation with this approach. But IH approach should be chosen for distal anterior cerebral artery aneurysms and certain cases of anterior communicating artery aneurysms such as high positioned aneurysm or aneurysm with significant hematoma at frontal lobe. interhemispheric approach.
Aneurysm ; Anterior Cerebral Artery ; Brain ; Frontal Lobe ; Hematoma ; Intracranial Aneurysm*