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

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*

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

OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.
Aneurysm ; Angiography ; Arteries ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck

OBJECTIVE: There is no clear treatment strategy for the management of multiple intracranial aneurysms because of variable anatomical distribution, difficult identification of the aneurysm ruptured, and poor overall outcomes. The purpose of this study was to assess the efficacy and safety of single-session coil embolization for multiple intracranial aneurysms. METHODS: Between September 2008 and December 2012, 209 aneurysms in 117 patients were treated at our institute. Twenty eight among the 117 patients had multiple aneurysms with a total of 71, and 60 of the 71 aneurysms underwent coil embolization in a single-session. RESULTS: A total of 60 aneurysms were treated with a single-session coil embolization, of which the most frequent locations were in the posterior communicating artery, followed by the middle cerebral artery. Immediate post-embolization angiographies showed total occlusion in 49 (81.7%) aneurysms, remnant neck in 6 (10%), and body-filling in 5 (8.3%). Procedure-related complications had developed in 2 (3.3%) of the 60 embolized aneurysms: an asymptomatic thromboembolic event, and a partial coil protrusion without a subsequent thromboembolic complication. CONCLUSION: With careful evaluation of individual aneurysm characteristics and configuration, multiple intracranial aneurysms previously thought to require multimodality therapy can be safely treated in a single-session coil embolization.
Aneurysm ; Angiography ; Arteries ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neck

Advances in microneurosurgical treatment of arterial aneurysm have led to increased interest being focused on aneurysm situated within the posterior cerebral fossa. Despite this, reports of neurosurgical intervention in such cases are still rare and there is no report about the distal posterior cerebral artery aneurysm in Korea. An aneurysm of the posterior cerebral artery has been referred to as a "distinct rarity", making up about 0.26 to 2.7% of all cerebral aneurysms. Especially, the incidence of the distal posterior cerebral artery aneurysm is quite rare and most of them are saccular in shape and single in number. The authors report a case of P4 segment aneurysm of left posterior cerebral artery, successfully treated by clipping cross neck and reviewed the literature, and discussed their anatomy, clinical feature, location, and variable operative methods.
Aneurysm ; Incidence ; Intracranial Aneurysm* ; Korea ; Neck ; Posterior Cerebral Artery*

The incidence of the distal anterior cerebral artery(DACA) aneurysm comprises about 2-6% of all intracerebral aneurysms. Because of the low incidence, unique anatomies of the distal anterior cerebral arteries and some technical difficulties in surgery, these aneurysms present such challenge to neurosurgeons. Presently, early surgery using interhemispheric approach is preferred. The auhtors experienced six patients with DACA aneurysms in 130 consecutive intracerebral aneurysms surgically treated between May. 1994 and Dec. 1997. The patients received operations within five days from the ictus, except one patient because of symptomatic vasospasm. The surgical approaches were all unilateral interhemispheric approaches. During the operations, infusion of large amount of mannitol and CSF volume removal were applied, although there were few difficulties in the interhemispheric dissections, the outcomes of the patients were excellent in three, good in three. The authors suggest that early operative interventions using unilateral interhemispheric approach without generous craniotomy can improve the outcomes of the patients with ruptured DACA aneurysm.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Humans ; Incidence ; Intracranial Aneurysm* ; Mannitol