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Surgical treatment of traumatic distal anterior cerebral artery aneurysm: a report of nine cases from a single centre

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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A Correction to this article was published on 13 December 2019

This article has been updated

Abstract

Background

Traumatic distal anterior cerebral artery (dACA) aneurysm is rare and can be easily neglected and misdiagnosed in patients with trauma. The aim of this study was to explore the radiologic characteristics of and therapeutic strategies for traumatic dACA aneurysm and to improve our understanding of unusual complications after trauma.

Methods

The clinical data of nine cases of traumatic dACA aneurysm from our neurosurgical department from July 1, 2010, to July 1, 2018, were retrospectively analysed.

Results

All 9 patients had a history of brain trauma. The initial computed tomography scan immediately after trauma showed subarachnoid haemorrhage in 8 cases. Among these cases, delayed intracranial haemorrhage occurred in 7 cases. The average interval between injury and diagnosis was 13.67 ± 9.43 days. All 9 cases were confirmed as traumatic dACA aneurysm by computed tomography angiography (CTA) and/or digital subtraction angiography. According to Lehecka’s classification system, traumatic dACA aneurysm located in the A3 and A4 segment was found in 3 and 6 cases, respectively. Surgical treatment was performed in 8 cases, including neck clipping, with or without wrapping in 3 cases, trapping in 4 cases, aneurysm excision and suturing in 1 case and conservative treatment in 1 case. Three patients required a ventriculoperitoneal shunt due to severe hydrocephalus. According to the Glasgow Outcome Scale scoring system, good recovery was achieved in 4 cases, moderate disability in 2 cases, severe disability in 1 case, and death in 2 cases.

Conclusion

Traumatic dACA aneurysm is a rare complication of brain trauma. Delayed intracranial haemorrhage and the sudden deterioration of neurologic function were the typical characteristics in patients with traumatic dACA aneurysm. CTA is the first-line screening modality for patients who present with intracerebral haemorrhage in the corpus callosum after trauma, particularly for patients who are older, in a poorer or critical condition. When the aneurysm is located in the A4 segment or involves a small branch, surgical trapping is the preferred definitive therapy to prevent further growth and disastrous bleeding. Early diagnosis and prompt treatment could help to improve clinical outcomes.

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Change history

  • 13 December 2019

    Incorrect family name of Dongsheng Guo.

References

  1. Amirjamshidi A, Rahmat H (1996) Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management. A survey of 31 cases and review of the literature. J Neurosurg 84:769–780

    Article  CAS  Google Scholar 

  2. Barua NU, Ross AH, Sanderman DR (2007) Traumatic callosomarginal aneurysm following orbital gunshot wound in a 16-year-old girl. Br J Neurosurg 21:237–238

    Article  CAS  Google Scholar 

  3. Burton C, Velasco F, Dorman J (1968) Traumatic aneurysm of a peripheral cerebral artery. Review and case report. J Neurosurg 28:468–474

    Article  CAS  Google Scholar 

  4. Cohen JE, Gomori JM, Segal R, Spivak A, Margolin E, Sviri G, Rajz G, Fraifeld S, Spektor S (2008) Results of endovascular treatment of traumatic intracranial aneurysms. Neurosurgery 63:476–485

    Article  Google Scholar 

  5. Cohen JE, Rajz G, Itshayek E, Shoshan Y, Umansky F, Gomori JM (2005) Endovascular management of traumatic and iatrogenic aneurysms of the pericallosal artery. Report of two case. J Neurosurg 102:555–557

    Article  Google Scholar 

  6. Cummings TJ, Johnson RR, Diaz FG, Michael DB (2000) The relationship of blunt head trauma, subarachnoid hemorrhage, and rupture of pre-existing intracranial saccular aneurysms. Neurol Res 22:165–170

    Article  CAS  Google Scholar 

  7. Dunn GP, Gerrard JL, Jho DH, Ogilvy CS (2011) Surgical treatment of a large fusiform distal anterior cerebral artery aneurysm with in situ end-to-side A3—A3 bypass graft and aneurysm trapping. Neurosurgery 68:E587–E591

    Article  Google Scholar 

  8. Dunn IF, Woodworth GF, Siddiqui AH, Smith ER, Vates GE, Day AL, Goumnerova LC (2007) Traumatic pericallosal artery aneurysm: a rare complication of transcallosal surgery. Case report. J Neurosurg 106:153–157

    PubMed  Google Scholar 

  9. Gillis CC, Gooderham PA, Haw CS (2013) Traumatic entrapment of the anterior cerebral artery: a case report. Clin Neurol Neurosurg 115:498–500

    Article  Google Scholar 

  10. Holmes B, Harbaugh RE (1993) Traumatic intracranial aneurysms: a contemporary review. J Trauma 35:855–860

    Article  CAS  Google Scholar 

  11. Hsieh CT, Lin EY, Tsai TH, Chiang YH, Ju DT (2007) Delayed rupture of pre-existing cerebral aneurysm in a young patient with minor head trauma. J Clin Neurosci 14:1120–1122

    Article  Google Scholar 

  12. Jung SH, Kim SH, Kim TS, Joo SP (2017) Surgical treatment of traumatic intracranial aneurysms: experiences at a single center over 30 years. World Neurosurg 98:243–250

    Article  Google Scholar 

  13. Kim MS, Sim SY (2014) Traumatic aneurysm of the callosomarginal artery-cortical artery junction from penetrating injury by scissors. J Korean Neurosurg 55:222–225

    Article  Google Scholar 

  14. Kumar A, Jakubovic R, Yang V, Dacosta L (2016) Traumatic anterior cerebral artery aneurysms and management options in the endovascular era. J Clin Neurosci 25:90–95

    Article  Google Scholar 

  15. Lam CH, Montes J, Farmer JP, O’Gorman AM, Meagher-Villemure K (1996) Traumatic aneurysm from shaken baby syndrome: case report. Neurosurgery. 39:1252–1255

    Article  CAS  Google Scholar 

  16. Lath R, Vaniprasad A, Kat E, Brophy BP (2002) Traumatic aneurysm of the callosomarginal artery. J Clin Neurosci 9:466–468

    Article  Google Scholar 

  17. Lehecka M, Porras M, Dashti R, Niemela M, Hernesniemi JA (2008) Anatomic features of distal anterior cerebral artery aneurysms: a detailed angiographic analysis of 101 patients. Neurosurgery 63:219–228

    Article  Google Scholar 

  18. Levine NB, Tanaka T, Jones BV, Crone KR (2004) Minimally invasive management of a traumatic artery aneurysm resulting from shaken baby syndrome. Pediatr Neurosurg 40:128–131

    Article  Google Scholar 

  19. Mao Z, Wang N, Hussain M, Li M, Zhang H, Zhang Q, Zhang P, Zhi X, Ling F (2012) Traumatic intracranial aneurysms due to blunt brain injury-a single center experience. Acta Neurochir 154:2187–2193

    Article  Google Scholar 

  20. Nakstad PH, Gjertsen O, Pedersen HK (2008) Correlation of head trauma and traumatic aneurysms. Interv Neuroradiol 14:33–38

    Article  Google Scholar 

  21. O’Brien D Jr, O’Dell MW, Eversol A (1997) Delayed traumatic cerebral aneurysm after brain injury. Arch Phys Med Rehabil 78:883–885

    Article  Google Scholar 

  22. Pradilla G, Wicks RT, Hadelsberg U, Gailloud P, Coon AL, Huang J, Tamargo RJ (2013) Accuracy of computed tomography angiography in the diagnosis of intracranial aneurysms. World Neurosurg 80:845–852

    Article  Google Scholar 

  23. Scholtes F, Henroteaux A, Otto B, Martin D (2015) Head trauma and distal anterior cerebral artery aneurysm: potential role of an adhesion to the falx. J Neurol Surg A Cent Eur Neurosurg 76:72–75

    PubMed  Google Scholar 

  24. Senegor (1991) Traumatic pericallosal aneurysm in a patient with no major trauma. Case report. J Neurosurg 75:475–477

    Article  CAS  Google Scholar 

  25. Shih TY, Kuo YL (2002) Development of intracranial complications following transoral stab wounds in children. Report of two cases. Pediatr Neurosurg 37:35–37

    Article  Google Scholar 

  26. Sim SY, Shin YS, Yoon SH (2008) Endovascular internal trapping of traumatic pericallosal pseudoaneurysm with hydrogel-coated self-expandable coil in a child: a case report. Surg Neurol 69:418–422

    Article  Google Scholar 

  27. Sui M, Mei Q, Sun K (2015) Surgical treatment achieves better outcome in severe traumatic pericallosal aneurysm: case report and literature review. Int J Clin Exp 8:1598–1603

    Google Scholar 

  28. Tubbs RS, Acakpo-Satchivi L, Blount JP, Oakes WJ, Wellons JC (2006) Pericallosal artery pseudoaneurysm secondary to endoscopic-assisted ventriculoperitoneal shunt placement. Case report. J Neurosurg 105:140–142

    Article  Google Scholar 

  29. Türe U, Yaşargil MG, Krisht AF (1996) The arteries of the corpus callosum: a microsurgical anatomic study. Neurosurgery. 39:1075–1084

    Article  Google Scholar 

  30. Van Rooij WJ, Van Rooij SB (2013) Endovascular treatment of traumatic pericallosal artery aneurysms. A case report. Interv Neuroradiol 19:56–59

    Article  Google Scholar 

  31. Yamanaka K, Ishihara M, Nakajima S, Yamasaki M, Yoshimine T (2011) Coil embolization of a traumatic intracranial aneurysm of the distal part of the azygos anterior cerebral artery followed up for 4 years. Neurol Med Chir 51:572–575

    Article  Google Scholar 

  32. Yang TC, Lo YL, Huang YC, Yang ST (2007) Traumatic anterior cerebral artery aneurysm following blunt craniofacial trauma. Eur Neurol 58:239–245

    Article  Google Scholar 

  33. Yuen CM, Kuo YL, Ho JT, Liao JJ (2007) Rapid regrowth of a successfully coiled traumatic pericallosal aneurysm. J Clin Neurosci 14:1215–1219

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge the help of all the staff involved in this study taking part in the medical record collection and review.

Funding

This study was supported by a grant from the National Natural Science Foundation of China No.81671154 to Dr. He.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, HuBei Province, People’s Republic of China

    Yue He, Yibo Ou, Heping Wang, Sheng Wang, Po Zhang & Dongsheng Guo

  2. Department of Operating Room, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, HuBei Province, People’s Republic of China

    Ling Wang

  3. Department of Neurosurgery, Jianghan Oilfield Central Hospital, Qianjiang, 433100, HuBei Province, People’s Republic of China

    Xiaobing He

Authors
  1. Yue He
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  2. Ling Wang
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  4. Heping Wang
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  5. Sheng Wang
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  6. Po Zhang
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  7. Xiaobing He
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  8. Dongsheng Guo
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Corresponding author

Correspondence to Dongsheng Guo.

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Ethics approval and consent to participate

This study was approved by the institutional review board and ethics committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, HuBei province, China. And written informed consent was accepted by all the patients or their guardians.

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Written informed consent was obtained from the patient for publication of this report.

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The authors declare that they have no conflict of interest.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

The original version of this article was revised. The name of Dongsheng Guo was incorrectly captured and is now corrected.

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He, Y., Wang, L., Ou, Y. et al. Surgical treatment of traumatic distal anterior cerebral artery aneurysm: a report of nine cases from a single centre. Acta Neurochir 162, 523–529 (2020). https://doi.org/10.1007/s00701-019-04121-x

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