Abstract

VEGA BASULTO, Sergio Diego et al. Stereotactic supported microsurgical treatment of distal anterior cerebral artery aneurysm based on the computed tomographic angiography. Arch. Neurocien. (Mex., D.F.) [online]. 2004, vol.9, n.4, pp.237-244. ISSN 1028-5938.

Surgical difficulties during the localization and microsurgical clipping of the distal anterior cerebral artery aneurysms imply special cares. Objective: to analyze the possibilities and advantages of the stereotactic supported microsurgical treatment based on the computed tomographic angiography. Patient and Method: a woman suffered of subarachnoid hemorrhage and inferior paraplegia. We performed a computerized tomography that evidenced blood in the anterior interhemispheric fissure and a paracentral intracerebral hematoma. A computed tomographic angiography confirmed a saccular aneurysm at the distal anterior cerebral artery located at the genus region. A microsurgical procedure supported on stereotactic approach was performed analyzing osseous and vascular relationships of the aneurysm. Estereoflex frame and stassis software were utilized. The interhemispheric fissure was the surgical corridor and laser guide confirmed trajectory to carry out a three centimeter craniotomy on the right of the middle line. Aneurysm was clipped without any vascular sacrifice. Conclusion: the proposal technique has the following advantages: to obviate intraarterial angiography, to assure the procedure accuracy and to reduce surgical time and brain retraction. It can be kept in mind in patients with single intracranial aneurysms of this localization, in which intracranial intravascular sailing and the application of intrasaccular coils is not always possible.

Keywords : computed tomographic angiography; distal anterior cerebral artery aneurysm; microsurgical treatment; stereotactic support.