Search

Objective: Anatomy of the ophthalmic artery (OA) is of great practical importance in surgery for anterior circulation aneurysms. In most cases, the OA arises from the supraclinoid segment of the internal carotid artery (ICA) and enters the orbit through the optic canal inferolaterally to the optic nerve. The OA arising from the anterior cerebral artery (ACA) and entering the optic canal above the optic nerve is extremely rare.Clinical case: We report a case of a 29-year-old female patient admitted to Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation) with a ruptured true aneurysm of the left posterior communicating artery (PCoA) and an abnormal origin of the OA from the ACA. The disease manifested itself as ischemic stroke in the basal ganglia on the left causing diagnostic difficulties during initial hospitalization. Cerebral angiography confirmed a PCoA aneurysm and origin of the OA from the ipsilateral ACA. During surgery the neck of the aneurysm was clipped, and the aneurysm dome was opened to control the extent of clipping and remove thrombotic masses. During their removal, hemorrhage appeared from the posterior pole of the aneurysm. During the exploration it was found that the aneurysm was a dilated PCoA connecting the right ICA with the right posterior cerebral artery (PCA). A thrombosed anterior thalamoperforating artery emerged from the superior surface of the dome, and its junction with the precommunicating segment of the right PCA was detected in the region of the posterior pole of the aneurysm. The second clip was placed at the communication site between the aneurysm and the right PCA. The patient was discharged in satisfactory condition with a stable neurological status.Conclusions: The combination of abnormal anatomy of arteries at the base of the brain and cerebral aneurysms increases the risk of tactical errors and perioperative complications. Each such case requires a careful comparison of the clinical, imaging, and intraoperative findings. In the presented case of the patient with the ruptured rare PCoA aneurysm, the disease manifested atypically due to the partial thrombosis of the aneurysm and hemorrhage into the aneurysmal wall. The imaging findings revealed lacunar stroke in the thalamoperforating artery basin and an ICA aneurysm with no signs of subarachnoid hemorrhage. During the surgery the aneurysm was initially regarded as typical saccular. The opening of the dome and removal of all thrombotic masses made it possible to determine the eccentric fusiform nature of the aneurysm, perform its radical exclusion, and prevent fatal hemorrhage in the postoperative period.

Based on the data analysis of foreign and native literature information about the anatomy of the anterior cerebral artery in adults has been summarized. The data on options for arteries discharge, the area of blood supply, major anomalies and the magnitude of its size characteristics (outer diameter, wall thickness, lumen diameter) have been considered in the work under the study.

The purpose of the article is to define variants of anterior cerebral artery (АСА) of adults depending on typological and combined variability of its morphological and biomechanical features. Material and methods: The research has included 228 samples of anterior cerebral arteries, 115 corpses of people aged 21-84 years received on autopsy. The following points have been under the research: external and internal diameters, wall thickness, general strength, strength range, absolute and relative deformation of an artery. Results: According to the studied parameters 3 groups of variants of arteries have been allocated: with average size of a sign (M±s), with lesser size of a sign ( M + s). Combined variability of morphological and biomechanical features of АСА has been presented. Conclusion: АСА groups with higher variability, especially at men, have been observed in 2,2-2,6 times more often, than at women. As exception, thin-walled АСА which in 1,7 times more often taped at women have been considered. It has been revealed that subjects of alternative group III in 1,2-1,7 times older than those of alternative group I of arteries. Age of subjects who have been classified according to biomechanical parameters of АСА wall has been approximately identical (r=0,28-0,51). The experimentally received data about morphological, deforming and strengthening features may be of great value in studying of blood flow modeling and in optimization of intravascular interventions on cerebral arteries.

In the experiment on monoaxonic longitudinal distension by tensile-testing machine Tira Test 28005 (Germany) with loading unit - 100 N the general rigidity, breaking point and relative lengthening of anterior cerebral artery (АСА) of adult people have been under study. Under the microscope on transverse sections the external diameter of the artery, its wall thickness have been measured and diameter of lumen have been calculated. In total 228 АСА (132 - from corpses of men, 92-from corpses of women) have been investigated. They have been received in 16 hours after autopsy of adult people whose cause of death has not been connected with vascular cerebral pathology. It has been revealed that right АСА is longer and narrower than left one. ACA's wall length and thickness predominate in men in comparison with women in average of 5,4 - 13,0%. With years АСА lengthens, its external diameter increases. Biomechanical parameters of ACA's wall do not have any authentic sexual differences, they don't depend on the side of the arterial ring. With years the rigidity of АСА decreases, especially in middle age. In old age its general rigidity increases. It is connected with the increase of ACA's wall thickness. The ability of АСА to lengthening doesn't depend upon age. Experimental findings may be used as criteria of age standard of morphological and biomechanical parameters of АСА

Various kinds of extracranial-intracranial arterial bypasses (EIAB's) have been used to maintain the blood flow in the brain, when the elective obliteration of the main cerebral arteries was planned while treating aneurysms unsuitable for direct clipping. This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms and has been applied with some success. However, when using these EIAB's, and mainly the superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, some of the surgical problems could not be solved in certain cases: such as the following: 1. In treating anterior communicating artery aneurysms (AcoA). 2. When the STA graft or the cortical MCA cannot be used in treating MCA or internal carotid artery (ICA) aneurysms. 3. When the shunt flow via the STA-MCA bypass channel may not be enough to maintain brain function. To avoid these weak points, some intracranial-intracranial bypass technics request. [ABSTRACT FROM AUTHOR]

Authors describe a 7-year-old boy, who developed a severe right-sided hemiparesis, aphasia, seizure, and confusion state during sport games. There was no headache. Allergic dermatitis in the past medical history and influenza vaccination 2 weeks before stroke were recorded. On the 12th day of disease, MRI of the brain revealed an acute infarction in the territory of left anterior and middle cerebral arteries with hemorrhagic transformation. MPA (15 day) showed occlusion of the left ACA and MCA. HR-MRI T1_db_fs weighted imaging (36 day) found intramural hematoma (IMH) in ACA and MCA with marked stenosis of the lumen. After 3 months, HR-MRI/MRA showed the complete regression of IMH, recanalization of the arterial lumen, prolonged irregular MCA stenosis. Neurological deficit regressed significantly.