Internal Carotid Artery Aneurysm & Anterior Communicating Artery Aneurysm |
Case #104: Flow-Assisted Neurosurgery |
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Courtesy F.T. Charbel, MD, Associate Professor, Dept. of Neurosurgery, University
of IL at Chicago
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Introduction |
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A woman with subarachnoid hemorrhage grade 4/5, re-ruptured after coiling and underwent surgery for clipping of two
aneurysms:
- a left internal bifurcation aneurysm
- anterior communicating artery aneurysm.
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Carotid Bifurcation Aneurysm - Baseline Flow MeasurementsBaseline Flow Measurements |
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Baseline flows
were measured in the internal carotid (ICA), anterior cerebral (ACA) and middle cerebral (MCA) arteries.
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ICA baseline flow: 163 ml/min
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Carotid Bifurcation Aneurysm Post-Clip Flow Measurements |
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A temporary clip was placed on the ICA and the carotid bifurcation
aneurysm was clipped. Flows were rechecked in the ICA, ACA and MCA following clipping.
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ICA post-clip flow: unchanged
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Anterior Communicating Artery Aneurysm Baseline Flow Measurements |
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Baseline flows were measured in the left
A1 and A2 branches of the anterior communicating artery.
A2 baseline flow: 40 ml/min
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Left A2 baseline flow: 40 ml/min
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Anterior Communicating Aneurysm Post-clip Flow Measurements |
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Following aneurysm clipping. flows were rechecked in the left A1 and A2 branches of the anterior communicating artery.
A1 post-clip flow: unchanged
A2 post-clip flow: compromised, 0 ml/min
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Left A2 post-clip flow: 0 ml/min
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A2 Post Clip Adjustment Flow Measurements |
The clip was readjusted and A2 branch flow
was rechecked.
A2 post-clip adjustment flow: 53 ml/min,
which accounts for a slight reperfusion hyperemia.
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Left A2 post-clip adjstment flow: 53 ml/min
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Summary |
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The clipping of the carotid bifurcation was
uneventful and the Charbel Micro-flowprobeTM confirmed that flow was fully preserved. After clipping, the A-Com aneurysm, the flow in the left A2 branch was zero. The clip was readjusted and A2 flow returned to baseline, as verified by flow measurements.
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