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  • Journal of Neurosurgery Publishing Group (JNSPG)  (11)
  • Yoshida, Kazumichi  (11)
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  • Journal of Neurosurgery Publishing Group (JNSPG)  (11)
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  • 1
    Online Resource
    Online Resource
    Expansive carotid artery remodeling: possible marker of vulnerable plaque
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2020
    In:  Journal of Neurosurgery Vol. 133, No. 5 ( 2020-11), p. 1435-1440
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 133, No. 5 ( 2020-11), p. 1435-1440
    Abstract: Accumulated findings in the pathophysiology of atherosclerosis have demonstrated that not only luminal narrowing but also plaque characteristics influence the risk of future ischemic events. The morphology of the carotid artery (CA) changes in response to atherosclerotic development by expansive remodeling (ER), the clinical significance of which remains unclear. This study aimed to define associations between ER and local risk factors, including CA geometry and traditional systemic risk factors for ischemic events, to determine whether ER could serve as a clinical marker of carotid vulnerable plaque. METHODS The authors retrospectively analyzed 66 patients with CA stenosis who were scheduled to undergo carotid endarterectomy or CA stenting. They calculated ER ratios in the internal CA (ICA) from long-axis MR images and as the maximal distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA/the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis. Relative overall signal intensity (roSI) was calculated to assess intraplaque hemorrhage and defined as the signal intensity of plaque on an axial T1-weighted image with maximal stenosis relative to that of the adjacent sternocleidomastoid muscle. The authors evaluated CA geometry by calculating the angles between the common CA (CCA) and ICA, and between the CCA and external CA (ECA) using digital subtraction angiography. The ER ratios, age, sex, percentage of stenosis, roSI, hypertension, hyperlipidemia, low-density lipoprotein, statin medication, diabetes, smoking habit, and ischemic heart disease were compared between 33 symptomatic and 33 asymptomatic patients. The authors also compared symptomatic status, age, sex, percentage of stenosis, ICA angle, ECA angle, roSI, and other traditional atherosclerotic risk factors between groups with extensive and slight ER. RESULTS The ER ratio was significantly greater in symptomatic than in asymptomatic patients (1.91 ± 0.46 vs 1.68 ± 0.40, p 〈 0.05). The ICA angle was significantly larger in the group with extensive ER than in those with slight ER (33.9° ± 20.2° vs 21.7° ± 13.8°, p 〈 0.01). The roSI, ECA angle, percentage stenosis, or any other traditional vascular risk factors were not associated with ER. CONCLUSIONS Carotid ER might be an independent indicator of carotid vulnerable plaque, which should be validated in a longitudinal study of patients with carotid atherosclerosis, including those with nonstenotic to moderate stenosis.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2019.7.JNS19727
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2020
    detail.hit.zdb_id: 2026156-1
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  • 2
    Online Resource
    Online Resource
    Prevalence and site of predilection of carotid webs focusing on symptomatic and asymptomatic Japanese patients
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery Vol. 135, No. 5 ( 2021-11), p. 1370-1376
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 135, No. 5 ( 2021-11), p. 1370-1376
    Abstract: Carotid webs (CWs) have increasingly been recognized as a cause of recurrent ischemic stroke. However, the natural history and clinical course of CWs remain unclear. The authors aimed to clarify the prevalence, imaging features, and optimal treatment of CWs in a Japanese cohort study. METHODS A series of 444 consecutive Japanese patients who had undergone CTA of the head and neck between April 2011 and October 2016 was retrospectively reviewed. CW was diagnosed on CT angiograms as a membrane-like intraluminal filling defect along the posterior wall of the carotid bulb or the origin of the internal carotid artery (ICA) on oblique sagittal images and a corresponding thin septum on axial images. RESULTS Two patients with CWs were identified among 132 patients with suspected stroke. The prevalence of CWs among symptomatic patients with suspected stroke was 1.5%. The prevalence of asymptomatic CWs was 2.2% (7 of 312 cases). The CWs were located in the posterior wall of the carotid bulb in 7 patients and just distal to the ICA origin in 2 patients. There were no apparent differences in the location or lesion length between symptomatic and asymptomatic CWs. Four of the 7 asymptomatic CWs remained asymptomatic for at least 2 years of follow-up. Two patients with symptomatic CWs developed recurrent cerebral infarction and transient ischemic attack despite being on a regimen of oral antiplatelet agents, and carotid endarterectomy was performed as radical treatment. Patients with CWs were younger than controls (median age 55 vs 69 years, p = 0.003) and were less frequently male than controls (33% vs 72%, p = 0.025). CW cases showed significantly fewer common atherosclerosis risk factors than the control group (p 〈 0.05). CONCLUSIONS Although limited to CTA patients, this study reported on the prevalence and common site of CWs, focusing on symptomatic and asymptomatic Japanese patients. Extensive cross-sectional and prospective observational studies are warranted to elucidate the overall prevalence and natural history of CWs.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2020.8.JNS201727
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 2026156-1
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  • 3
    Online Resource
    Online Resource
    High intratumoral susceptibility signal grade on susceptibility-weighted imaging: a risk factor for hemorrhage after stereotactic biopsy
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2023
    In:  Journal of Neurosurgery Vol. 138, No. 1 ( 2023-01-01), p. 120-127
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 138, No. 1 ( 2023-01-01), p. 120-127
    Abstract: This study aimed to examine the association of preoperative intratumoral susceptibility signal (ITSS) grade with hemorrhage after stereotactic biopsy (STB). METHODS The authors retrospectively reviewed 66 patients who underwent STB in their institution. Preoperative factors including age, sex, platelet count, prothrombin time–international normalized ratio, activated thromboplastin time, antiplatelet agent use, history of diabetes mellitus and hypertension, target location, anesthesia type, and ITSS data were recorded. ITSS was defined as a dot-like or fine linear low signal within a tumor on susceptibility-weighted imaging (SWI) and was graded using a 3-point scale: grade 1, no ITSS within the lesion; grade 2, 1–10 ITSSs; and grade 3, ≥ 11 ITSSs. Postoperative final tumor pathology was also reviewed. The association between preoperative variables and the size of postoperative hemorrhage was examined. RESULTS Thirty-four patients were men and 32 were women. The mean age was 66.6 years. The most common tumor location was the frontal lobe (27.3%, n = 18). The diagnostic yield of STB was 93.9%. The most common pathology was lymphoma (36.4%, n = 24). The ITSS was grade 1 in 37 patients (56.1%), grade 2 in 14 patients (21.2%), and grade 3 in 15 patients (22.7%). Interobserver agreement for ITSS was almost perfect (weighted kappa = 0.87; 95% CI 0.77–0.98). Age was significantly associated with ITSS (p = 0.0075). Postoperative hemorrhage occurred in 17 patients (25.8%). Maximum hemorrhage diameter (mean ± SD) was 1.78 ± 1.35 mm in grade 1 lesions, 2.98 ± 2.2 mm in grade 2 lesions, and 9.51 ± 2.11 mm in grade 3 lesions (p = 0.01). Hemorrhage 〉 10 mm in diameter occurred in 10 patients (15.2%), being symptomatic in 3 of them. Four of 6 patients with grade 3 ITSS glioblastomas (66.7%) had postoperative hemorrhages 〉 10 mm in diameter. After adjusting for age, ITSS grade was the only factor significantly associated with hemorrhage 〉 10 mm (p = 0.029). Compared with patients with grade 1 ITSS, the odds of postoperative hemorrhage 〉 10 mm in diameter were 2.57 times higher in patients with grade 2 ITSS (95% CI 0.31–21.1) and 9.73 times higher in patients with grade 3 ITSS (95% CI 1.57–60.5). CONCLUSIONS ITSS grade on SWI is associated with size of postoperative hemorrhage after STB.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2022.4.JNS212505
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2023
    detail.hit.zdb_id: 2026156-1
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  • 4
    Online Resource
    Online Resource
    Periventricular anastomosis in moyamoya disease: detecting fragile collateral vessels with MR angiography
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2016
    In:  Journal of Neurosurgery Vol. 124, No. 6 ( 2016-06), p. 1766-1772
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 124, No. 6 ( 2016-06), p. 1766-1772
    Abstract: The authors’ aim in this paper was to determine whether periventricular anastomosis, a novel term for the abnormal collateral vessels typical of moyamoya disease, is reliably measured with MR angiography and is associated with intracranial hemorrhage. METHODS This cross-sectional study sampled consecutive patients with moyamoya disease or moyamoya syndrome at a single institution. Periventricular anastomoses were detected using MR angiography images reformatted as sliding-thin-slab maximum-intensity-projection coronal images and were scored according to 3 subtypes: lenticulostriate, thalamic, and choroidal types. The association between periventricular anastomosis and hemorrhagic presentation at onset was evaluated using multivariate analyses. RESULTS Of 136 eligible patients, 122 were analyzed. Eighteen (14.8%) patients presented with intracranial hemorrhage with neurological symptoms at onset. Intra- and interrater agreement for rating of the periventricular anastomosis score was good (κ w = 0.65 and 0.70, respectively). The prevalence of hemorrhagic presentation increased with the periventricular anastomosis score: 2.8% for Score 0, 8.8% for Score 1, 18.9% for Score 2, and 46.7% for Score 3 (p 〈 0.01 for trend). Univariate analysis revealed that age (p = 0.02) and periventricular anastomosis score (p 〈 0.01) were factors tentatively associated with hemorrhagic presentation. The score remained statistically significant after adjustment for age (OR 3.38 [95% CI 1.84–7.00]). CONCLUSIONS The results suggest that periventricular anastomosis detected with MR angiography can be scored with good intra- and interrater reliability and is associated with hemorrhagic presentation at onset in moyamoya disease. The clinical utility of periventricular anastomosis as a predictor for hemorrhage should be validated in further prospective studies.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2015.6.JNS15845
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2016
    detail.hit.zdb_id: 2026156-1
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  • 5
    Online Resource
    Online Resource
    Vessel wall imaging and carotid artery stenting for recurrent cervical internal carotid artery vasospasm syndrome: illustrative case
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2023
    In:  Journal of Neurosurgery: Case Lessons Vol. 5, No. 23 ( 2023-06-5)
    Details
    In: Journal of Neurosurgery: Case Lessons, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 5, No. 23 ( 2023-06-5)
    Abstract: Recurrent cervical internal carotid artery vasospasm syndrome (RCICVS) causes cerebral infarction, ocular symptoms, and occasionally chest pain accompanied by coronary artery vasospasm. The etiology and optimal treatment remain unclear. OBSERVATIONS The authors report a patient with drug-resistant RCICVS who underwent carotid artery stenting (CAS). Magnetic resonance angiography revealed recurrent vasospasm in the cervical segment of the internal carotid artery (ICA). Vessel wall imaging during an ischemic attack revealed vascular wall thickening of the ICA, similar to that in reversible cerebral vasoconstriction syndrome. The superior cervical ganglion was identified at the anteromedial side of the stenosis site. Coronary artery stenosis was also detected. After CAS, the symptoms of cerebral ischemia were prevented for 2 years, but bilateral ocular and chest symptoms did occur. LESSONS Vessel wall imaging findings suggest that RCICVS is a sympathetic nervous system-related disease. CAS could be an effective treatment for drug-resistant RCICVS to prevent cerebral ischemic events.
    Type of Medium: Online Resource
    ISSN: 2694-1902
    URL: Article
    DOI: 10.3171/CASE2341
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2023
    detail.hit.zdb_id: 3106696-3
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  • 6
    Online Resource
    Online Resource
    The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2015
    In:  Journal of Neurosurgery Vol. 123, No. 2 ( 2015-08), p. 434-440
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 123, No. 2 ( 2015-08), p. 434-440
    Abstract: The purpose of the present study was to investigate the association between carotid artery (CA) expansive remodeling (ER) and symptoms of cerebral ischemia. METHODS One hundred twenty-two consecutive CAs scheduled for CA endarterectomy (CEA) or CA stent placement (CAS) were retrospectively studied. After excluding 22 CAs (2 were contraindicated for MRI, 8 had near-occlusion, 6 had poor image quality, and 6 had restenosis after CEA or CAS), there were 100 CAs (100 patients) included in the final analysis. The study included 50 symptomatic patients (mean age 73.6 ± 8.9 years, 6 women, mean stenosis 68.5% ± 21.3%) and 50 asymptomatic patients (mean age 72.0 ± 5.9 years, 5 women, mean stenosis 79.4% ± 8.85%). Expansive remodeling was defined as enlargement of the internal carotid artery (ICA) with outward plaque growth. The ER ratio was calculated by dividing the maximum distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA by the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis using long-axis, high-resolution MRI. RESULTS The ER ratio of the atherosclerotic CA was significantly greater than that of normal physiological expansion (carotid bulb; p 〈 0.01). The ER ratio of symptomatic CA stenosis (median 1.94, interquartile range [IQR] 1.58–2.23) was significantly greater than that of asymptomatic CA stenosis (median 1.52, IQR 1.34–1.81; p = 0.0001). When the cutoff value of the ER ratio was set to 1.88, the sensitivity and specificity to detect symptoms were 0.6 and 0.78, respectively. The ER ratio of symptomatic patients was consistently high regardless of the degree of stenosis. CONCLUSIONS There was a significant correlation between ER ratio and ischemic symptoms. The ER ratio might be a potential indicator of vulnerable plaque, which requires further validation by prospective observational study of asymptomatic patients.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2014.12.JNS14185
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2015
    detail.hit.zdb_id: 2026156-1
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  • 7
    Online Resource
    Online Resource
    Long-term outcomes of coil embolization of unruptured intracranial aneurysms
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2018
    In:  Journal of Neurosurgery Vol. 129, No. 6 ( 2018-12), p. 1492-1498
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 129, No. 6 ( 2018-12), p. 1492-1498
    Abstract: Long-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers. METHODS The authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died. RESULTS Overall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort. CONCLUSIONS This study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2017.6.JNS17174
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2018
    detail.hit.zdb_id: 2026156-1
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  • 8
    Online Resource
    Online Resource
    Unstable moyamoya disease: clinical features and impact on perioperative ischemic complications
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2015
    In:  Journal of Neurosurgery Vol. 122, No. 2 ( 2015-02), p. 400-407
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 122, No. 2 ( 2015-02), p. 400-407
    Abstract: Unstable moyamoya disease, reasonably defined as cases exhibiting either rapid disease progression or repeated ischemic stroke, represents a challenge in the treatment of moyamoya disease. Despite its overall efficacy, direct bypass for such unstable disease remains controversial in terms of safety. This study aims to reveal factors associated with unstable disease and to assess its impact on postoperative silent or symptomatic ischemic lesions. METHODS This retrospective cohort study included both pediatric and adult patients with moyamoya disease who had undergone 140 consecutive direct bypass procedures at Kyoto University Hospital. “Unstable moyamoya disease” was defined as either the rapid progression of a steno-occlusive lesion or repeat ischemic stroke, either occurring within 6 months of surgery. The extent of progression was determined through a comparison of the findings between 2 different MR angiography sessions performed before surgery. The clinical variables of the stable and unstable disease groups were compared, and the association between unstable disease and postoperative diffusion-weighted imaging (DWI)–detected lesion was assessed through univariate and multivariate analyses with generalized estimating equations. RESULTS Of 134 direct bypass procedures performed after patients had undergone at least 2 sessions of MR angiography, 24 (17.9%) were classified as cases of unstable disease. Age younger than 3 years (p = 0.029), underlying disease causing moyamoya syndrome (p = 0.049), and radiographic evidence of infarction (p = 0.030) were identified as factors associated with unstable disease. Postoperative DWI-defined lesions were detected after 13 of 140 procedures (9.3%), although only 4 lesions (2.9%) could be classified as a permanent complication. The incidence of postoperative DWI-detected lesions in the unstable group was notable at 33.3% (8 of 24). Univariate analysis revealed that unstable disease (p 〈 0.001), underlying disease (p = 0.028), and recent stroke (p = 0.012) were factors associated with DWI-detected lesions. Unstable disease remained statistically significant after adjustment for covariates in both the primary and sensitivity analyses (primary analysis: OR 6.62 [95% CI 1.79–24.5]; sensitivity analysis: OR 5.36 [95% CI 1.47–19.6] ). CONCLUSIONS Unstable moyamoya disease, more prevalent in younger patients and those with underlying disease, is a possible risk factor for perioperative ischemic complications. Recognition of unstable moyamoya disease may contribute to an improved surgical result through focused perioperative management based on appropriate surgical risk stratification.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2014.10.JNS14231
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2015
    detail.hit.zdb_id: 2026156-1
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  • 9
    Online Resource
    Online Resource
    Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease : Clinical article
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2013
    In:  Journal of Neurosurgery: Pediatrics Vol. 12, No. 6 ( 2013-12), p. 626-632
    Details
    In: Journal of Neurosurgery: Pediatrics, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 12, No. 6 ( 2013-12), p. 626-632
    Abstract: In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes. Methods Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment. Results Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment. Conclusions Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.
    Type of Medium: Online Resource
    ISSN: 1933-0707 , 1933-0715
    URL: Article
    DOI: 10.3171/2013.9.PEDS13111
    RVK:
    XA 55270.2
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2013
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  • 10
    Online Resource
    Online Resource
    Successful shrinkage of anterior communicating artery aneurysm after ACA–ACA bypass with interposed occipital artery graft in pediatric moyamoya disease: illustrative case
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery: Case Lessons Vol. 2, No. 17 ( 2021-10-25)
    Details
    In: Journal of Neurosurgery: Case Lessons, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 2, No. 17 ( 2021-10-25)
    Abstract: Selecting therapeutic options for moyamoya disease (MMD)-associated anterior communicating artery (ACoA) aneurysm, a rare pathology in children, is challenging because its natural course remains unclear. OBSERVATIONS A 4-year-old boy exhibiting transient ischemic attacks was diagnosed with unilateral MMD accompanied by an unruptured ACoA aneurysm. Although superficial temporal artery to middle cerebral artery anastomosis eliminated his symptoms, the aneurysm continued to grow after surgery. Since a previous craniotomy and narrow endovascular access at the ACoA precluded both aneurysmal clipping and coil embolization, the patient underwent a surgical anastomosis incorporating an occipital artery graft between the bilateral cortical anterior cerebral arteries (ACAs). This was intended to augment blood flow in the ipsilateral ACA territory and to reduce the hemodynamic burden on the ACoA complex. The postoperative course was uneventful, and radiological images obtained 12 months after surgery revealed good patency of the bypass and marked shrinkage of the aneurysm in spite of the intact contralateral internal carotid artery. LESSONS Various clinical scenarios should be assessed carefully with regard to this pathology. Bypass surgery aimed at reducing flow to the aneurysm might be an alternative therapeutic option when neither coiling nor clipping is feasible.
    Type of Medium: Online Resource
    ISSN: 2694-1902
    URL: Article
    DOI: 10.3171/CASE21460
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
    detail.hit.zdb_id: 3106696-3
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