Acom aneurysm

Acom aneurysm

1. MANAGEMENT OF ACOM ANEUYRSM PRESENTED BY ANKIT JAIN

2. INDICATIONS

3. PREOP EVALUATION

4. APPROACH SYMMETRIC A1-RT SIDE ASYMMETRIC A1-DOMINANT SIDE BETTER PROXIMAL CONTROL DOME IS AWAY BETTER NECK VISUALISATION

5. STEP 1 :A1 EXPOSURE

6. STEP 2:GYRUS RECTUS RESECTION

7. A1-ACOA-A2 EXPOSURE

8. In Yasargil’s experience,superior aneurysms were most common (34%), followed by anterior (23%), posterior (14%), and inferior (13%); multiple lobes or mixed projection was encountered in 16% of aneurysms.

9. Inferiorly projecting aneurysms hide the contralateral A1 segment,which limits proximal control. Anteriorly projecting aneurysms hide the contralateral A1-A2 junction, which hinders dissection of the distal aneurysm neck. Superiorly projecting aneurysms hide the contralateral A2 segment. Posteriorly projecting aneurysms hide the ACoA perforators, which puts them in jeopardy during permanent clipping.

10. ANTERIORLY PROJECTING ANEURYSM

11. INFERIORLY PROJECTING ANEURYSM

12. POSTERIORLY PROJECTING ANEURYSM