⚡ Quick Summary
This study presents a successful case of microsurgical clipping for a ruptured hypophyseal artery aneurysm in an elderly patient, emphasizing the importance of advanced imaging and personalized management strategies. The results demonstrate the effectiveness of microsurgical techniques in complex anatomical scenarios where endovascular methods may fall short.
🔍 Key Details
- 👩⚕️ Patient: 82-year-old woman with subarachnoid hemorrhage symptoms
- 🧪 Imaging Techniques: Non-contrast CT and digital subtraction angiography (DSA)
- 🔍 Aneurysm Characteristics: Saccular, 12 × 10 mm, with a broad neck of 3.13 mm
- ⚙️ Surgical Technique: Microsurgical clipping via right pterional craniotomy
🔑 Key Takeaways
- 🔬 Microsurgical clipping remains the gold standard for wide-necked aneurysms.
- 🧠 Advanced imaging techniques like 3D DSA enhance surgical precision.
- 🏥 Successful outcomes were achieved with complete exclusion of the aneurysm.
- 📅 Follow-up imaging showed stable cerebral atrophy without recurrence at three months.
- 🤖 Emerging technologies like AI and augmented reality are set to optimize aneurysm management.
- 🌍 Personalized treatment approaches are crucial for complex cases.
📚 Background
The management of ruptured intracranial aneurysms is a complex and often debated topic in neurosurgery. Aneurysms located in high-risk areas, such as the hypophyseal artery, pose significant challenges due to their anatomical complexity and proximity to critical vascular structures. While endovascular therapies have transformed treatment paradigms, microsurgical clipping remains a vital option, particularly for wide-necked aneurysms where endovascular techniques may not be optimal.
🗒️ Study
This case study details the treatment of an 82-year-old woman who presented with a thunderclap headache and signs of subarachnoid hemorrhage. Imaging confirmed a saccular aneurysm arising from the hypophyseal artery, necessitating a microsurgical approach. The procedure was performed through a right pterional craniotomy, showcasing the importance of meticulous surgical technique and advanced imaging in achieving successful outcomes.
📈 Results
Postoperative imaging confirmed correct clip placement and complete exclusion of the aneurysm, with resorption of subarachnoid blood. The patient’s neurological examination returned to normal, and follow-up imaging at three months revealed stable cerebral atrophy with compensatory ventricular enlargement, indicating no recurrence of the aneurysm.
🌍 Impact and Implications
This case underscores the critical role of microsurgical clipping in managing anatomically complex aneurysms, particularly in patients where endovascular options may be limited. The integration of advanced imaging technologies and personalized treatment strategies can significantly enhance surgical outcomes, paving the way for improved patient care in neurosurgery. As the field evolves, the incorporation of innovative technologies such as artificial intelligence and augmented reality will further refine decision-making processes and treatment pathways.
🔮 Conclusion
The successful management of this ruptured hypophyseal artery aneurysm highlights the enduring relevance of microsurgical techniques in neurosurgery. With advancements in imaging and surgical technology, we are moving towards a future where personalized, high-precision care becomes the norm. Continued research and innovation in this field are essential for optimizing treatment strategies and improving patient outcomes.
💬 Your comments
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Complex Anatomy, Advanced Techniques: Microsurgical Clipping of a Ruptured Hypophyseal Artery Aneurysm.
Abstract
Background: Ruptured intracranial aneurysms remain the subject of debate in their management, but the management of lesions located at high-risk locations, such as the hypophyseal artery, continue to prove to be a challenge in anatomical orientation and proximity to vascular structures. While endovascular therapies have changed the treatment paradigms, microsurgical clipping is the gold standard for wide-necked aneurysms for which endovascular techniques may be suboptimal. The successful treatment of a ruptured hypophyseal artery aneurysm in an elderly patient is described in this report, which highlights the importance of advanced imaging, careful technique, and new understanding of personalized aneurysm management. Methods: An 82-year-old woman was admitted with a thunderclap headache, alteration of consciousness and meningeal signs, suggestive of subarachnoid hemorrhage (SAH). A non-contrast computed tomography (CT) and digital subtraction angiography (DSA) confirmed a saccular 12 × 10 mm aneurysm with a broad 3.13 mm neck arising from the hypophyseal artery. The location and morphology of the aneurysm required microsurgical clipping, which was performed through a right pterional craniotomy. Results: Correct clip placement, complete exclusion of the aneurysm, and resorption of the subarachnoid blood were both observed on postoperative imaging. The neurological examination was completely normal, with no complications. Follow-up imaging at three months demonstrated stable, marked cerebral atrophy with compensatory ventricular enlargement without evidence of recurrence. Conclusions: This case illustrates the important role of micro-surgical clipping in anatomically complex aneurysms and its sustainable outcome and accuracy in cases where endovascular practices would have limitations. Advanced imaging, like three-dimensional DSA and intraoperative tools, have revolutionized precision surgery, allowing achievement of optimal outcomes, even for more-complicated cases. With an evolving, dynamic field and exciting new technologies coming to the fore-such as artificial intelligence to predict rupture risk and augmented reality navigation-decision-making and treatment of complex aneurysms will be optimized along secure pathways towards tailored, high-resolution treatment in the sense of personalized and yet high-precision care.
Author: [‘Toader C’, ‘Serban M’, ‘Dobrin N’, ‘Covache-Busuioc RA’, ‘Radoi MP’, ‘Ciurea AV’, ‘Munteanu O’]
Journal: J Clin Med
Citation: Toader C, et al. Complex Anatomy, Advanced Techniques: Microsurgical Clipping of a Ruptured Hypophyseal Artery Aneurysm. Complex Anatomy, Advanced Techniques: Microsurgical Clipping of a Ruptured Hypophyseal Artery Aneurysm. 2025; 14:(unknown pages). doi: 10.3390/jcm14072361