Anterior communicating artery aneurysm orientation

Inferior or downward direction

Posterior or backward direction

In anterosuperior-projecting anterior communicating artery aneurysms, the aneurysm dome usually adheres to one or both proximal A2 segment, which may present technical difficulties. A video demonstrates microsurgical clipping of a ruptured anterosuperior-projecting AComA aneurysm. A 52-year-old male presented with a Hunt and Hess grade II subarachnoid hemorrhage (SAH). Computed tomography showed SAH in the basal cisterns, sylvian and interhemispheric fissures. Angiography demonstrated a wide-necked AComA aneurysm projecting anterosuperiorly. Considering the risk of recurrence, the patient decided to accept surgical treatment. The patient was positioned supine and the aneurysm was exposed via the lateral supraorbital approach. The carotid cistern and the optic cistern was opened to release cerebrospinal fluid (CSF) and achieve adequate brain relaxation. A subpial resection of a small portion of the gyrus rectus was performed to visualize the ipsilateral A2, the recurrent artery of Heubner and the base of the aneurysm. A plane was dissected between the anterior aspect of both A2 segment and the posterior aspect of the aneurysm. A straight clip was placed to parallel to the ACoA to completely obliterate the aneurysm. Postoperative angiography confirmed complete obliteration of the aneurysm. The patient recovered well without any complications. Successful treatment requires preoperative surgical planning, precise dissection, and preservation of critical structures. With adherence to these general principles, these aneurysms can be treated safely and effectively 1).

Xu F, Bambakidis NC. Microsurgical clipping of ruptured anterosuperior-projecting anterior communicating artery aneurysms: how I do it. World Neurosurg. 2018 May 17. pii: S1878-8750(18)31023-4. doi: 10.1016/j.wneu.2018.05.070. [Epub ahead of print] PubMed PMID: 29778597.
  • anterior_communicating_artery_aneurysm_orientation.txt
  • Last modified: 2022/08/16 11:38
  • by administrador