A patient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass. At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery. The difficulty in preoperative diagnosis and relevant literature are reviewed 1).
Giant anterior communicating artery aneurysm is, as a rule, treated by an approach from the direction in which early arrival at the aneurysm neck is accomplished. Approaching from the side of dominant A1 is generally recommended, but for such an aneurysm that projects anteriorly, the interhemispheric approach is recommended.