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| Name | Clip Reconstruction of Giant Distal Anterior Cerebral Artery Aneurysm |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 09-10-2015 14:36:48 |
| Video Discription | Giant distal anterior cerebral artery (DACA) aneurysms are very rare. Their treatment is most challenging, due to the complexities of the aneurysm neck and branches involved, as well as their relatively deep locations. Various strategies can be utilized in the treatment of these complex aneurysms, including endovascular coiling, flow-diverting stents, surgical trapping, microsurgical clip reconstruction and a wide spectrum of bypass techniques. We present a case of a 36-year-old male with seizures. Work-up with MRI and angiogram revealed a giant (5 cm) partially thrombosed aneurysm of the DACA right after the anterior communicating artery. A right-sided cranio-orbital approach, combined with an interhemispheric approach, was performed. After thromboendarterectomy was done, we exposed the ipsilateral A1 and A2, as well as the contralateral A1 and A2 and their branches. The aneurysm was originating from the proximal A2 without any branch involvement and its neck was relatively broad. Under pentobarbital burst suppression, temporary clips were placed and the neck of the aneurysm was reconstructed with multiple clips, with under 18 minutes temporary clipping time. Postoperative angiography revealed obliteration of the aneurysm with minimal neck remnant and filling of the entire pericallosal artery. The patient was discharged home on postoperative day 5 and made an excellent recovery. Surgical treatment of giant aneurysms of the DACA is challenging, and treatment should be individualized based on the particular anatomy of the case. Although necessary precautions, including preparation of multiple bypass options, must be exercised and be available, direct clip reconstruction should be the first option, if feasible. |
| Category | Science & Technology |
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