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| Name | A3-A3 In-Situ Bypass and Clipping of a Giant ACoA Aneurysm |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 27-02-2018 17:27:10 |
| Video Discription | Giant thrombotic aneurysms are uncommon, and those with a serpentine channel connecting inflow and outflow are rare. Serpentine aneurysms cannot be clipped and must be treated instead with bypass and trapping. This video demonstrates a serpentine anterior communicating artery (ACoA) aneurysm that was treated with an A3-A3 anterior cerebral artery (ACA) in-situ bypass and distal aneurysm occlusion. A 72 year-old man presented with progressive cognitive decline and memory loss. A giant thrombotic ACoA aneurysm was diagnosed, fed by a dominant right A1, with a hypoplastic left A1 ACA, a serpentine channel through the aneurysm, and delayed filling of the left A2 ACA from the aneurysm. The patient was positioned supine with the head fixated in a neutral position (nose up), and the aneurysm was exposed through a bifrontal craniotomy with an interhemispheric approach. An A3-A3 side-to-side bypass created a right-left communication between the arteries and the aneurysm’s outflow was clip occluded distally. The base of the aneurysm incorporated the ACoA, its perforators, and the recurrent artery of Heubner, precluding trapping of the aneurysm. Postoperative angiography showed patency of the bypass, near complete thrombosis of the aneurysm, and robust distal cortical perfusion. The patient recovered well from surgery and a good outcome was observed at 3-month follow-up. Serpentine aneurysms can be treated with distal clip occlusion when perforators cannot be well visualized or safely excluded with complete trapping. The A3-A3 bypass is an example of an intracranial-to-intracranial bypass that avoids the harvest of an extracranial donor artery. |
| Category | Science & Technology |
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