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| Name | Left A3 ACA – Right A3 ACA In Situ Bypass and Distal Clipping of a Dolichoectatic A2 ACA Aneurysm |
| Video Uploader | Video From Barrow Neurological Institute |
| Upload Date | This Video Uploaded At 26-05-2020 20:48:24 |
| Video Discription | This operative video shows a left A3 anterior cerebral artery (ACA) – right A3 ACA in situ bypass and distal clipping of a dolichoectatic A2 ACA aneurysm. The patient had an incidentally discovered 17 mm aneurysm located on the A2 segment of the ACA, distal to the anterior communicating artery (ACoA) complex. The right A2 ACA exited out of the aneurysm dome and the right A1 ACA was absent. Our surgical strategy consisted of a bifrontal craniotomy with distal revascularization and distal clip occlusion. A midline approach without gravity retraction was planned. The interhemispheric fissure was split and the ACAs were followed deep into the fissure to the aneurysm. The A3 segments were mobilized, trapped using temporary aneurysm clips, and arteriotomized. Using 10-0 suture, anchoring stitches were placed at each end of the anastomosis and running continuous sutures were then used to complete the anastomosis. Indocyanine green (ICG) videoangiography confirmed patency of the bypass. The distal A2 segment was visualized as it emerged from the aneurysm, and a single clip was applied just proximal to a branch, eliminating the outflow and distally occluding the aneurysm. Postoperatively, the aneurysm filled on an angiogram. The aneurysm was fed by both the right and left A2 ACAs, consistent with a fenestrated ACoA that was not appreciated on the preoperative studies. The aneurysm was coil occluded and the left A2 ACA supplied both ACA territories, with the right side supplied from the bypass. The patient did well and was discharged home. In conclusion, A3 ACA – A3 ACA in situ bypass plus distal aneurysm occlusion is usually effective with dolichoectatic aneurysms. In this case, persistent aneurysm filling resulted from an unusual fenestrated neck. Bypass and endovascular aneurysm occlusion was an easy solution for this unexpected remnant, simplifing surgery by eliminating the need for subfrontal exposure and a second craniotomy. |
| Category | Science & Technology |
| Tags | aca-aca bypass | bifrontal craniotomy | interhemispheric fissure split | interhemispheric fissure dissection | aca aneurysm | dolichoectatic aneurysm clipping | fenestrated acoa | cerebrovascular bypass | cerebrovascular surgery | neurosurgery | neurosurgery video |
