Anterior Communicating Artery Aneurysm: Subarachnoid and Intracerebral Hemorrhage from an Aneurysm on the Posterior Aspect of the Anterior Communicating Artery – Microsurgical Clipping with a Fenestrated and Angulated Clip Without Direct Visual Control During Clip Application
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A 72-year-old female patient suddenly lost consciousness due to a subarachnoid hemorrhage (SAH) and a large intracerebral hematoma (ICH) stemming from the rupture of an aneurysm on the small anterior communicating artery (AcomA). The poor clinical condition of the patient meant that the ICH needed to be surgically removed. The small wide-necked aneurysm was not suitable for coil occlusion. Since there was no escaping surgery, the decision was made to also clip the aneurysm. As the aneurysm was hidden on the posterior wall of the AcomA and therefore not actually visible during the operation, a fenestrated clip was used. CTA following the operation confirmed that this had completely obliterated the aneurysm while leaving the afferent and efferent vessels patent. When the patient was referred on to a rehabilitation facility, she was awake, aphasic, and with no motor deficit. Most ruptured anterior communicating artery (AcomA) aneurysms are nowadays eliminated by endovascular therapy. However, in selected cases in which the aneurysm is not suitable for endovascular therapy, surgical clipping is the suggested route. In this chapter, we address the surgical approach, the as yet unsolved issue of which side to approach from, and radiological follow-up for ruptured AcomA aneurysms which have been microsurgically clipped. Microsurgical clipping of ruptured AcomA aneurysms is the main topic of this chapter.
KeywordsAnterior communicating artery Intracranial aneurysm Microsurgical clipping Fenestrated clip
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