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Case Reports
. 2024 Oct 5;166(1):395.
doi: 10.1007/s00701-024-06279-5.

Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it

R Chase Ransom  1 , Stephen Graepel  1 , Giuseppe Lanzino  1 , Lorenzo Rinaldo  2
Affiliations
Case Reports

Fenestrated clipping of previously coiled posterior-superiorly projecting anterior communicating artery aneurysms: How I do it

R Chase Ransom et al. Acta Neurochir (Wien). .

Abstract

Background: Anterior communicating artery (ACOM) aneurysms are among the most common aneurysms associated with aneurysmal subarachnoid hemorrhage (International Study of Unruptured Intracranial Aneurysms I (N Engl J Med 339:1725-1733, 1998), Wiebers (Lancet 362:103-110, 2003)). Surgical clipping of posterior-superiorly projecting ACOM aneurysms can be challenging, as the ipsilateral A2 can interfere with clip trajectory and ACOM perforating vessels obstructed from view. Intraluminal coils can further increase the difficulty of the procedure.

Method: The relevant surgical anatomy with illustration is presented. A video detailing our technique on an illustrative case is provided.

Conclusion: Surgical clipping of posterior-superiorly projecting ACOM aneurysms can require complex clip configurations. We describe the key steps of posterior-superiorly projecting ACOM aneurysm clipping through a lateral supraorbital craniotomy and fenestrated tandem clipping.

Keywords: Aneurysms; Anterior communicating artery; Microneurosurgery; Surgical clipping.

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References

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